Agency Disclosure in the Real Estate Transaction and the Impact of Related State Policies

Although agency disclosure is required by every state, recent national surveys of home buyers and sellers indicate that disclosure varies significantly across the United States. This study seeks to determine the causes of these disparities by examining states¡¯ educational standards, disclosure forms, regulatory environments, and buyer characteristics. The results identify several variables that have a deterministic impact on the probability of disclosure and suggest corrective actions and policies that states can implement to improve the effectiveness of agency disclosure in the real estate transaction.

The Cape San Blas Ecological Study

Eglin AFB on Cape San Blas consists of approximately 250 acres located about 180 miles east of the main Eglin reservation. This area lies on the S1. Joseph peninsula, part of a dynamic barrier island chain that extends across the northern Gulf of Mexico. Due to the natural forces that formed Cape San Blas and those that maintain this area, St. Joseph Peninsula has experienced severe land form change over time (see GIS land form change maps). These changes allow for fluctuations in habitat types along Cape San Blas (see GIS land cover change maps)that influence the floral and faunal species using this area. The dynamic environment along Cape San Blasincludes flatwoods, interdunal swale, rosemary scrub, and beachfront. These habitats support a wide array of species, including several threatened and endangered species such as the loggerhead sea turtle (Caretta caretta), PipingPlover (Charadnus melodus), Least Tern (Sterna antillarum), and Bald Eagle (Haliaeetus leucocephalus). Proper management of these species and their habitats require knowledge of their abundance and distribution, and the effects disturbances have on their survival. In addition to threatened and endangered flora and fauna, Cape San Blas also supports tourists and recreationists. Although Gulf County is sparsely populated, with approximately 13,000 inhabitants throughout 578 square miles, summer tourism and heavy recreational use of beaches for fishing, crabbing, and shelling place continued and increasing pressure on the natural resources of these areas (Rupert 1991). Gulf County is also one of the few remaining counties in Florida that permits vehicular traffic on its beaches, including Cape San Blas. In addition to recreational use of these habitats;EAFB also uses the area for military missions. Air Force property on Cape San Blas is primarily used for radar tracking of flying missions over the Gulf of Mexico, although in recent years it has been used for missile launchings and other various military activities. To allow continued military and public use of Air Force property while also protecting the unique flora and fauna of the area,EAFB proposed a characterization of the resources found along Cape San Blas. A complete inventory of the physical features of the area included investigating topography, soil chemistry, hydrology, archeology, and the dynamics of land mass and land cover change over time. Various thematic layers within a geographic information system (GIS) were used to spatially portray georeferenced data. Large scale changes over time were assessed using stereo aerial photography. Vegetation transects, soil samples, elevation transects, an archeological survey, freshwater wells, and a tidal monitor were used to investigate the remaining features. (247 page document

Smoking Enhances Risk for New External Genital Warts in Men

Repeat episodes of HPV-related external genital warts reflect recurring or new infections. No study before has been sufficiently powered to delineate how tobacco use, prior history of EGWs and HIV infection affect the risk for new EGWs. Behavioral, laboratory and examination data for 2,835 Multicenter AIDS Cohort Study participants examined at 21,519 semi-annual visits were evaluated. Fourteen percent (391/2835) of men reported or were diagnosed with EGWs at 3% (675/21,519) of study visits. Multivariate analyses showed smoking, prior episodes of EGWs, HIV infection and CD4+ T-lymphocyte count among the infected, each differentially influenced the risk for new EGWs

Opportunities to encourage mail order pharmacy delivery service use for diabetes prescriptions: a qualitative study.

