Home Values Research Articles

Economic Valuation for Coastal Water Infrastructure Planning: Analysis of the Housing Market and Nutrient Pollution in Suffolk County, NY

The waters around Suffolk County, New York, are plagued by water quality concerns from nitrogen inputs, algal blooms, and eutrophication. Meanwhile, waterfront and near-water homes fuel a robust real estate market with many iconic regions, such as the Hamptons. Aging cesspools and septic systems are a paramount concern in the area. With approximately 74% of homes outside sewer systems, several jurisdictions are evaluating approaches to funding retrofits that would improve septic systems and water quality. It is therefore an ideal location to assess the impact that water quality has on home values; this paper investigates property sales near the Long Island Sound, South Shore Bays, and Peconic Estuary System. Results show that water quality has a significant impact on nearby home sales, with the largest effects generally seen nearest to the coastline. These results inform a discussion about potential benefits and costs of widespread septic tank and cesspool retrofitting, which is currently incentivized by grant and loan programs.

The applicability of self-reported home values in housing wealth inequality assessment: evidence from an emerging country

One of the measures of housing wealth inequality is the property’s market value. In existing analyses, this figure is often a subjective value determined by homeowners. Little is known about the validity of using this type of data as a substitute for market value in inequality studies. Therefore, this paper aims to examine whether self-reported home values can be applied to evaluate housing wealth inequality. In order to achieve this goal, first, a theoretical framework on the irrelevance of valuation bias for the assessment of housing wealth inequality was developed, followed by an empirical analysis. The latter included gathering information on subjective flat values and their characteristics in Warsaw. Next, a geographically weighted regression was calibrated to calculate the market value of these dwellings. Then, using the Gini coefficient, housing wealth inequality levels were estimated separately for subjective and objective home values. The results revealed that the former could serve as a very good proxy for the latter in housing wealth inequality analysis. The findings hold across almost all identified subgroups based on respondents’ gender, age, income, wealth, education and employment status. Finally, recommendations were formulated for public institutions and housing research.

Optimization of United States Residential Real Estate Investment through Geospatial Analysis and Market Timing.

In this study, we examined the long-term spatial patterns and trends of home values within the United States from 1996 to 2019. The Zillow Home Value Index (ZHVI) data were obtained from the Zillow’s housing data portal. The overall trends indicated both coasts of the United States having the highest concentration of hotspots. The ideal time to sell varied seasonally across the country. We used geo-statistical analysis techniques, such as cluster analysis and emerging hot spot analysis (EHSA), to reveal the average and long-term trends in spatial patterns of home values. Washington was the only state with sporadic hot spots. The Western United States showed consecutive hotspots, most notably in California, but in surrounding states as well. The Northeast, Mid-Atlantic, and Florida were dominated by oscillating hotspots. Texas and the Southeast display new hotspots that signal change, indicative of southward migration of population. Finally, the Midwest has been a historical cold spot, but Cleveland has improved to a diminishing cold spot, pointing to the revitalization of the region. The seasonal level analysis displayed southern and coastal states as those benefiting most from winter home sales, and the colder northern states captured the most value and sold quicker in the summer months. This intuitive analysis of the country’s variation in ideal sale month reveals a local view of when to sell rather than a generalized view of the entire United States.

Estimating the Effect of Tidal Marsh Restoration on Housing Prices: A Hedonic Analysis in the Nisqually National Wildlife Refuge, Washington, USA

This study employs the hedonic pricing method and a rich spatial and temporal dataset from two counties in Washington, USA to determine the effect of the 2009 Nisqually Restoration project (NRP) on housing prices in adjacent communities. The NRP restored 308 hectares of wetlands via dike removal in the Billy Frank Jr. Nisqually National Wildlife Refuge (NNWR), leading to improvements in salmon and bird abundance and recreational opportunities. We find that the ecological improvements made by the NRP increased the value of homes within 0.5 mile of the refuge by $37,631; homes 0.5 to 1 mile by $10,489; and homes 1 to 1.5 miles by $31,186. Our findings are consistent with previous wetland hedonic price analyses and may be useful inputs in natural resource management and policy decision-making.

