Primary Residence Research Articles

Swimming in the Deep End

individuals earning $200,000 (or $300,000 jointly with a spouse) over a two-year period or those with personal net worth exceeding $1 million, excluding primary residence. The review, which is required under the Dodd–Frank Act, ous review since their enactment more than 30 years ago. In a recent interview with the , I noted that capital raised via the private investment markets now rivals their public counterparts. Given the age of these accreditation rules and the fact that more than 9 million households now meet the accredited investor standard, a checkup is long overdue. As I noted, with this new focus on private ticated is “pretty long-in-the-tooth” and clearly needs review. The SEC’s Investor Advisory Committee (IAC), which CFA

Social Estrangement Factors Associated with Income Generation Among Homeless Young Adults in Three U.S. Cities

This study examines social estrangement factors associated with 3 forms of income generation used by homeless young adults: formal sources (i.e., full-time, part-time, temporary employment), informal sources (e.g., selling personal possessions, selling drugs, theft, prostitution), and the combination of formal and informal sources. A sample of 601 homeless young adults was recruited from 3 cities (Los Angeles, CA [n = 200], Austin, TX [n = 200], and Denver, CO [n = 201]) to participate in semi-structured interviews. A multinomial logistic regression model is used to assess whether demographic, homelessness history, arrest history, transience, peer substance use, antisocial personality disorder, and substance use disorder variables predict involvement in the 3 forms of income generation as compared with participants who report no work-related income. Homeless young adults who earn income through formal sources are differentiated from those who report no work-related income by 2 variables: gender and primary residence. Those who earn income via informal sources are differentiated from homeless young adults who report no work-related income by 6 variables: age, city, primary residence, transience, peer substance use, and antisocial personality disorder. Participants who earn income through a combination of formal and informal sources are distinguished from those who report no work-related income by 7 variables: gender, city, primary residence, transience, peer substance use, antisocial personality disorder, and substance use disorder. Study findings suggest there might be value in combining supportive housing, employment, and clinical services for this population.

Code status and resuscitation options in the electronic health record

AimThe advance discussion and documentation of code-status is important in preventing undesired cardiopulmonary resuscitation and related end of life interventions. Code-status documentation remains infrequent and paper-based, which limits its usefulness. This study evaluates a tool to document code-status in the electronic health records at a large teaching hospital, and analyzes the corresponding data. MethodsEncounter data for patients admitted to the Medical Center were collected over a period of 12 months (01-APR-2012–31-MAR-2013) and the code-status attribute was tracked for individual patients. The code-status data were analyzed separately for adult and pediatric patient populations. We considered 131,399 encounters for 83,248 adult patients and 80,778 encounters for 55,656 pediatric patients in this study. Results71% of the adult patients and 30% of the pediatric patients studied had a documented code-status. Age and severity of illness influenced the decision to document code-status. Demographics such as gender, race, ethnicity, and proximity of primary residence were also associated with the documentation of code-status. ConclusionAbsence of a recorded code-status may result in unnecessary interventions. Code-status in paper charts may be difficult to access in cardiopulmonary arrest situations and may result in unnecessary and unwanted interventions and procedures. Documentation of code-status in electronic records creates a readily available reference for care providers.

The Trauma of Commercial Sexual Exploitation of Youth: A Comparison of CSE Victims to Sexual Abuse Victims in a Clinical Sample.

This study examined the demographic features, trauma profiles, clinical severity indicators, problem behaviors, and service utilization characteristics of youth victims of commercial sexual exploitation (CSE) compared with a matched sample of sexually abused/assaulted youth who were not exploited in commercial sex. Secondary data analysis and propensity score matching were used to select a sample of 215 help-seeking youth who were exploited in prostitution (n = 43) or who were sexually abused/assaulted but not exploited in prostitution (n = 172) from the National Child Traumatic Stress Network Core Data Set (NCTSN CDS). Propensity Score Matching was used to select a comparison sample based on age, race, ethnicity, and primary residence. Statistically significant differences were noted between the groups on standardized (e.g., UCLA Posttraumatic Stress Disorder Reaction Index [PTSD-RI], Child Behavior Checklist [CBCL]) and other measures of emotional and behavioral problems (e.g., avoidance and hyperarousal symptoms, dissociation, truancy, running away, conduct disorder, sexualized behaviors, and substance abuse). This study provides useful insight into the symptom and service utilization profiles of youth exploited in commercial sex as compared with youth with other types of sexually exploitive experiences. Targeted screening and event-sensitive measures are recommended to more accurately identify youth exploited in commercial sex. More research is needed to determine if and what modifications to trauma therapies may be required to address the more severe symptomatology and behavior problems associated with youth exploited in commercial sex.

