Community Life and Housing in Rural Nebraska: 2005 Nebraska Rural Poll Results

Many rural communities are experiencing population decline. However, rural residents have continued to show a strong attachment to their communities. How do rural Nebraskans feel about their community? Are they satisfied with the services provided? Do they own their home? What is the condition of their home? This report details 2,851 responses to the 2005 Nebraska Rural Poll, the tenth annual effort to understand rural Nebraskans’ perceptions. Respondents were asked a series of questions about their community and housing. Trends for some of these questions are examined by comparing data from the nine previous polls to this year’s results. For all questions, comparisons are made among different respondent subgroups, that is, comparisons by age, occupation, region, etc. Based on these analyses, some key findings emerged: Rural Nebraskans’ views of the change in their community are similar to those expressed last year. This year, 28 percent believe their community has changed for the better, compared to 26 percent last year. And, in 2005, only 20 percent think their community has changed for the worse, compared to 22 percent last year. The proportion of expected movers who plan to leave the state decreased this year. Last year, 56 percent of the persons planning to move from their community expected to leave the state. That proportion decreased to 47 percent this year. Rural Nebraskans living in or near the largest communities are more likely than persons living in or near the smaller communities to say their community has changed for the better. Thirty-nine percent of persons living in or near communities with populations of 10,000 or more believe their community has changed for the better during the past year, but only 15 percent of persons living in or near communities with less than 500 people share this opinion. The community services and amenities that rural Nebraskans are most dissatisfied with include: entertainment, retail shopping and restaurants. At least one-third of rural Nebraskans express dissatisfaction with these three services. They are most satisfied with parks and recreation, library services, basic medical care services, highways and bridges, and education (K - 12). At least one-half of rural Nebraskans are satisfied with the following items in their community: appearance of residential areas (66%), crime control (61%), maintenance of sidewalks and public areas (57%) and noise (54%). Rural Nebraskans generally have positive views about their community. Sixty percent agree that their community is an ideal place to live and 52 percent say their community has good business leaders. Rural Nebraskans have mixed opinions about the future of their community. Fortyfour percent agree that their community’s future looks bright, but 42 percent disagree with this statement. Fourteen percent have no opinion. Rural Nebraskans living in or near the larger communities are more likely than residents of the smaller communities to think their community’s future looks bright. Fifty-nine percent of persons living in or near communities with populations of 10,000 or more agree with this statement, compared to only 25 percent of residents living in or near communities with less than 500 people. Further, 61 percent of the residents of the smallest communities disagree with this statement, compared to only 28 percent of the residents of the largest communities. Over three-quarters of rural Nebraskans disagree that younger residents of their community tend to stay there after completing high school. Seventy-six percent disagree with this statement, 16 percent have no opinion and eight percent agree that younger residents stay after completing high school. When comparing responses by age, younger persons are more likely than older persons to agree that younger residents stay in their community after high school. Sixteen percent of persons age 19 to 29 agree with this statement, compared to only six percent of persons age 50 to 64. Younger persons are more likely than older persons to be planning to move from their community next year. Fifteen percent of persons between the ages of 19 and 29 are planning to move next year, compared to only two percent of persons age 65 and older. An additional 17 percent of the younger respondents indicate they are uncertain if they plan to move. Most rural Nebraskans own their home. Eighty-four percent of rural Nebraskans own their home. Older persons are more likely than younger persons to own their home. Eighty-eight percent of persons over the age of 50 own their home, compared to only 52 percent of persons age 19 to 29. Housing in rural Nebraska has an average age of 50 years. Twenty-four percent of residences were built before 1930. Another 24 percent were built between 1930 and 1959. Twenty-nine percent were built between 1960 and 1979 and the remaining 24 percent were built in 1980 or later. The housing stock in smaller communities is older than the housing located in larger communities. Over one-third (35%) of the residences in communities with less than 1,000 people were built before 1930. Only 12 percent of the homes in communities with populations of 10,000 or more were built in this time period. Most rural Nebraskans appear satisfied with their home. Only 24 percent say the current size of their home does not meet their needs. The same proportion (24%) say their home is in need of major repairs. Thirty-eight percent agree that their home needs a lot of routine maintenance, but 87 percent like the location (neighborhood) of their home. One-third of rural Nebraskans living in or near the smallest communities say their home is in need of major repairs. Only 19 percent of persons living in or near communities with populations of 5,000 or more are facing this problem. Home ownership is very important to most rural Nebraskans. Eighty-two percent believe it is very important to own their home. An additional 12 percent say it is somewhat important and six percent say it is not at all important. However, persons who do not currently own their home do not feel it is important for them to do so. Only 32 percent of renters say it is very important to own their home, compared to 91 percent of home owners. And, 35 percent of renters say it is not at all important to own their home.

