Subsidized Housing, Private Developers and Place: A Spatial Analysis of the Clustering of Low Income Housing Tax Credit Properties in the 25 Largest U.S. Cities

The Low Income Housing Tax Credit Program is the primary federal program for producing new units of affordable housing. The program provides financial incentives to private developers to develop and operate affordable rental housing. In recent years, evidence has emerged that the program has led to clusters of subsidized housing in some cities. It is hardly surprising that some clustering would exist in a program in which the housing is constructed and owned by private developers. Despite the significant number of units produced by the program and despite the potential tendency for clustering of units built under this program, the locational patterns within the LIHTC program remain largely unexamined. Instead, most studies of the LIHTC program have focused on the national level rather than on individual cities. In contrast to previous studies, this study seeks to improve our understanding of variations in the LIHTC program across cities. The hypothesis of this study is that, because private developers produce housing in the LIHTC program and because the factors that influence private developers vary across cities, there is likely to be significant variation in the locational patterns of LIHTC developments across cities. The results of this study show, among other things, that clustering of LIHTC properties exists in the study cities, this clustering is extreme in some cases, and the clusters are associated with high poverty tracts in some cities. Given the LIHTC program\u27s emphasis on market-driven policies and a similar emphasis in some other federal housing programs, such findings will likely be applicable to other affordable housing programs

‘Project Spraoi’: A randomized control trial to improve nutrition and physical activity in school children

Background Recent evidence predicts that by 2030, Ireland will have the highest rate of obesity in Europe. Consequently, there are concerns that health problems associated with this condition will present in childhood. Studies have shown that interventions based on increasing physical activity (PA) levels, reducing sedentary lifestyles and improving nutritional habits all pose protective mechanisms against obesity and its related disorders in youth. Yet, to date, there are no interventions being delivered in Ireland that concurrently target PA, nutritional habits and sedentary time amongst school children. Purpose The purpose of this study is to implement and evaluate an intervention that targets PA, nutritional habits and sedentary time in primary school children. Methods ‘Project Spraoi’ is a school based health promotion intervention, based on ‘Project Energize,’ which has been in operation in New Zealand since 2004. Measures of PA, nutritional knowledge/behaviours and health parameters including body composition, blood pressure (BP) and fitness will be gathered before and after the programme completion (24 months). For comparative purposes, we will compare these scores to a separate group who will not participate in the intervention and to counterparts partaking in Project Energize, NZ. Conclusions There is strong evidence that quality multi-component school-based programmes can increase PA, improve weight status and promote healthier dietary habits. Due to the increasing obesity levels, the implementation of such a programme that is rigorously evaluated is warranted in Ireland

Prospective Validation of the Emergency Heart Failure Mortality Risk Grade for Acute Heart Failure: The ACUTE Study

Background: Improved risk stratification of acute heart failure in the emergency department may inform physicians\u27 decisions regarding patient admission or early discharge disposition. We aimed to validate the previously-derived Emergency Heart failure Mortality Risk Grade for 7-day (EHMRG7) and 30-day (EHMRG30-ST) mortality. Methods: We conducted a multicenter, prospective validation study of patients with acute heart failure at 9 hospitals. We surveyed physicians for their estimates of 7-day mortality risk, obtained for each patient before knowledge of the model predictions, and compared these with EHMRG7 for discrimination and net reclassification improvement. We also prospectively examined discrimination of the EHMRG30-ST model, which incorporates all components of EHMRG7 as well as the presence of ST-depression on the 12-lead ECG. Results: We recruited 1983 patients seeking emergency department care for acute heart failure. Mortality rates at 7 days in the 5 risk groups (very low, low, intermediate, high, and very high risk) were 0%, 0%, 0.6%, 1.9%, and 3.9%, respectively. At 30 days, the corresponding mortality rates were 0%, 1.9%, 3.9%, 5.9%, and 14.3%. Compared with physician-estimated risk of 7-day mortality (PER7; c-statistic, 0.71; 95% CI, 0.64-0.78) there was improved discrimination with EHMRG7 (c-statistic, 0.81; 95% CI, 0.75-0.87; P=0.022 versus PER7) and with EHMRG7 combined with physicians\u27 estimates (c-statistic, 0.82; 95% CI, 0.76-0.88; P=0.003 versus PER7). Model discrimination increased nonsignificantly by 0.014 (95% CI, -0.009-0.037) when physicians\u27 estimates combined with EHMRG7 were compared with EHMRG7 alone (P=0.242). The c-statistic for EHMRG30-ST alone was 0.77 (95% CI, 0.73-0.81) and 30-day model discrimination increased nonsignificantly by addition of physician-estimated risk to 0.78 (95% CI, 0.73-0.82; P=0.187). Net reclassification improvement with EHMRG7 was 0.763 (95% CI, 0.465-1.062) when assessed continuously and 0.820 (0.560-1.080) using risk categories compared with PER7. Conclusions: A clinical model allowing simultaneous prediction of mortality at both 7 and 30 days identified acute heart failure patients with a low risk of events. Compared with physicians\u27 estimates, our multivariable model was better able to predict 7-day mortality and may guide clinical decisions. Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02634762