Consistency among Office, Home, and Ambulatory Blood Pressure Values in Women with Chronic Hypertension and History of Eclampsia or Preeclampsia.

Adequate control of blood pressure (BP) is essential to prevent complications in pregnant women with a history of eclampsia or pre-eclampsia. However, the importance of office (OBPM), home (HBPM), and ambulatory (ABPM) BP measurements for proper control and prognosis in high-risk pregnancy is unknown. The present study aimed to compare BP values obtained during these three different BP measurements in women with a history of eclampsia or pre-eclampsia. This study included 79 pregnant women with chronic hypertension and a documented history of eclampsia or pre-eclampsia in previous pregnancy/pregnancies. Every fifth week of the study, all participants underwent ABPM, HBPM and OBPM. BP values from the 10th, 25th, and 37th weeks of pregnancy were evaluated. Therapy was intended to meet the ABPM treatment goal of <130/80 mmHg. Day, night, and 24 h ABPM systolic BP values were lower than HBPM and OBPM values at each study visit. Night and 24 h ABPM diastolic BP values were lower than HBPM and OBPM values, while day 24 h ABPM values were slightly higher than HBPM and OBPM values. ABPM provides different BP values than OBPM and HBPM. Target BP for ABPM in high-risk pregnancy hypertension should be estimated based on the predictive value of adverse pregnancy outcomes.

Adjacency Neighborhood Effects and Owner-Assessed Home Values

Adjacency neighborhood effects such as neighbor interactions or perceived neighborhood quality have been neglected in the housing literature due to a lack of data. We investigate the impact of these effects on the housing wealth perceived by homeowners. Using a national longitudinal survey, we find that perceived neighborhood quality positively impacts owner-assessed home values. However, this effect is driven by homeowners’ assessment of their neighborhoods’ quality relative to other neighborhoods rather than their neighborhoods’ perceived cleanliness or upkeep. Depending on the financial characteristics of homeowners, we also find neighbor interactions and perceived neighborhood safety to have a significant relation with self-assessed home values. Trust and support among neighbors and joint feel of the home and neighborhood on the other hand have no relation with estimated values. While neighborhood quality consistently explains owner-assessed values, home quality only has a relation with value estimates for homeowners with certain financial characteristics. Considering the importance of perceived housing wealth for household financial decisions as well as transaction prices, our findings have implications for policy makers and developers.

Beyond the City–County Divide: Examining Consolidation Referenda Since 2000

Despite the relative infrequency of successful city-county consolidation campaigns, local government officials and reformers continue revisiting the possibilities and perceived benefits associated with consolidation. While studies analyzing campaigns for and against consolidation efforts exist, little is known beyond factors at the city and/or county level. For this reason, it is important to dig deeper and explore the differences at smaller geographic levels. Utilizing demographic, geographic, and electoral data, this study examines the factors which contribute to support (or opposition) to consolidation at the voting precinct-level in reform efforts over the last two decades. Results indicate that factors related to higher levels of education, home values, and larger Hispanic populations tend to increase the vote share in favor of consolidation, while areas with larger median household incomes demonstrate lower levels of support. These findings help extend our understanding of boundary change and voting in local referenda in the United States.

Orthopaedic Surgeon Distribution in the United States.