Rural Nebraska: Looking Back at a Decade of Change and Progress: 2005 Nebraska Rural Poll Results

To commemorate the 10th anniversary of the Nebraska Rural Poll, rural Nebraskans were asked about changes they may have experienced during the past ten years. Where have they lived during the past decade? In what types of business activities have they been involved? Have they received any education or training during that time period? What has been their experience with the Internet? This report details 2,851 responses to the 2005 Nebraska Rural Poll, the tenth annual effort to understand rural Nebraskans’ perceptions. Respondents were asked a series of questions about changes they have experienced during the past ten years. For all questions, comparisons are made among different respondent subgroups, that is, comparisons by age, occupation, region, etc. Based on these analyses, some key findings emerged: One quarter of rural Nebraskans have lived somewhere other than their current community during the past ten years. Of those who have lived elsewhere, they have moved their primary residence an average of 2.2 times. Younger rural Nebraskans are more likely than older residents to have lived elsewhere during the past decade. Sixty-six percent of persons between the ages of 19 and 29 have lived in a different location, compared to only 12 percent of persons age 65 and older. Many rural Nebraskans who have lived in a different community during the past ten years have lived in another state. Forty-one percent of persons who have lived elsewhere during the past decade have lived in a different state. Forty-five percent have lived in a larger community (18% have lived in either Omaha or Lincoln and 27% have lived in or near a Nebraska community larger than their current one - other than Lincoln or Omaha). Thirty-six percent have lived in or near a Nebraska community smaller than their current one. Twenty percent of rural Nebraskans currently own a business. Thirteen percent started operating a business during the past ten years, 10 percent closed or stopped operating a business during this time period and four percent tried unsuccessfully to start a business. Persons living in or near the smallest communities are more likely than persons living in or near larger communities to currently own a business. Twenty-nine percent of persons living in or near communities with less than 500 people currently own a business, compared to 15 percent of persons living in or near communities with at least 10,000 persons. In general, rural Nebraskans have favorable opinions about self-employment but they also recognize the hardships and risks involved with this type of employment. Sixtyone percent agree that self-employment is desirable because they can be their own boss. Forty-four percent agree that self-employment provides a better quality of life than being an employee. However, 74 percent agree that self-employed individuals work longer hours than traditional employees and 70 percent agree that the cost of health insurance makes self-employment unappealing. Younger persons are more likely than older persons to agree that the cost of health insurance makes self-employment unappealing. Eighty percent of persons age 19 to 29 agree with that statement, compared to 55 percent of persons age 65 and older. One-half of rural Nebraskans have participated in formal education courses, workshops or other training activities during the past ten years. Sixty-nine percent of rural Nebraskans have Internet access either at home or at work. Sixty-six percent have acquired Internet access either at home or at work during the past ten years. An additional three percent had acquired access more than ten years ago. Persons with higher levels of income are more likely than persons with lower incomes to have acquired Internet access. Sixty-six percent of persons with household incomes of $60,000 or more have acquired Internet access at both home and work during the past ten years, compared to only 11 percent of persons with household incomes less than $20,000. Information searches and email are the most important reasons for having an Internet connection. Eighty-nine percent of rural Nebraskans with access to the Internet at either home or work say that information searches are an important or very important reason for having an Internet connection. Eighty-three percent say email is an important reason. In general, rural Nebraskans say their satisfaction with various features of their Internet connection has increased during the past ten years. Fifty-five percent of rural Nebraskans with an Internet connection at home say their satisfaction with the availability of service has increased during the past ten years and 50 percent report an increase in their satisfaction with the speed of their connection. Persons living in or near the larger communities are more likely than persons living in or near the smaller communities to say their satisfaction with the speed of their Internet connection has increased during the past ten years. Fifty-four percent of persons living in or near communities with populations of 5,000 or more say their satisfaction with the speed of their connection has increased over the past decade, compared to 43 percent of persons living in or near communities with less than 1,000 people.