Geographic predictors of primary multidrug-resistant tuberculosis cases in an endemic area of Lima, Peru

Peru reports among the highest multidrug-resistant tuberculosis (MDR-TB) rates in the Americas, with a growing proportion in previously untreated tuberculosis (TB) cases. The identification of clusters of primary MDR-TB compared with drug-susceptible TB (DS-TB) could help prioritize interventions. To examine the clustering of primary MDR-TB case residences and their proximity to high-risk locations in San Juan de Lurigancho District, Lima, Peru. Enrolled primary MDR-TB and primary DS-TB cases were interviewed and their primary residence was recorded using handheld Global Positioning System devices. Kuldorff's spatial scan statistic was used for cluster detection (SaTScan(TM), v. 9.1.1). Identified clusters were visualized in Quantum Geographic Information Systems software (v1.8.0). The following cluster centers were tested: a health centre with the highest TB and MDR-TB rates (Clinic X), a hospital and two prisons. Using regression analyses, we examined predictors of primary MDR-TB cases. A statistically significant cluster of primary MDR-TB cases was identified within a 2.29 km radius around Clinic X. Proximity to Clinic X remained a significant predictor of primary MDR-TB in adjusted regression analyses. We identified a hotspot of primary MDR-TB cases around Clinic X in a TB-endemic area. Causes of this clustering require investigation; targeted interventions for this high-risk area should be considered.

Negative equity in Ireland: estimates using loan-level data

Purpose – This paper aims to, using a unique loan-level data set, show the extent to which negative equity in Ireland is concentrated in younger age groups. The sharp decline in house prices since 2007 has led to the emergence of widespread negative equity in Ireland. However, little is known about the type of borrower experiencing negative equity. Design/methodology/approach – This paper uses a unique data set that, for a large sample of mortgages, provides details on both the characteristics of the borrowers and their mortgages. Using this data set, the paper estimates the incidence of negative equity by analysing loans taken out to purchase a primary residence in the period 2005-2012. Findings – The analysis finds the situation in Ireland to be much more severe than that being experienced in other housing market downturns at present, with 64 per cent of borrowers in the period 2005-2012 experiencing negative equity. Analysis by age gives rise to concern, with the majority of those in negative equity aged under 40 years. The paper also points to the large wealth loss experienced by Irish households, in the order of 43 billion, as a result of the fall in property values. Originality/value – The paper is one of the first using loan-level time-series data in Ireland. It highlights the growth in negative equity during the crisis and the extent to which it is concentrated in the younger age groups. It also provides an estimate of the loss in wealth suffered by all households due to the fall in Irish house prices.

Detection and treatment rates for perinatal depression in a state Medicaid population.