Prevalence of Ex?Vivo High On-treatment Platelet Reactivity on Antiplatelet Therapy after Transient Ischemic Attack or Ischemic Stroke on the PFA-100(?) and VerifyNow(?).

The prevalence of ex vivo high on-treatment platelet reactivity (HTPR) to commonly prescribed antiplatelet regimens after transient ischemic attack (TIA) or ischemic stroke is uncertain. METHODS: Platelet function inhibition was simultaneously assessed with modified light transmission aggregometry (VerifyNow; Accumetrics Inc, San Diego, CA) and with a moderately high shear stress platelet function analyzer (PFA-100; Siemens Medical Solutions USA, Inc, Malvern, PA) in a pilot, cross-sectional study of TIA or ischemic stroke patients. Patients were assessed on aspirin-dipyridamole combination therapy (n = 51) or clopidogrel monotherapy (n = 25). RESULTS: On the VerifyNow, HTPR on aspirin was identified in 4 of 51 patients (8%) on aspirin-dipyridamole combination therapy (? 550 aspirin reaction units on the aspirin cartridge). Eleven of 25 (44%) patients had HTPR on clopidogrel (? 194 P2Y12 reaction units on the P2Y12 cartridge). On the PFA-100, 21 of 51 patients (41%) on aspirin-dipyridamole combination therapy had HTPR on the collagen-epinephrine (C-EPI) cartridge. Twenty-three of 25 patients (92%) on clopidogrel had HTPR on the collagen-adenosine diphosphate (C-ADP) cartridge. The proportion of patients with antiplatelet HTPR was lower on the VerifyNow than PFA-100 in patients on both regimens (P < .001). CONCLUSIONS: The prevalence of ex vivo antiplatelet HTPR after TIA or ischemic stroke is markedly influenced by the method used to assess platelet reactivity. The PFA-100 C-ADP cartridge is not sensitive at detecting the antiplatelet effects of clopidogrel ex vivo. Larger prospective studies with the VerifyNow and with the PFA-100 C-EPI and recently released Innovance PFA P2Y cartridges (Siemens Medical Solutions USA, Inc) in addition to newer tests of platelet function are warranted to assess whether platelet function monitoring predicts clinical outcome in ischemic cerebrovascular disease

Longitudinal assessment of von Willebrand factor antigen and von Willebrand factor propeptide in response to alteration of antiplatelet therapy after TIA or ischaemic stroke.

