RESUMO
Given projected increases in flood damages, managed retreat strategies are likely to become more widespread. Voluntary buyouts, where governments acquire flood-damaged properties and return the sites to open space, have been the primary form of federally funded retreat in the USA to date. However, little attention has been paid to the cost structure of buyout projects. Using a transaction cost framework, we analyze the costs of activities that comprise floodplain buyouts. Federal data do not distinguish transaction costs, but they do suggest that the cost of purchasing properties often accounts for 80% or less of total project costs. Through a systematic review (n = 1103 publications) and an analysis of government budgets (across n = 859 jurisdiction-years), we find limited sources with relevant cost information, none of which reports transaction costs. The absence of activity-level cost data inhibits more targeted policy reform to support community-driven and efficient buyout programs. Better data collection and reporting can inform more impactful and equitable buyout policy.
RESUMO
Falls affect more than 29 million American adults ages ≥65 years annually. Many older adults experience recurrent falls requiring medical attention. These recurrent falls may be prevented through screening and intervention. In 2014 to 2015, records for 199 older adult patients admitted from a major urban teaching hospital's emergency department were queried. Open-ended variables from clinicians' notes were coded to supplement existing closed-ended variables. Of the 199 patients, 52 (26.1%) experienced one or more recurrent falls within 365 days after their initial fall. Half (50.0%) of all recurrent falls occurred within the first 90 days following discharge. A large proportion of recurrent falls among older adults appear to occur within a few months and are statistically related to identifiable risk factors. Prevention and intervention strategies, delivered either during treatment for an initial fall or upon discharge from an inpatient admission, may reduce the incidence of recurrent falls among this population.
RESUMO
Young men who have sex with men (YMSM) have high rates of recreational drug use and binge drinking that are related to increases in unprotected sex and HIV risk. We describe the development of a community-level intervention focused on MSM ages 15 to 29 who identify as Black or White and who reported episodic use of alcohol and/or drugs. Intervention content included culturally-relevant role model stories and peer outreach. Outcome measures, including number of partners and a risk score indicating risk for HIV from protected or unprotected insertive or receptive anal sex, were examined over 36 months in a sample of YMSM in Philadelphia, the intervention site, and Baltimore, the comparison site. Decreases in risk scores over time were significantly larger in the intervention sample than in the comparison sample. Effects were greater for YMSM who engaged in binge drinking and/or marijuana use, compared to those who used other drugs.