The purpose of this investigation was to assess detection and treatment rates for perinatal depression among women enrolled in the California State Medicaid (Medi-Cal) program in comparison to female beneficiaries of reproductive age who did not give birth during the same study period. Investigators conducted a retrospective longitudinal cohort analysis of women between the ages of 18 and 39 years old who were continuously enrolled in the Medi-Cal fee-for-service program between January 2006 and December 2009. The perinatal cohort consisted of women with evidence of a live birth occurring between October 2007 and March 2009. The control cohort consisted of women in the same age group and health plan without evidence of pregnancy during this time frame. The primary outcome of this investigation was diagnosis of depression during 3 contiguous 9-month time frames: immediately prior to presumed conception, during pregnancy, and throughout the postpartum period. Secondary outcomes included within-group and cohort comparisons of treatment patterns (antidepressant or psychotherapy). A multivariable analysis of demographic factors predicting depression diagnosis or treatment was conducted as well. A total of 6030 women was identified in the perinatal cohort, and 56,709 women were included in the control group. The perinatal cohort was significantly less likely than nonpregnant controls to receive a diagnosis of depression both during pregnancy (prevalence=1.6% vs 3.5%; OR=0.45; 95% CI=0.35-0.55) and postpartum (2.2% vs 3.6%; OR=0.59; 95% CI=0.50-0.71). Similar differences were noted in antidepressant prescribing patterns apparent during these 2 time frames. A subgroup analysis of women who received a depression diagnosis revealed that only 48% of the perinatal cohort was provided any treatment during pregnancy (vs 72% of the control group; p<0.0001) or postpartum (57% vs 73%; p<0.0001). Specific demographic factors predicting a lower prevalence of depression detection or treatment included Hispanic descent, age <25 years, or primary residence in an rural setting. Depression was often overlooked and undertreated among women who are pregnant or postpartum in comparison to services delivered to similar nonpregnant controls. Significant disparities in the healthcare received by certain subpopulations of perinatal women suggest that research into barriers to care and subsequent interventions are warranted.

Using the National Death Index to identify duplicate cancer incident cases in Florida and New York, 1996-2005.

IntroductionCancer registries link incidence data to state death certificates to update vital status and identify missing cases; they also link these data to the National Death Index (NDI) to update vital status among patients who leave the state after their diagnosis. This study explored the use of information from NDI linkages to identify potential duplicate cancer cases registered in both Florida and New York.MethodsThe Florida Cancer Data System (FCDS) and the New York State Cancer Registry (NYSCR) linked incidence data with state and NDI death records from 1996 through 2005. Information for patients whose death occurred in the reciprocal state (the death state) was exchanged. Potential duplicate cases were those that had the same diagnosis and the same or similar diagnosis date.ResultsNDI identified 4,657 FCDS cancer patients who died in New York and 2,740 NYSCR cancer patients who died in Florida. Matching identified 5,030 cases registered in both states; 508 were death certificate-only (DCO) cases in the death state’s registry, and 3,760 (74.8%) were potential duplicates. Among FCDS and NYSCR patients who died and were registered in the registry of the reciprocal state, more than 50% were registered with the same cancer diagnosis, and approximately 80% had similar diagnosis dates (within 1 year).ConclusionNDI identified DCO cases in the death state’s cancer registry and a large proportion of potential duplicate cases. Standards are needed for assigning primary residence when multiple registries report the same case. The registry initiating the NDI linkage should consider sharing relevant information with death state registries so that these registries can remove erroneous DCO cases from their databases.

Abstract 265: TeleStroke: Expanding Access and Coordination of Care from Acute Stroke to Follow-up

Background: The University of Utah Medical Center (UUMC) serves a wide geographical area, encompassing 10% of the continental US landmass. Stroke patients are often transported from remote facilities for specialty care. The UUMC Telestroke Center routinely provides acute care, but has only rarely been used for outpatient follow-up. The objective of this study was to develop a novel pathway for follow-up care after inpatient admissions for acute ischemic stroke (AIS) utilizing the existing telestroke infrastructure, with the goals of improving quality outcomes, reducing patient costs, and increasing access to care. Methods: Utilizing LEAN methodology, the existing care model was process-mapped to assess for potential areas of improvement. Over one month in 2013, a convenience sample of 27 inpatients admitted with AIS were surveyed to assess for potential barriers associated with travel to appointments, as well as for attitudes towards utilizing tele-health technologies for follow-up care. We analyzed primary residence patient zip-codes to determine which communities might be optimal for tele-health follow-up visits. Results: Ten patients (37%) lived ≤50 miles from UUMC; 7 (26%) 51-100 miles; 8 (30%)101-500 miles; and 2 (7.4%) &gt; 500 miles away. Patients estimated the costs associated with a visit (excluding appointment fees) as: $0-9 (3.8%), $10-100 (42.3%), $101-500 (38.5%), $501-1000 (11.5%), and &gt;$1000 (3.8%). Twenty-two patients (88%) said they would be interested in a tele-followup visit if it were closer to home and/or reduced travel time, and 59% of respondents said they would actually prefer this option to an in-office visit. Due to these results, an ideal community clinic partner was identified based upon geographic patient demographics, existing tele-health infrastructure, university-based scheduling, shared billing and meaningful-use software, and an expressed interest in collaboration. Follow-up tele-visits will link a stroke specialist physician at UUMC with a patient at the community clinic via 2-way audio-video telehealth equipment. A medical assistant with additional training in the neurologic exam will help facilitate the visit. Clinic training and coordination has already occurred, and a go-live date is anticipated for late February 2014. Discussion: A proof-of-concept health care model has been established at UUMC to provide tele-health follow-up after AIS admission to reduce significant barriers to follow-up care. Outcome metrics will include patient satisfaction, stroke and all cause readmission rates, medication compliance, and outpatient follow-up rates. Beyond increasing access to care, we hope that utilizing remote sites for follow-up will increase communication and coordination with primary care providers at these sites, in essence building a remote care “neighborhood” for our patients and optimizing care after discharge.

