Home Value Protection: Final Report

The following report provides an overview of a Home Value Protection (HVP) product to evaluate the practicality of making such a program more widely available and provide background for anyone considering such a plan. The paper is based largely on the Home Value Protection product established in Syracuse New York in 2002, and a number of the authors of this paper participated in the establishment of the Syracuse Home Value Protection program.The paper contains four sections:1: Investor OutreachThis section provides background information about the Syracuse program, the current and potential participants and what roles they might play, a review of a few of the ways such a program could be implemented, and links to various media coverage.2: Index ResearchThe Syracuse program measured changes in house values by a real estate index for the area (rather than individual house sale price), and this section evaluates a number of different index methods using four markets historical data to see how well the different indexes would have performed with a HVP product (had it been available).3: Capital Requirements & PricingThis section provides a model for estimating the pricing requirements and capital required for a program across multiple markets. While not exhaustive, this approach will provide a useful reference and starting point for anyone evaluating investment in such a program.4: Regulatory EnvironmentThis section provides information on some of the regulatory entities across the markets used in the analysis. Due to the variations in the way a HVP product could be implemented, regulations could apply in a variety of ways and this section can only offer a starting point for potential investors or participants

Structure and triclustering in Ba-Al-O glass

Glass-forming ability in the (BaO) x(Al 2O 3) 1-x system (0≤x≤1) was investigated by using the containerless aerodynamic levitation and laser-heating method. The main glass-forming region was found to occur for 0.40(2) ≤x≤ 0.48(2), where there is insufficient oxygen to form an ideal network of corner-sharing AlO 4 tetrahedra in which the oxygen atoms are twofold coordinated, with another narrow glass-forming region at x = 0.62(2) around the eutectic composition. The glass corresponding to x = 0.4 was chosen for further investigation by using both neutron and x-ray diffraction, and a detailed atomistic model was built by applying a combination of molecular dynamics and reverse Monte Carlo methods. The results show a network structure based predominantly on corner-sharing tetrahedral AlO 4 motifs in which triclusters (OAl 3 units formed by three tetrahedral Al atoms sharing a common vertex) play an integral part, with as many as 21% of the oxygen atoms involved in these configurations. The barium ions bind to an average of 7.4 O atoms, most of which are twofold-coordinated bridging oxygen atoms. The larger size of barium compared to calcium narrows the range of glass-forming compositions in alkaline-earth aluminates such that the main glass-forming range corresponds to a regime in which an oxygen-deficient Al-O network is stabilized by the formation of triclusters

Deep ocean storage of heat and CO2 in the Fram Strait, Arctic Ocean during the last glacial period

MME is funded by the Research Council of Norway and the Co-funding of Regional, National, and International Programmes (COFUND) Marie Sklodowska-Curie Actions under the EU Seventh Framework Programme (FP7), project number 274429, and the Research Council of Norway through its Centres of Excellence funding scheme, grant number 223259.The Fram Strait is the only deep gateway between the Arctic Ocean and the Nordic Seas and thus is a key area to study past changes in ocean circulation and the marine carbon cycle. Here, we study deep ocean temperature, δ18O, carbonate chemistry (i.e., carbonate ion concentration, [CO32-]), and nutrient content in the Fram Strait during the late glacial (35,000-19,000 years BP) and the Holocene based on benthic foraminiferal geochemistry and carbon cycle modelling. Our results indicate a thickening of Atlantic water penetrating into the northern Nordic Seas, forming a subsurface Atlantic intermediate water layer reaching to at least ~2600 m water depth during most of the late glacial period. The recirculating Atlantic layer was characterized by relatively high [CO32-] and low δ13C during the late glacial, and provides evidence for a Nordic Seas source to the glacial North Atlantic intermediate water flowing at 2000-3000 m water depth, most likely via the Denmark Strait. In addition, we discuss evidence for enhanced terrestrial carbon input to the Nordic Seas at ~23.5 ka. Comparing our δ13C and qualitative [CO32-] records with results of carbon cycle box modelling suggests that the total terrestrial CO2 release during this carbon input event was low, slow, or directly to the atmosphere.Publisher PDFPeer reviewe

Centerscope

Centerscope, formerly Scope, was published by the Boston University Medical Center "to communicate the concern of the Medical Center for the development and maintenance of improved health care in contemporary society.

Assessing the impact of multidrug-resistant tuberculosis in children : an exploratory qualitative study

Please cite as follows: Franck, C. et al. 2014. Assessing the impact of multidrug-resistant tuberculosis in children: an exploratory qualitative study. BMC Infectious Diseases, 14(1):426, doi:10.1186/1471-2334-14-426.The original publication is available at http://www.biomedcentral.com/1471-2334/14/426Publication of this article was funded by the Stellenbosch University Open Access Fund.Background: While the prevalence of multidrug-resistant (MDR) tuberculosis (TB) is high among children in the Western Cape of South Africa, the psychosocial implications of treatment for children with MDR-TB remain poorly understood. We sought to explore how MDR-TB and its treatment impact children on an individual, familial, and social level. Methods: Semi-structured interviews were conducted with 20 children and caregivers purposively sampled from a prospective clinical cohort of children. The sample was stratified by age at the start of treatment (children >10 years, and 5-10 years). Caregiver proxy interviews were conducted with younger children, supplemented with child interviews; older children were interviewed directly, supplemented with caregiver proxy interviews. Data were analysed using grounded theory. Results: Findings revealed pill volume and adverse effects produced significant physical, psychological and academic disturbances in children. Adverse effects related to the medication were important obstacles to treatment adherence. While there appear to be no long-lasting effects in younger children, a few older children showed evidence of persisting internalised stigma. Caregivers suffered important treatment-related financial and psychological costs. Community support, notably through the continued involvement of children in strong social networks, promoted resilience among children and their families. Conclusions: We found that the current treatment regimen for childhood MDR-TB has significant psychological, academic, and financial impacts on children and their families. There is a need for psychosocial support of children and caregivers to mitigate the negative effects of community stigma, and to manage the stressors associated with chronic illness.Publishers’ versio