BackgroundMedication non-adherence is a major contributor to poor outcomes in diabetes. Previous research has shown an association between use of mail order pharmacy delivery and better medication adherence, but little is known about the barriers and facilitators to mail order pharmacy use in diabetes patients. This qualitative study examined factors related to mail order pharmacy use versus traditional "brick and mortar" pharmacies to refill prescriptions.MethodsWe conducted four 90-min focus groups in 2016 among 28 diabetes patients in the Hawaii and Northern California regions of Kaiser Permanente, a large integrated health care delivery system. We queried participants on their preferred mode for refilling prescriptions and perceived barriers and facilitators of mail order pharmacy use. One researcher independently coded each focus group transcript, with two of these transcripts double-coded by a second researcher to promote reliability. We employed thematic analysis guided by the Capability, Opportunity, Motivation, and Behavior (COM-B) framework using NVivo 11 software.ResultsA total of 28 diabetes patients participated. Participants' average age was 64.1 years; 57% were female; and racial/ethnic backgrounds included Asian/Native Hawaiian/Pacific Islander (36%), Black/African-American (21%) Hispanic/Latino (7%), and non-Hispanic White (36%). Analysis uncovered 26 themes related to the decision to use mail order pharmacy, with each theme representing a barrier or facilitator mapped to the COM-B framework. Most themes (20/26) fell into the COM-B category of 'Opportunity.' Opportunity barriers to mail order pharmacy use included unpredictability of medication delivery date, concerns about mail security, and difficulty coordinating refill orders for multiple prescriptions. In contrast, facilitators included greater access and convenience (e.g., no need to wait in line or arrange transportation) compared to traditional pharmacies. Motivational facilitators to mail order pharmacy use included receiving a pharmacy benefit plan incentive of a free one-month supply of prescriptions.ConclusionsThis study found that while patients with diabetes may benefit from mail order pharmacy use, they perceive numerous barriers to using the service. These findings will inform the design of interventions and quality improvement initiatives to increase mail order pharmacy use, which in turn may improve medication adherence and outcomes in diabetes patients, across health care systems

Modelling the Cost-Effectiveness and Budget Impact of a Newborn Screening Program for Spinal Muscular Atrophy and Severe Combined Immunodeficiency

Spinal muscular atrophy (SMA) and severe combined immunodeficiency (SCID) are rare, inherited genetic disorders with severe mortality and morbidity. The benefits of early diagnosis and initiation of treatment are now increasingly recognized, with the most benefits in patients treated prior to symptom onset. The aim of the economic evaluation was to investigate the costs and outcomes associated with the introduction of universal newborn screening (NBS) for SCID and SMA, by generating measures of cost-effectiveness and budget impact. A stepwise approach to the cost-effectiveness analyses by decision analytical models nested with Markov simulations for SMA and SCID were conducted from the government perspective. Over a 60-year time horizon, screening every newborn in the population and treating diagnosed SCID by early hematopoietic stem cell transplantation and SMA by gene therapy, would result in 95 QALYs gained per 100,000 newborns, and result in cost savings of USD 8.6 million. Sensitivity analysis indicates 97% of simulated results are considered cost-effective against commonly used willingness-to-pay thresholds. The introduction of combined NBS for SCID and SMA is good value for money from the long-term clinical and economic perspectives, representing a cost saving to governments in the long-term, as well as improving and saving lives

Economic Evaluation of Newborn Screening for Severe Combined Immunodeficiency

Evidence on the cost-effectiveness of newborn screening (NBS) for severe combined immunodeficiency (SCID) in the Australian policy context is lacking. In this study, a pilot population-based screening program in Australia was used to model the cost-effectiveness of NBS for SCID from the government perspective. Markov cohort simulations were nested within a decision analytic model to compare the costs and quality-adjusted life-years (QALYs) over a time horizon of 5 and 60 years for two strategies: (1) NBS for SCID and treat with early hematopoietic stem cell transplantation (HSCT); (2) no NBS for SCID and treat with late HSCT. Incremental costs were compared to incremental QALYs to calculate the incremental cost-effectiveness ratios (ICER). Sensitivity analyses were performed to assess the model uncertainty and identify key parameters impacting on the ICER. In the long-term over 60 years, universal NBS for SCID would gain 10 QALYs at a cost of US $0.3 million, resulting in an ICER of US$33,600/QALY. Probabilistic sensitivity analysis showed that more than half of the simulated ICERs were considered cost-effective against the common willingness-to-pay threshold of A$50,000/QALY (US$35,000/QALY). In the Australian context, screening for SCID should be introduced into the current NBS program from both clinical and economic perspectives

Transient x-ray diffraction used to diagnose shock compressed Si crystals on the Nova laser

Transient x-ray diffraction is used to record time-resolved information about the shock compression of materials. This technique has been applied on Nova shock experiments driven using a hohlraum x-ray drive. Data were recorded from the shock release at the free surface of a Si crystal, as well as from Si at an embedded ablator/Si interface. Modeling has been done to simulate the diffraction data incorporating the strained crystal rocking curves and Bragg diffraction efficiencies. Examples of the data and post-processed simulations are presented

Mid-Upper Arm Circumference based Nutrition Programming: evidence for a new approach in regions with high burden of Acute Malnutrition

In therapeutic feeding programs (TFP), mid-upper arm circumference (MUAC) shows advantages over weight-for-height Z score (WHZ) and is recommended by the World Health Organization (WHO) as an independent criterion for screening children 6-59 months old. Here we report outcomes and treatment response from a TFP using MUAC ≤118 mm or oedema as sole admission criteria for severe acute malnutrition (SAM)