There is limited research on the supply and distribution of orthopaedic surgeons in the United States. The goal of this study was to analyze the association of orthopaedic surgeon distribution in the United States with geographic and sociodemographic factors. County-level data from the US Department of Health and Human Services Area Health Resources Files were used to determine the density of orthopaedic surgeons across the United States on a county level. Data were examined from 2000 to 2019 to analyze trends over time. Bivariate and multivariable negative binomial regression models were constructed to identify county-level sociodemographic factors associated with orthopaedic surgeon density. In 2019, 51% of the counties in the United States did not have an orthopaedic surgeon. Metropolitan counties had a mean of 22 orthopaedic surgeons per 100,000 persons while nonmetropolitan and rural counties had a mean of 2 and 0.1 orthopaedic surgeons per 100,000 persons, respectively. Over the past 2 decades, there was a significant increase in the percentage of orthopaedic surgeons in metropolitan counties (77% in 2000 vs 93% in 2019, P < 0.001) and in the proportion of orthopaedic surgeons 55 years and older (32% in 2000 vs 39% in 2019, P < 0.001). Orthopaedic surgeon density increased with increasing median home value (P < 0.001) and median household income (P < 0.001). Counties with a higher percentage of persons in poverty (P < 0.001) and higher unemployment rate (P < 0.001) and nonmetropolitan (P < 0.001) and rural (P < 0.001) counties had a lower density of orthopaedic surgeons. On multivariable analysis, a model consisting of median home value (P < 0.001), rural counties (P < 0.001), percentage of noninsured persons (P < 0.001), and percentage of foreign-born persons (P < 0.001) predicted orthopaedic surgeon density. Access to orthopaedic surgeons in the United States in rural areas is decreasing over time. County-level socioeconomic factors such as wealth and urbanization were found to be closely related with surgeon density.

The role of socioeconomic status in mediating Black-White racial disparities in endometrial cancer incidence and survival (421)

The role of socioeconomic status in mediating Black-White racial disparities in endometrial cancer incidence and survival (421)

Using Spatial Context and Demographic Analysis to Assess Surface Permeability in Philadelphia

Surface permeability significantly impacts the urban environment. Specifically, impermeable surfaces result in runoff, which in turn causes flooding and pollution. Left unchecked, impermeable surfaces can lead to hazardous conditions for unlucky city residents. These concerns are prominent in Philadelphia, and in response the municipal government has launched an ambitious plan to increase permeability by installing green infrastructure. This paper explores how spatial and demographic research can be combined to provide a holistic assessment of surface permeability across one of America’s largest cities. First, 2020 satellite imagery, provided by the USGS, was used to classify permeable and impermeable surfaces over the entire city. Next, demographic data from the 2014-2018 American Community Survey – household income, rent, and home value, all by census block group – were individually merged with the surface permeability classification to generate three overlays (e.g., surface permeability correlated with household income). Upon quantitative and qualitative examination of these overlays, it was found that impermeable surfaces are unevenly distributed and inequitably concentrated in Philadelphia’s less-affluent communities. Overall, the methodology used in this research demonstrates a multi-disciplinary and reproducible procedure for joint environmental-demographic research. Additionally, the conclusions reached offer location-specific insights that can help inform Philadelphia’s future green infrastructure investments and runoff mitigation strategies.

Abstract 3668: Socioeconomic disparities in healthcare utilization and overall survival among patients with cancer: Application of area-level socioeconomic status in a nationwide electronic health record-derived database