Building Information Modelling (BIM) Effectiveness in Performing Life Cycle Assessment of Building

The scope of this project is to study the effectiveness of building information modelling (BIM) in performing life cycle assessment in a building. For the purposes of the study will be used “Revit” which is a BIM software and Tally which is an LCA tool integrated in Revit. The project is divided in six chapters. The first chapter consists of a theoretical introduction into building information modelling and its connection to life cycle assessment. The second chapter describes the characteristics of building information modelling (BIM). In addition, a comparison has been made with the traditional architectural, engineering and construction business model and the benefits to shift into BIM. In the third chapter it will be a review of the most well-known and available BIM software in the market. In chapter four life cycle assessment (LCA) will be described in general and later on specifically for the purpose of the case study that will be used in the following chapter. Moreover, the tools that are available to perform an LCA will be reviewed. Chapter five will present the case study that consists of a model in a BIM software (Revit) and the LCA performed by Tally, an LCA tool integrated into Revit. In the last chapter will be a discussion of the results that were obtained, the limitation and the possible future improvement in performing life cycle assessment (LCA) in a BIM model.

Studying the Roles of Nonprofits, Government, and Business in Providing Activities and Services to Youth in the Phoenix Metropolitan Area

The article addresses the questions, What do children in urban areas do on Saturdays? What types of organizational resources do they have access to? Does this vary by social class? Using diary data on children's activities on Saturdays in the Phoenix-Mesa-Scottsdale metropolitan area, the authors describe the different types of venues (households, businesses, public space, associations, charities, congregations, and government/tribal agencies) that served different types of children. They find that the likelihood of using a charity or business rather than a government or tribal provider increased with family income. Also, the likelihood of using a congregation or a government facility rather than a business, charity, or household increased with being Hispanic. The authors discuss the implications for the urban division of labor on Saturdays and offer research questions that need further investigation.

Modeling of red blood cell life-spans in hematologically normal populations

Despite the impact of red blood cell (RBC) Life-spans in some disease areas such as diabetes or anemia of chronic kidney disease, there is no consensus on how to quantitatively best describe the process. Several models have been proposed to explain the elimination process of RBCs: random destruction process, homogeneous life-span model, or a series of 4-transit compartment model. The aim of this work was to explore the different models that have been proposed in literature, and modifications to those. The impact of choosing the right model on future outcomes prediction--in the above mentioned areas--was also investigated. Both data from indirect (clinical data) and direct life-span measurement (biotin-labeled data) methods were analyzed using non-linear mixed effects models. Analysis showed that: (1) predictions from non-steady state data will depend on the RBC model chosen; (2) the transit compartment model, which considers variation in life-span in the RBC population, better describes RBC survival data than the random destruction or homogenous life-span models; and (3) the additional incorporation of random destruction patterns, although improving the description of the RBC survival data, does not appear to provide a marked improvement when describing clinical data.

Aging and Mental Health: Business as Usual?

Cautions that in developing training models in mental health and aging, psychologists must not overlook what experience has taught them about mental health intervention or what they know already about older adults. It is suggested that a life-span developmental view complements a community and preventive approach to the mental health needs of the elderly. Creation of a separate subspecialty of clinical geropsychology will not effectively serve older adults. What is needed is a synthesis ofalready existing expertise in areas such as life-span development, clinical psychology, and community psychology. This synthesis provides a conceptual foundation and set of intervention approaches on which to base training programs in mental health and aging.