Aachen und Köln, Ingelheim und Mainz – Residenz und Stadt: Siedlungsentwicklung zwischen Spätantike und Frühmittelalter

Aachen developed abruptly in the 8th Century from the traditions of a Roman middle size agglomeration and fortified late-antique small settlement (burgus), to becoming the seat of a representative Frankish ruler. In the 9th Century the complex, structuralised and well established Palatinate existed. In the primary royal residence, the business of government took place at the highest level, and a representative church was found necessary. At the end of the 9th Century, the residential development was significantly interrupted during the Viking invasions. In contrast, the episcopal city of Cologne, only temporarily used as a city of royal residence, developed more or less continuously from the traditions of the Roman to a medieval trading centre. Since the 7th Century numerous stone churches dominated the landscape of the city. The troubled times of 5th Century and the events of the late 9th Century have, however, had different consequences in Cologne. How do these scenarios of urban development work in contrast to Episcopal city and the seat of power in Mainz and the Palatinate Ingelheim? At all four sites, the archaeology of recent years has brought serious new insights that can be compared to examine the forms of continuity.

Long-term behavior at foraging sites of adult female loggerhead sea turtles (Caretta caretta) from three Florida rookeries.

We used satellite telemetry to study behavior at foraging sites of 40 adult female loggerhead sea turtles (Caretta caretta) from three Florida (USA) rookeries. Foraging sites were located in four countries (USA, Mexico, the Bahamas, and Cuba). We were able to determine home range for 32 of the loggerheads. One turtle moved through several temporary residence areas, but the rest had a primary residence area in which they spent all or most of their time (usually >11 months per year). Twenty-four had a primary residence area that was <500 km2 (mean = 191). Seven had a primary residence area that was ≥500 km2 (range = 573–1,907). Primary residence areas were mostly restricted to depths <100 m. Loggerheads appeared to favor areas with larger-grained sediment (gravel and rock) over areas with smaller-grained sediment (mud). Short-term departures from primary residence areas were either looping excursions, typically involving 1–2 weeks of continuous travel, or movement to a secondary residence area where turtles spent 25–45 days before returning to their primary residence area. Ten turtles had a secondary residence area, and six used it as an overwintering site. For those six turtles, the primary residence area was in shallow water (<17 m) in the northern half of the Gulf of Mexico (GOM), and overwintering sites were farther offshore or farther south. We documented long winter dive times (>4 h) for the first time in the GOM. Characterizing behaviors at foraging sites helps inform and assess loggerhead recovery efforts.

Abstract T P308: Re-assessment of Lipid Profiles in Stroke Patients Post-hospital Discharge - Room for Improvement