Abstract Introduction: While lower socioeconomic status (SES) is associated with worse cancer outcomes, most electronic health records (EHRs) lack documentation of SES. Here we apply an area-level SES measure to an EHR-derived database to evaluate representativeness according to SES. We then examine socioeconomic disparities in the timeliness of healthcare utilization (biomarker testing and systemic treatment) and overall survival (OS) in 3 common cancers. Methods: This retrospective study uses the nationwide Flatiron Health EHR-derived de-identified database of cancer patients who have clinical activity between January 2011-August 2021. Census block group data from the American Community Survey (2015-2019) was used to measure SES per the Yost Index (incorporating income, home values, rental costs, poverty, blue-collar employment, unemployment, and education information). SES quintiles were determined from the US population and then applied to patients based on their residential addresses. Our database included 2,067,644 cancer patients from community practices. Patients with advanced non-small-cell lung cancer (aNSCLC, n=51,596), metastatic breast cancer (mBC, n=18,268), and multiple myeloma (MM, n=8,246) were sampled and followed from advanced, metastatic, or initial diagnosis date, respectively. Differences were evaluated using Χ2 tests for categorical variables and log-rank tests for Kaplan-Meier survivor functions. Results: Compared to the US population, our database of cancer patients has a similar SES distribution (differences &amp;lt;3%), capturing cancer patients living in the most (Q1) and least affluent areas (Q5) of the country. Yet, among the 1.5% of cancer patients who participated in clinical trials, only 15.2% lived in the least affluent areas. aNSCLC and mBC patients living in the least affluent areas were less likely to receive biomarker testing within 30 days of index diagnosis than those in the most affluent areas (59.4% vs. 68.7%; 74.9% vs. 81.0%, both p&amp;lt;.01). Similar patterns were observed in receipt of systemic treatment within 60 days of index diagnosis (aNSCLC: 58.9% vs. 64.9%; mBC: 76.0% vs. 80.1%, both p&amp;lt;.01). No differences in healthcare utilization were observed among MM patients. Patients in the least affluent areas had lower median OS (months) than those in the most affluent areas (aNSCLC: 10.8 [95% CI: 10.4-11.3] vs. 12.2 [95% CI: 11.8-12.7]; mBC: 28.0 [95% CI: 26.6-29.5] vs. 34.5 [95% CI: 33.1-36.9], MM: 57.4 [95% CI: 53.5-61.5] vs. 67.5 [95% CI: 62.5-76.4]; all p&amp;lt;.01). Conclusion: Lower SES was associated with reduced clinical trial participation, less timely healthcare utilization, and worse OS. Making SES available in real-world data can support the development of inclusive clinical trials and inform interventions to reduce cancer care disparities. Citation Format: Jenny S. Guadamuz, Xiaoliang Wang, Jeremy Snider, James Walters, Rebecca A. Miksad, Gregory S. Calip. Socioeconomic disparities in healthcare utilization and overall survival among patients with cancer: Application of area-level socioeconomic status in a nationwide electronic health record-derived database [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3668.

Gates, guards and patrols: impacts of community security features on home values

PurposeThis study aims to investigate the price effects, if any, of various types of residential developments' security mechanisms.Design/methodology/approachPrevious literature suggests home buyers pay a premium for homes located within gated communities, but no prior study investigates the various levels of community security features often associated with gated communities. This study extends this literature by examining the presence of gates, guards and patrols (individually and in combination) within residential communities. The findings indicate that home prices are significantly higher in communities that have gates, guards, or guards and patrols. In the presence of guards and patrols, however, the premium associated with gates disappears. These results suggest that the previously identified premium for homes in gated communities may be more appropriately interpreted as a premium for enhanced security provided by guards and patrols within the communities.FindingsPrices of homes in communities exhibit premiums for security gates, security guards and security patrols, but the premium associated with security gates is less impactful than security guards and security patrols.Research limitations/implicationsDevelopers, home buyers, appraisers and other parties should carefully consider neighborhood security features when evaluating home prices in communities.Practical implicationsThe presence of security guards and security patrols implies higher home prices in residential communities and are more impactful than security gates alone.Originality/valuePrior research reports a price premium for homes in gated communities. This study contributes to that literature and finds that the premium associated with security guards and security patrols dominates the mere presence of security gates.

Influence of Home Culture on Child Development in Church: The Case of Atonsu District Assemblies of God,Ghana in the Kumasi Metropolis.

This paper sought to explore how the Assemblies of God Church in the Atonsu District is employing the home culture and its value system in its child development programmes. The study adopted a qualitative research approach and descriptive survey design. Data was collected from 50 purposively selected respondents using interviews. The data gathered was analysed using thematic content analysis. The study found that for the holistic development of the child, the church largely needs resources from the home culture and its value system. The study concludes that the home culture and its value system employed in child upbringing are not in conflict with Christian virtues of child education described in the Bible and as practiced by the Assemblies of God Church. This indicates that the indigenous system of child upbringing is in harmony with Christian child development programmes of the Assemblies of God Church. The study recommends that for any effective child development, the church must take into consideration the home culture and its value systems as this can help strengthen the collaborative influence of the church on the home value systems in total child development. Keywords: Home culture, Assemblies of God Church, Collaboration and Child Development