Information integration and management through the design and construction phases of a project life cycle

Information management is a key aspect of successful construction projects. Having inaccurate measurements and conflicting data can lead to costly mistakes, and vague quantities can ruin estimates and schedules. Building information modeling (BIM) augments a 3D model with a wide variety of information, which reduces many sources of error and can detect conflicts before they occur. Because new technology is often more complex, it can be difficult to effectively integrate it with existing business practices. In this paper, we will answer two questions: How can BIM add value to construction projects? and What lessons can be learned from other companies that use BIM or other similar technology? Previous research focused on the technology as if it were simply a tool, observing problems that occurred while integrating new technology into existing practices. Our research instead looks at the flow of information through a company and its network, seeing all the actors as part of an ecosystem. Building upon this idea, we proposed the metaphor of an information supply chain to illustrate how BIM can add value to a construction project. This paper then concludes with two case studies. The first case study illustrates a failure in the flow of information that could have prevented by using BIM. The second case study profiles a leading design firm that has used BIM products for many years and shows the real benefits of using this program.

A 13-Year Summary of the ISU Beef Cow Business Record

A 13-year summary of the Iowa State University Extension Service’s Beef Cow Business Record (BCBR) was compiled to show the trends in cost, profit, and production for beef-cow enterprises in Iowa. During these 13 years, 966 yearly records were summarized on herds with an average size of 74.6 cows. Each year-end summary sorts the producers with profits in the top and the bottom thirds of the group so that differences can be analyzed. The average cost to maintain a beef cow from 1982 to 1994 was $370.80. Cost components included in this average total were: feed and pasture, $177.10; operating, $45.40; depreciation, taxes, and insurance, $19.70; labor, $44.90; and capital, $83.70. Producers sorted into the top one-third profit group had 13-year average total cow costs of $309.80, but the bottom onethird profit group averaged $437.10. Economic returns per cow for these same 13 years were: return to capital, labor, and management, $139.50; return to labor and management, $56.20; and net profit, $20.20. Top-profit producers had an average net profit of $126.20 per cow, whereas the least profitable group had an average loss of $107.40. Of this $233.60 difference, $127.30 was due to production cost, and the remaining $106.30 was caused by gross return differences. The average number of pounds of beef produced per cow from 1984 through 1994 was 567. This production was achieved with 2.5 acres of pasture, 3.9 acres of cornstalk grazing, and 4,675 pounds of stored feed per cow unit. Top-profit producers used 673 pounds of stored feed per hundredweight of production, but the least profitable producers used 1,015 pounds. Top-profit producers produced 74 pounds more per cow while using 1,313 pounds less stored feed.

Real-life results of balloon kyphoplasty for vertebral compression fractures from the SWISSspine registry

BACKGROUND CONTEXT The Swiss Federal Office of Public Health mandated a nationwide health technology assessment-registry for balloon kyphoplasty (BKP) for decision making on reimbursement of these interventions. The early results of the registry led to a permanent coverage of BKP by basic health insurance. The documentation was continued for further evidence generation. PURPOSE This analysis reports on the 1 year results of patients after BKP treatment. STUDY DESIGN Prospective multicenter observational case series. PATIENT SAMPLE The data on 625 cases with 819 treated vertebrae were documented from March 2005 to May 2012. OUTCOME MEASURES Surgeon-administered outcome instruments were primary intervention form for BKP and the follow-up form; patient self-reported measures were EuroQol-5D questionnaire, North American Spine Society outcome instrument /Core Outcome Measures Index (including visual analog scale), and a comorbidity questionnaire. Outcome measures were back pain, medication, quality of life (QoL), cement extrusions, and new fractures within the first postoperative year. METHODS Data were recorded preoperatively and at 3 to 6-month and 1-year follow-ups. Wilcoxon signed-rank test was used for comparison of pre- with postoperative measurements. Multivariate logistic regression was used to identify factors with a significant influence on the outcome. RESULTS Seventy percent of patients were women with mean age of 71 years (range, 18-91 years); mean age of men was 65 years (range, 15-93 years). Significant and clinically relevant reduction of back pain, improvement of QoL, and reduction of pain killer consumption was seen within the first postoperative year. Preoperative back pain decreased from 69.3 to 29.0 at 3 to 6-month and remained unchanged at 1-year follow-ups. Consequently, QoL improved from 0.23 to 0.71 and 0.75 at the same follow-up intervals. The overall vertebra-based cement extrusion rates with and without extrusions into intervertebral discs were 22.1% and 15.3%, respectively. Symptomatic cement extrusions with radiculopathy were five (0.8%). A new vertebral fracture within a year from the BKP surgery was observed in 18.4% of the patients. CONCLUSIONS The results of the largest observational study for BKP so far are consistent with published randomized trials and systematic reviews. In this routine health care setting, BKP is safe and effective in reducing pain, improving QoL, and lowering pain_killer consumption and has an acceptable rate of cement extrusions. Postoperative outcome results show clear and significant clinical improvement at early follow-up that remain stable during the first postoperative year.