Introduction: According to guidelines patients receiving a lipid-lowering agent at discharge for stroke should receive follow-up lipid profile. Our measure takes the currently collected STK-6, one step further and tries to identify whether these patients receive follow-up lipid testing by comparing non-abstracted electronic health record data to abstracted data. Methods: Data was extracted from the Cleveland Clinic EMR (Epic Systems, Inc.) utilized by the Cleveland Clinic Health System (10 hospitals and 16 family health centers). The cohort was based on patients with an admission for stroke from 2008 to 2012 utilizing STK-6 criteria. We examined this cohort for whether they received a lipid panel within the 12 months after the discharge date and limited patients to those that received follow up encounters at our healthcare system. Demographic factors including age, gender, race, ethnicity, distance to hospital, primary diagnosis for hospitalization and presence of comorbid conditions were also extracted. This data was compared to our abstracted publically reported STK-6 data which comes from claims data. Results: Of the 508 patients included in results for STK-6 reporting, only 391 (77%) were also identified through the EMR. Of these, 274 patients had follow up at least one year within the healthcare system. Only 97(35%) patients had lipid panel lab results indicated in the EMR within one year of discharge. Testing was not statistically different based on patient characteristics: patients &lt; 70 yrs vs 70+ (37% vs 30%, p=0.27), whites vs non-whites (35% vs. 36%, p=0.93), males vs. females (39% vs 30%, p=0.12). There was no significant difference in distance to the hospital from patients primary residence either between those without and with follow up lipid testing (mean distance=39 miles vs.17 miles, p=0.22). Conclusions: Follow up lipid testing following stroke discharge is not consistently performed among patients treated at a large healthcare system. There are not any highly significant differences in testing based on patient demographic characteristics or distance to the hospital. Further understanding of the reasons for poor follow up testing is required as well as evaluating concordance of the data pulled from the EMR when compared to abstracted data.

Combustion of Pakistani Lignite (Thar Coal) in a Pilot-Scale Pulverized Fuel Down-Fired Combustion Test Facility

In this study, Pakistan’s first and foremost pilot-scale combustion test results of Thar lignite Block-8 have been reported. The reported data will be an addition to the existing literature on lignite firing testing. In this paper, NOx, CO, and CO2 measurements were recorded at different axial locations in a down-fired combustion test facility for 2, 2.3, and 2.6 s of primary combustion zone residence times in a 4 m long down-fired pulverized fuel furnace. The overall NOx and SO2 emissions have also been reported for unstaged and air-staged combustion conditions. The reported data (emissions and carbon burnouts) is for fuel/air stoichiometric ratios of 0.9, 1.01, and 1.16 near the burner zone. The fly ash sample was analyzed, and the percentage of iron oxide was found in the range of 18–21%, whereas the percentage of alumina concentration was in the range of 14–16%, for varying stoichiometric ratios. Furthermore, slagging and fouling analyses have also been carried out on the collected ash samples during testing.

Using dynamic scenario analyses to evaluate how market factors could shape San Diego California New Car buyer’s interest in purchasing a Plug-in Electric Vehicle (PEV)

This analysis creates three temporally sequential hypothetical future time periods for a PEV market. In these scenarios, we present six factors which are likely to influence PEV ownership. These factors are the incremental cost of PEVs, the size of vehicles available for purchase, the vehicle manufacturers producing PEVs, vehicle turnover, the cost to install home charging infrastructure and the authority to install charging infrastructure at a primary residence. In each time period the characteristics of the vehicle and consumer market change to capture the dynamics of vehicle supply and new car buyers. Results from a mixed-method questionnaire of 470 San Diego California residents is matched with the hypothetical scenarios created for this analysis, which provides a baseline measure of how interest in PEVs might evolve over time for San Diego CA new car buyers. Incremental changes from the baseline conditions in each of the factors illustrate how different strategies such as: price reduction, larger vehicles offered for sale, introduction of new makes producing PEVs, and workplace charging infrastructure, might play a role in changing the pool of San Diego CA new car buyers who are interested in purchasing a PEV.

Control of the Asian tiger mosquito (Aedes albopictus) in a firmly established area in Spain: risk factors and people's involvement

The tiger mosquito is a competent vector of dengue and chikungunya in Europe. Therefore, evaluating control strategies is a priority. In this work we aimed to determine the key factors affecting Aedes albopictus production, the preferred larval habitats, and we explored the involvement of the citizens in Sant Cugat, Spain. A source-reduction campaign including door-to-door visits and interviews to local inhabitants (2008-2010) and larval surveys (2010) was carried out. Civil workers inspected 3720 premises and interviewed 820 local inhabitants. Larval habitats, detected in 7.2% of the premises (n=266), were negatively associated with primary residence OR=0.4 (95% CI 0.3-0.6); and positively associated with schools OR=2.4 (95% CI 1.1-5.0), solid waste OR=5.1 (95% CI 3.0-8.9), scuppers OR=5.0 (95% CI 3.5-7.3) among other variables. Preventive measures were taken by 83.2% of householders (n=682). In 2010, 10.3% more citizens claimed to avoid having stagnant water compared with 2008. Simultaneously another 10.3% stopped using insecticides. Solid waste, scuppers and vegetable gardens were found to be important factors characterizing premises with larval habitats. People claimed to know about this insect and they considered it to be an important issue that diminished their quality of life.