Property values and cyanobacterial algal blooms: Evidence from satellite monitoring of Inland Lakes

We examine how the frequency of cyanobacterial harmful algal blooms (cyanoHABs) generates economic costs through the mechanism of residential property values. We assemble nearly two decades worth of nationwide data on property sales near US inland lakes along as well as satellite-derived measures of the annual frequency of cyanoHABs in over 2000 large lakes during the years 2008–2011. We combine these data sources to estimate broad scale hedonic property models to recover the marginal willingness to pay to reduce the frequency of cyanobacterial blooms in seven climate regions across the United States. We find heterogeneity in the marginal cost of cyanoHABs, with a 10-percentage point increase in annual occurrence reducing average home values for near-shore properties by 3.5% in the Upper Midwest, 3.8% in the South, 3.3% in the Southeast, and 4.3% in the Northeast. We find null or inconclusive results for other regions. We use our estimates to illustrate the household-, lake-, and regional-level impacts of counterfactual changes in the frequency of cyanoHABs.

Racial and socioeconomic disparities in telemedicine use among US patients initiating cancer treatment during the COVID-19 pandemic.

6511 Background: The COVID-19 pandemic was associated with declines in in-person clinical visits. While telemedicine visits have increased, uptake has varied. Here we assess demographic and socioeconomic factors associated with telemedicine use among patients initiating treatment for 21 common cancers at community oncology clinics. Methods: This retrospective study uses the nationwide Flatiron Health electronic health record-derived de-identified database of patients with cancer. Patient characteristics were determined using structured and unstructured data curated via technology-enabled abstraction. We included patients (≥ 18 years) who initiated first-line cancer treatment between March 2020 and September 2021 (follow-up through December 2021). We focused on differences in telemedicine use (≥ 1 telemedicine visit within 90 days after treatment initiation) across race/ethnicity, insurance coverage, rurality (per Rural-Urban Commuting Areas), and socioeconomic status (SES). SES was defined using census block group data from the American Community Survey (2015-2019) (quintiles representing least to most affluent areas) based on patient addresses and measured using the Yost Index (incorporating income, home values, rental costs, poverty, blue-collar employment, unemployment, and education information). We used logistic regression models adjusted for clinical characteristics ( i.e., age, sex, performance status, and stage) to examine differences in telemedicine use. Results: This study included 24,164 patients (48.1% women, median age: 69 [interquartile range: 61-77] years), of whom 15.9% used telemedicine services. Black patients were less likely to use telemedicine services than White patients (11.4% vs. 15.6%, odds ratio [OR] 0.69 [95% confidence interval [CI]: 0.59-0.79], p&lt;0.01). Telemedicine use was also lower among patients without documented insurance than well-insured (commercial and Medicare payers) patients (10.7% vs. 15.9%, OR 0.62 [95% CI: 0.54-0.72], p&lt;0.01). Those in rural (9.8%, OR 0.51 [95% CI: 0.45-0.58], p&lt;0.01) and suburban areas (13.1%, OR 0.71 [95%: 0.64-0.79], p&lt;0.01) were less likely to use telemedicine services than patients in urban areas (17.6%). Finally, patients in the least affluent areas had lower telemedicine use than those in the most affluent areas (10.2% vs. 24.3%, OR 0.35 [95% CI: 0.31-0.40], p&lt;0.01). Conclusions: During the COVID-19 pandemic, nearly one-fifth of patients initiating cancer treatment used telemedicine services. However, there were substantial disparities: Black, uninsured, non-urban, and less affluent patients are less likely to use telemedicine services. While telemedicine may expand access to specialty care, the proliferation of these services may widen cancer care disparities if vulnerable populations do not have equitable access.