The impact of commencing or changing antiplatelet therapy on von Willebrand factor antigen (VWF:Ag) and von Willebrand factor propeptide (VWF:Ag II) levels has not been comprehensively assessed following TIA or ischaemic stroke. In this pilot, longitudinal, observational analytical study, VWF:Ag and VWF:Ag II levels were simultaneously quantified in platelet poor plasma by ELISA in patients within 4 weeks of TIA or ischaemic stroke (baseline), and then 14 days (14d) and >90 days (90d) after altering antiplatelet therapy. Ninety-one patients were recruited. Eighteen were initially assessed on no antiplatelet therapy, and then after 14d (N = 17) and 90d (N = 8) on aspirin monotherapy; 21 patients were assessed on aspirin and after 14d and 90d on clopidogrel; 52 were assessed on aspirin monotherapy, and after 14d and 90d on aspirin and dipyridamole combination therapy. VWF:Ag, VWF:Ag II levels and VWF:Ag/VWF:Ag II ratio were unchanged at 14d and 90d in the overall study population (p ? 0.1). VWF:Ag and VWF:Ag II levels remained stable at 14d and 90d after commencing aspirin (p ? 0.054), and after changing from aspirin to clopidogrel (p ? 0.2). Following the addition of dipyridamole MR to aspirin, there was a significant reduction in VWF:Ag levels at 14d (p = 0.03) and 90d (p = 0.005), but not in VWF:Ag II levels (p ? 0.3). The addition of dipyridamole to aspirin led to a persistent reduction in VWF:Ag but not in VWF:Ag II levels, suggesting that dipyridamole may inhibit release of platelet-derived VWF:Ag following TIA or ischaemic stroke

Effects of Interventions That Include Aided Augmentative and Alternative Communication Input on the Communication of Individuals With Complex Communication Needs: A Meta-Analysis

The purpose of this meta-analysis was to investigate the effects of augmentative and alternative communication (AAC) interventions that included aided AAC input (e.g., aided AAC modeling, aided language modeling, aided language stimulation, augmented input) on communicative outcomes (both comprehension and expression) for individuals with developmental disabilities who use AAC

Preliminary Investigation of Visual Attention to Complex AAC Visual Scene Displays in Individuals With and Without Developmental Disabilities

Visual scene displays (VSDs) are one type of augmentative and alternative communication (AAC) display in which an integrated scene (typically a photograph) presents people engaged in shared activities, with “hotspots” for the concepts embedded within. Most AAC displays are more complex than a single VSD, and also contain a navigation bar. This preliminary study examined visual attention to these more complex AAC displays by participants with autism spectrum disorder (ASD) (n = 13), Down syndrome (n = 13), intellectual and developmental disabilities other than Down syndrome or ASD (n = 9), and preschoolers with typical development (n = 20). Participants viewed images that simulated complex AAC displays containing a main VSD and a navigation bar with thumbnail VSDs arranged in one of four locations (top, bottom, left, or right). Both the main VSD and the navigation bar attracted attention, with participants across groups looking at both elements more than expected based on the space those elements occupied within the display. Within the main VSD, participants spent more time fixating on the meaningful elements (i.e., children and shared activity) compared to the background. Results suggested that gaze patterns to the meaningful elements of the main VSD were influenced by the location of the navigation bar. The finding that bar location may influence visual attention patterns makes it an important AAC system design factor that warrants additional research

Family Leisure as a Context to Support Augmentative and Alternative Communication Intervention for Young Children with Complex Communication Needs

Families are often the most significant communication partners for children who require augmentative and alternative communication (AAC). Because family-centered approaches are recommended practice in speech-language pathology, a primary role for speech-language pathologists (SLPs) serving children who require AAC is to support families in integrating communication into highly valued, existing family activities. Family leisure activities can provide a naturally supportive context for AAC, because they provide multiple opportunities for children to interact and practice using AAC with natural communication partners. This article aims to guide SLPs in utilizing family leisure as a context for AAC intervention. We describe the benefits and constraints of engaging in leisure for families with children with disabilities. We define family leisure, which includes two distinct types of leisure activities: core and balance. Finally, we provide a case example of a family that highlights the integration of AAC into both types of leisure activities

Bridging the Gap from Values to Actions: A Family Systems Framework for Family-Centered AAC Services

Despite the growing recognition of the importance of family involvement in augmentative and alternative communication (AAC) intervention, little guidance exists on how professionals can establish successful collaborative relationships with families. In this paper, we discuss family systems theory and ecological systems theory as a framework to guide family-centered AAC practice, review family-focused research in AAC, consider how AAC may impact the family system, and provide examples of the clinical implications of using the proposed family systems framework to improve family-centered AAC practice