What is the Real Cost of an Overnight Stay After an Ambulatory General Surgical Procedure?

Outpatient surgery is performed widely throughout the Army Medical Command (MEDCOM). It is common practice throughout Medical Command to admit barracks dwelling active duty service members (ADSMs) undergoing ambulatory surgical procedures for overnight observation. We hypothesized that overnight observation of these individuals has not prevented adverse outcomes that would have otherwise occurred if the patient had been discharged to the barracks. We reviewed the postoperative course of all ADSMs undergoing ambulatory surgery with subsequent overnight hospital stay because of primary barracks residence. Procedures included hernia repair, lipoma excisions, and pilonidal cystectomies. Inclusion criteria were ADSMs who stayed overnight purely on the basis of their military barracks residence. 145 patients met our inclusion criteria. Their mean age was 23 ± 3.2, 90.9% were males. The mean hospital length of stay was 24 ± 11.4 hours. There were four (2.78%) postoperative complications, three patients with postoperative urinary retention, and one patient with mild bleeding from a pilonidal excision site, all within 8 hours postoperatively. No adverse outcomes were noted during the period of their hospitalization. Barracks dwelling ADSMs do not have adverse outcomes during their inpatient observational hospitalization. An outpatient escort would be sufficient to ensure adequate observation.

Vogt–Koyanagi–Harada disease in First Nations and Métis of Northern Alberta

ObjectiveThe objective of this article was to describe the incidence, clinical characteristics, and visual outcomes of Vogt–Koyanagi–Harada disease in First Nations and Métis individuals. DesignA retrospective chart review. ParticipantsNineteen First Nation and Métis Canadian residents in Northern Alberta. MethodsElectronic records for a 17-year period (1994–2010) were reviewed. Charts were reviewed for age, sex, length of follow-up, location of primary residence, diagnostic criteria at presentation, disease stage at presentation, duration of symptoms before presentation, ocular and extraocular manifestations at presentation, treatments, compliance, and complications. The time to an eye reaching 20/40, 20/200, and a halving of the baseline visual angle was plotted using Kaplan–Meier methodology. ResultsOf 19 First Nations and Métis individuals identified, 84.2% were female, and the average age at presentation was 30.8 years. The most common presenting symptom and sign were blurred vision (89.5%) and anterior segment inflammation (89.5%), respectively. Fifteen (78.9%) patients had extraocular manifestations, the most common being alopecia (26.3%) and cerebrospinal fluid pleocytosis (26.3%). All patients were initially treated with corticosteroids; immunomodulatory therapy was used for 2 (10.5%) patients. Twelve (63.2%) patients experienced ocular complications; 47.4% of patients had difficulty with treatment compliance and attending follow-up appointments. The median time to achieve 20/40 vision was shorter for compliant patients compared with noncompliant patients (P = 0.048). ConclusionsThe features of Vogt–Koyanagi–Harada disease in First Nations and Métis Canadians are most similar to series of South Asian and Hispanic patients. Compliant patients were found to achieve 20/40 vision significantly sooner than noncompliant patients.