HYPERTENSION PHENOTYPES IN YOUNG INDIVIDUALS BASED ON COMBINED OR ISOLATED ELEVATION OF OFFICE, HOME AND AMBULATORY BLOOD PRESSURE MEASUREMENTS AND ASSOCIATION WITH ORGAN DAMAGE

Objective: To assess the prevalence of white-coat (WCH) and masked (MH) hypertension detected by only ambulatory or only home blood pressure (BP) monitoring (isolated), or both (dual), and their association with preclinical target organ damage (TOD). Design and method: Young individuals referred for elevated BP and healthy volunteers aged 6–25 years were evaluated with office (2–3 visits; triplicate measurements), home (7 days, duplicate morning and evening measurements) and 24-hour ambulatory BP monitoring. TOD assessment included echocardiographic left ventricular mass index (LVMI), carotid intima-media thickness (IMT) and pulse wave velocity (PWV; Complior). Normotension (NT) was defined as normal office, home and ambulatory BP and sustained hypertension (SH) as all measurements being elevated. WCH and MH phenotypes were identified based on isolated or combined (dual) home and ambulatory BP values. Results: Analysis included 320 individuals (mean age 13.8 ± 3.8 years, 66.6% males, 32.2% children, 55.9% adolescents, 11.9% young adults, BMI 24.1 ± 4.8 kg/m2), of whom 276 had LVMI, 212 IMT and 168 PWV assessment. 182 (56.9%) participants had NT and 39 (12.2%) SH. Among 54 (16.9%) participants with WCH, 35 had dual WCH (64.8%) and 19 (35.2%) isolated ambulatory or home WCH. Among 45 (14.1%) with MH, 17 had dual MH (37.8%) and 28 isolated ambulatory or home MH (62.2%). Participants with dual and isolated intermediate phenotypes didn’t differ according to age, sex and BMI. Individuals with SH had higher LVMI, IMT and PWV than NT (all P &lt; 0.05; Figure). Intermediate phenotypes based on selective or combined elevation of out-of-office BP presented intermediate values of indices of TOD between NT and SH. Isolated ambulatory or home WCH was associated with higher LVMI values than NT (P &lt; 0.05), whereas dual MH was associated with higher IMT than NT (all P &lt; 0.05). Conclusions: These findings suggest that in young individuals intermediate hypertension phenotypes with selective (isolated WCH) or combined elevation of BP (dual MH) in out-of-office measurement methods appear to carry an increased risk of preclinical TOD compared with NT.

70-OR: Association of Diabetes Screening with Demographic, Neighborhood Level Census, and Area Gentrification Characteristics

Research assessing predictors of preventive screening often focuses on individual patient factors, despite known relationships between neighborhood environment and health. Using a retrospective cohort study of 519,826 patients meeting US Preventive Service Task Force guideline recommendation for screening for prediabetes and type 2 diabetes (age 35-70 years and BMI ≥25) from Kaiser Permanente Northern California in 2018, we used logistic regression to assess the relationship between diabetes screening and census neighborhood tract-level measures, and area gentrification measures developed by the Urban Displacement Project, controlling for age, sex, race, ethnicity, and BMI. Thirty-eight percent of patients were screened for diabetes. Patients aged 60-70 years had higher odds of diabetes screening compared to patients aged 35-39 years (OR: 2.73, 95% CI: 2.67-2.78) . Men had lower odds of screening compared to women (OR: 0.91, 0.90-0.92) . Asian patients had higher odds of screening compared to White patients (OR 1.44, 1.42-1.46) . Patients with BMI ≥40 had higher odds of screening compared to patients with BMI 25-29.9 (OR: 1.34, 1.30-1.37) . Patients living in census tracts with the lowest median values of homes (OR: 0.93, 0.90-0.96) and with the lowest median household income (OR: 0.95, 0.91-0.99) had lower odds of diabetes screening compared to those in census tracts with the highest values. Patients living in census tracts classified as Ongoing Displacement/Low Income Susceptible to Displacement had lower odds of screening (OR: 0.96, 0.93-0.98) compared to those living in stable moderate mixed income tracts. We found insufficient screening rates and that gentrification and area-level socioeconomic factors were associated with lower diabetes screening, even after adjusting for individual demographic and clinical factors. Health care systems should consider addressing social needs and community resources as a path to improving preventive care. Disclosure T.Thomas: None. W.T.Dyer: None. L.A.Rodriguez: None. J.Schmittdiel: None. Funding Kaiser Permanente Northern California Community Benefit Programs; The Permanente Medical Group (TPMG) Delivery Science Fellowship Program; National Institute of Diabetes and Digestive and Kidney Diseases grant T32DK11668401. Dr. Schmittdiel received additional support from the NIDDK-funded Health Delivery Systems Center for Diabetes Translational Research (1P30 DK92924) .