Source of health insurance and immunization rates: Findings from the 1996 Texas immunization survey

This study was a further investigation of the 1996 Texas Immunization Survey conducted by the Associateship for Disease Control and Prevention of the Texas Department of Health. The 1996 survey was conducted through 4,599 completed telephone interviews of families with a child between the ages of 3–35 months concerning the immunization status of Texas children. The present study determined differences in immunization rates for children aged 3–35 months for the last shot in the immunization series that should be completed before 2 years of age, a total of four shots, both overall and for different health insurance groups. Life tables were used to determine the percentage and distribution over time of completed vaccination rates for each shot. Emphasis was placed on the proportion of children that were immunized at the end of the recommended range of the immunization schedule, and at 2 years of age. Univariate and multivariate analysis was also performed in order to ascertain which risk factors predict whether or not a child will be immunized. RESULTS: Between 80–90% were immunized for the last shot of Hepatitis B; Measles, Mumps, and Rubella; and Polio at 2 years of age. Approximately 2/3 of the sample was immunized for Diphtheria, Pertussis, and Tetanus. Most of the children were immunized by the end of the recommended range of the immunization schedule except for Measles, Mumps, and Rubella. Children of parents with private indemnity insurance were significantly more likely to have received two of the four shots; children of uninsured parents were significantly less likely to have received three of the four shots. In multivariate analysis, maternal education was the only variable that consistently predicted immunization status for the different shots. Results indicate that a substantial gap exists for immunization rates between children with private insurance and uninsured children, despite recent policy changes to provide immunizations free of charge. Health care providers should pay extra attention to the poor and uninsured to make sure that all children receive timely immunizations. ^

Delivery of health care at the end of life in cancer patients of four swiss cantons a retrospective database study (SAKK 89/09)

Background The use of cancer related therapy in cancer patients at the end-of-life has increased over time in many countries. Given a lack of published Swiss data, the objective of this study was to describe delivery of health care during the last month before death of cancer patients. Methods Claims data were used to assess health care utilization of cancer patients (identified by cancer registry data of four participating cantons), deceased between 2006-2008. Primary endpoints were hospitalization rate and delivery of cancer related therapies during the last 30 days before death. Multivariate logistic regression assessed the explanatory value of patient and geographic characteristics. Results 3809 identified cancer patients were included. Hospitalization rate (mean 68.5%, 95%CI 67.0-69.9) and percentage of patients receiving anti-cancer drug therapies (ACDT, mean 14.5%, 95%CI 13.4-15.6) and radiotherapy (mean 7.7%, 95%CI 6.7-8.4) decreased with age. Canton of residence and insurance type status most significantly influenced the odds for hospitalization or receiving ACDT. Conclusions The intensity of cancer specific care showed substantial variation by age, cancer type, place of residence and insurance type status. This may be partially driven by cultural differences within Switzerland and the cantonal organization of the Swiss health care system.

Days spent in acute care hospitals at the end of life of cancer patients in four Swiss cantons: a retrospective database study (SAKK 89/09).