The Influence of Geographic Isolation on Late Preterm Infant and Mother Outcomes

Risk of adverse outcome in late-preterm infants (born between 34 and 36 weeks and 6 days' gestation) is heightened for those living in geographic isolation (GI). We examined the relationships between GI and several mother and infant outcomes. This was a tricenter cross-sectional study of 38 English-speaking late-preterm infant/mother dyads admitted to neonatal intensive care in a predominately rural Midwestern state. Eligibility for the study included English-speaking mothers and their biologically born late-preterm infants with no known anomalies. METHODS AND MAIN OUTCOME: Outcomes included maternal knowledge of infant development (Knowledge of Infant Development Inventory) and competence (Competence in Preterm Infant Care questionnaire), maternal perception of vulnerability (Vulnerable Baby Scale ([VBS]), risk, and temperament (Pictorial Assessment of Temperament ([PAT]). Infant readmission and follow-up data were also examined. Potential covariates included any use of the Internet for healthcare information, demographic data, and mother and infant health history and were obtained from medical records and from the mother. Level of GI was determined by time and distance traveled (minutes) from the mother's primary residence to the closest regional healthcare center. Study participants traveled 61 ± 58 miles and 72 ± 62 minutes on average. The Mean ± SD scores on assessment were as follows: Knowledge of Infant Development Inventory 77 ± 10, and Competence in Preterm Infant Care questionnaire 90 ± 14, VBS 27.5 ± 3.5, and PAT 17.5 ± 3. Bivariate associations were observed between distance and time and VBS scores (P = .03 for both). Multiple regression analysis showed significant relationship between time (P = .02) and PAT scores when maternal education (0.09) and the number of hours spent in the NICU (P = .01) were entered into the model. The association between time traveled and VBS scores became marginally significant when maternal age and Internet use were entered into the regression models. The odds for a mother to perceive her infant at risk for suboptimal outcomes were 6 times greater for each 1-hour additional travel time (odds ratio = 6.0; 95% confidence interval: 1.3-36; P = .001). There was no association between GI and readmission rate and follow-up care. Readmission rate was 8%, and anticipatory guidance was found to be inadequate. Remote access to appropriate healthcare services elicits more than legitimate concerns for the late preterm infant and warrants further investigation with consideration for how services might be more easily accessed for this at-risk group.

International Real Estate Review

The supply of rental housing is by and large provided by landlord households. Little is understood about the factors, beyond financial portfolio considerations, that affect the inclination of people or households to become landlords. Studies of the American rental market have pointed to differences across income, wealth, ethnicity, and education in the willingness to rent out residential property to others. Here, we examine the question for Israel. We find that income and wealth are positively associated with the inclination to be a landlord. Education has an effect in Israel in contrast to the US (and Australia). Human capital in Israel appears to complement with rental property capital, unlike the case for the US and Australia, where they appear to be substitutes. In most cases, rental property in Israel and housing capital in the landlord's primary residence appear to be complementary. Ethnic minorities and new immigrants are under-represented among landlords. For households who own rental property, the income from such rentals is empirically analyzed.

Does Travel Distance Influence Length of Stay in Elective Colorectal Surgery?

Length of stay following elective colorectal surgery is being reported as a quality measure in surgical outcome registries, such as the National Surgical Quality Improvement Program. Regional referral centers with large geographic catchment areas attract patients from significant distances. The aim of this study was to examine the effect of patient distance traveled, from primary residence to a tertiary care hospital, on length of stay in elective colorectal surgery patients. Retrospective population-based cohort study uses data obtained from the National Surgical Quality Improvement Program database. This study was conducted at a tertiary referral hospital. Data on 866 patients undergoing elective colorectal surgery from May 2003 to April 2011 were reviewed. Demographics, surgery-related variables, and distance traveled were analyzed relative to the length of stay. Of the 866 patients, 54% were men, mean age was 57 years, mean distance traveled was 145 miles (range, 2-2984 miles), and mean length of stay was 8.8 days. Univariate analysis showed a significant increase in length of stay with increased distance traveled (p = 0.02). Linear regression analysis revealed a significant association between increased length of stay and male sex (p = 0.006), increasing ASA score (p = 0.000), living alone (p = 0.009), and increased distance traveled (p = 0.028). For each incremental increase in log distance traveled, the length of stay increases by 2.5%. This is a retrospective review that uses National Surgical Quality Improvement Program data. It is not known how many patients left the hospital and did not return to their primary residence. In a model that controlled for variables, increased travel distance from a patient's residence to the surgical hospital was associated with an increase in length of stay. If length of stay is a reportable quality measure in patients undergoing colorectal surgery, significant travel distance should be accounted for in the risk adjustment model calculations.