Does Automated Collateral Evaluation Lower Mortgage Credit Risk Relative to Home Appraisal Valuations?

Automated valuation models (AVMs) are increasingly being used as a substitute for home appraisals in mortgage origination. This article examines whether there are differences in the credit risk of mortgages originated using AVMs relative to traditional appraisals. This question is explored through modeling the conditional default rates of loans originated through Freddie Mac’s automated collateral evaluation (ACE) program relative to those originated with appraisals. We show that ACE loans have about a 9.6% lower default risk in comparison to otherwise similar loans originated with appraisals. This superior default performance can be explained by the ACE decision logic employing data beyond that found in a traditional appraisal and the more efficient utilization of available information through statistical modeling. These findings are limited to Freddie Mac’s use of its AVM, the Home Value Explorer®, and the algorithmic decision logic in the ACE program.

Sistem Pendukung Keputusan Pemilihan Pegawai Honorer Kelurahan Medan Sinembah Menerapkan Metode ROC dan MOORA

An honorary employee is someone who works for a company that is eligible to be employed as a daily employee for a predetermined period of time and also with a definite salary from the company he works for. The problem experienced in this study is about the process of selecting honorary employees. The selection of honorary employees so far has only looked at education, even though in the process of selecting honorary employees several criteria must be used. The criteria in this study are Education, Age, Height, Distance from Home, Work Experience, Character and Test Values. From the problems encountered, it is very appropriate if the Medan Sinembah Village party implements a Decision Support System. The method used in this study is ROC and MOORA, this method was chosen because it is able to provide the best decision based on predetermined criteria where the best alternative is alternative A18 on behalf of "Andry" with a value of Yi = 0.328

When Dialysis "Becomes Life": Pediatric Caregivers' Lived Experiences Obtained From Patient-Reported Outcomes Measures.

IntroductionQualitative research reveals significant caregiver impact resulting from managing children requiring chronic dialysis but offers few quantitative measures of their lived experiences.Materials and MethodsThis cross-sectional study included 25 caregivers of children on chronic peritoneal dialysis (PD) and hemodialysis (HD) enrolled from 2018 to 2019 at a large pediatric dialysis program in the U.S.Patient Reported Outcomes Measures Information System (PROMIS) measures and free text commentary were collected and analyzed to evaluate the self-reported impact and wellbeing of these caregivers.ResultsAmong all dialysis modalities, caregivers' positive affect (43.4 ± 10) and general life satisfaction (45.1 ± 11.5) were significantly lower than the general adult population. Compared with HD caregivers, PD caregivers demonstrated significantly more fatigue and sleep disturbance and less positive affect and life satisfaction. Amongst HD caregivers, sleep disturbance, positive affect, and meaning/purpose differed significantly from the general population. Analyses of text commentary revealed that caregivers also expressed the feelings of loss, importance of knowing the impact of dialysis prior to initiation, need for a support group, and value of home nursing.ConclusionsCaregivers of children on chronic dialysis had significantly poorer self-rated health and wellbeing compared with the general adult population. This may be due in part to their feelings of social isolation. Our findings highlight opportunities to improve caregivers' lived experiences.