Challenges of diabetes prevention in the real world : results and lessons from the Melbourne diabetes prevention study

OBJECTIVE: To assess effectiveness and implementability of the public health programme Life! Taking action on diabetes in Australian people at risk of developing type 2 diabetes. RESEARCH DESIGN AND METHODS: Melbourne Diabetes Prevention Study (MDPS) was a unique study assessing effectiveness of Life! that used a randomized controlled trial design. Intervention participants with AUSDRISK score ≥15 received 1 individual and 5 structured 90 min group sessions. Controls received usual care. Outcome measures were obtained for all participants at baseline and 12 months and, additionally, for intervention participants at 3 months. Per protocol set (PPS) and intention to treat (ITT) analyses were performed. RESULTS: PPS analyses were considered more informative from our study. In PPS analyses, intervention participants significantly improved in weight (-1.13 kg, p=0.016), waist circumference (-1.35 cm, p=0.044), systolic (-5.2 mm Hg, p=0.028) and diastolic blood pressure (-3.2 mm Hg, p=0.030) compared with controls. Based on observed weight change, estimated risk of developing diabetes reduced by 9.6% in the intervention and increased by 3.3% in control participants. Absolute 5-year cardiovascular disease (CVD) risk reduced significantly for intervention participants by 0.97 percentage points from 9.35% (10.4% relative risk reduction). In control participants, the risk increased by 0.11 percentage points (1.3% relative risk increase). The net effect for the change in CVD risk was -1.08 percentage points of absolute risk (p=0.013). CONCLUSIONS: MDPS effectively reduced the risk of diabetes and CVD, but the intervention effect on weight and waist reduction was modest due to the challenges in recruiting high-risk individuals and the abbreviated intervention

Development and measurement properties of the AxEL (attitude toward education and advice for low-back-pain) questionnaire

Introduction: Clinician time and resources may be underutilised if the treatment they offer does not match patient expectations and attitudes. We developed a questionnaire (AxEL-Q) to guide clinicians toward elements of first-line care that are pertinent to their patients with low back pain. Methods: We used guidance from the COSMIN consortium to develop the questionnaire and evaluated it in a sample of people with low back pain of any duration. Participants were recruited from the community, were over 18 years and fluent in English. Statements that represented first-line care were identified. Semantic scales were used to measure attitude towards these statements. These items were combined to develop the questionnaire draft. Construct validity was evaluated with exploratory factor analysis and hypotheses testing, comparing to the Back Beliefs Questionnaire and modified Pain Self-Efficacy Questionnaire. Reliability was evaluated and floor and ceiling effects calculated. Results: We recruited 345 participants, and had complete data for analysis for 313 participants. The questionnaire draft was reduced to a 3-Factor questionnaire through exploratory factor analysis. Factor 1 comprised 9 items and evaluated Attitude toward staying active, Factor 2 comprised 4 items and evaluated Attitude toward low back pain being rarely caused by a serious health problem, Factor 3 comprised 4 items and evaluated Attitude toward not needing to know the cause of back pain to manage it effectively. There was a strong inverse association between each factor and the Back Beliefs Questionnaire and a moderate positive association with the modified Pain Self-Efficacy Questionnaire. Each independent factor demonstrated acceptable internal consistency; Cronbach α Factor 1 = 0.92, Factor 2 = 0.91, Factor 3 = 0.90 and adequate interclass correlation coefficients; Factor 1 = 0.71, Factor 2 = 0.73, Factor 3 = 0.79. Conclusion: This study demonstrates acceptable construct validity and reliability of the AxEL-Q, providing clinicians with an insight into the likelihood of patients following first-line care at the outset

Risk stratification for arrhythmic death in an emergency department cohort: a new method of nonlinear PD2i analysis of the ECG

Heart rate variability (HRV) reflects both cardiac autonomic function and risk of sudden arrhythmic death (AD). Indices of HRV based on linear stochastic models are independent risk factors for AD in postmyocardial infarction (MI) cohorts. Indices based on nonlinear deterministic models have a higher sensitivity and specificity for predicting AD in retrospective data. A new nonlinear deterministic model, the automated Point Correlation Dimension (PD2i), was prospectively evaluated for prediction of AD. Patients were enrolled (N = 918) in 6 emergency departments (EDs) upon presentation with chest pain and being determined to be at risk of acute MI (AMI) >7%. Brief digital ECGs (>1000 heartbeats, ∼15 min) were recorded and automated PD2i results obtained. Out-of-hospital AD was determined by modified Hinkle-Thaler criteria. All-cause mortality at 1 year was 6.2%, with 3.5% being ADs. Of the AD fatalities, 34% were without previous history of MI or diagnosis of AMI. The PD2i prediction of AD had sensitivity = 96%, specificity = 85%, negative predictive value = 99%, and relative risk >24.2 (p ≤ 0.001). HRV analysis by the time-dependent nonlinear PD2i algorithm can accurately predict risk of AD in an ED cohort and may have both life-saving and resource-saving implications for individual risk assessment