Number of days spent in acute hospitals (DAH) at the end of life is regarded as an important care quality indicator for cancer patients. We analysed DAH during 90 days prior to death in patients from four Swiss cantons. Claims data from an insurance provider with about 20% market share and patient record review identified 2086 patients as dying of cancer. We calculated total DAH per patient. Multivariable generalised linear modelling served to evaluate potential explanatory variables. Mean DAH was 26 days. In the multivariable model, using complementary and alternative medicine (DAH = 33.9; +8.8 days compared to non-users) and canton of residence (for patient receiving anti-cancer therapy, Zürich DAH = 22.8 versus Basel DAH = 31.4; for other patients, Valais DAH = 22.7 versus Ticino DAH = 33.7) had the strongest influence. Age at death and days spent in other institutions were additional significant predictors. DAH during the last 90 days of life of cancer patients from four Swiss cantons is high compared to most other countries. Several factors influence DAH. Resulting differences are likely to have financial impact, as DAH is a major cost driver for end-of-life care. Whether they are supply- or demand-driven and whether patients would prefer fewer days in hospital remains to be established.

Quality of life, symptom experience, and use of complementary and alternative medicine among women with ovarian cancer

The objectives of this dissertation were to determine the quality of life in women with ovarian cancer and the association of their physical and emotional well-being with the number of symptoms, duration of symptoms, and the scores of common symptoms of ovarian cancer; to study the prevalence of complementary and alternative medicine techniques for symptom relief and its association with the number of symptoms, age, education, insurance, comorbidity, and satisfaction with medical care they received, and their pre-diagnostic experience of symptoms.^ This study was based on a secondary data analysis of a study of early detection of ovarian cancer. A sample of 139 women with ovarian cancer was recruited and was administered a questionnaire comprised of questions on their quality of life, their symptoms and what they did about the symptoms, whether they used any complementary and alternative medicine techniques, and other medical conditions they had. Out of this sample, 53 patients underwent in-depth interviews relating to their symptoms before the diagnosis and their experiences with the health care system leading to the ovarian cancer diagnosis. ^ In article #1, ovarian cancer patients were observed to have significantly poorer quality of life on all subscales and summary scores except pain, compared to that of the general population of US women. Physical well-being scores were negatively associated with the number of symptoms before diagnosis and a significant negative association of comorbidity index was observed with physical well-being. Higher education and increase in time since diagnosis was found to have better physical scores. Emotional well-being scores showed marginally significant associations with number of symptoms and bloating. ^ In article #2, a thematic content analysis of the ovarian cancer patients’ interviews revealed that on recognition of their symptoms women first assumed their symptoms to be a normal transient occurrence due to a pre-existing disease condition, or due to some other disease. A series of misattributions of their symptoms on their and their doctors’ part impacted their health care seeking.In article #3, a significantly greater likelihood of CAM use with an increase in the number of symptoms was observed.^ Based on the foregoing results, it is important to educate women on possible signs of ovarian cancer and also to educate doctors about the results of current research regarding ovarian cancer diagnosis. This will help to avoid a delay in getting a diagnosis and improve women’s quality of life. It emphasizes the diagnosis of ovarian cancer in earlier stages by more sensitive screening techniques. This study emphasizes the importance of consideration of comorbidity in any quality of life research. Additionally, educating women in the safe use of CAM techniques carries immense significance because the efficacy and safety of many of the currently advertized CAM products has not been scientifically validated. Further research is needed to confirm the findings of this study. ^

Intensive care unit utilization among patients with cancer at the end of life

Over the last 2 decades, survival rates in critically ill cancer patients have improved. Despite the increase in survival, the intensive care unit (ICU) continues to be a location where end-of-life care takes place. More than 20% of deaths in the United States occur after admission to an ICU, and as baby boomers reach the seventh and eighth decades of their lives, the volume of patients in the ICU is predicted to rise. The aim of this study was to evaluate intensive care unit utilization among patients with cancer who were at the end of life. End of life was defined using decedent and high-risk cohort study designs. The decedent study evaluated characteristics and ICU utilization during the terminal hospital stay among patients who died at The University of Texas MD Anderson Cancer Center during 2003-2007. The high-risk cohort study evaluated characteristics and ICU utilization during the index hospital stay among patients admitted to MD Anderson during 2003-2007 with a high risk of in-hospital mortality. Factors associated with higher ICU utilization in the decedent study included non-local residence, hematologic and non-metastatic solid tumor malignancies, malignancy diagnosed within 2 months, and elective admission to surgical or pediatric services. Having a palliative care consultation on admission was associated with dying in the hospital without ICU services. In the cohort of patients with high risk of in-hospital mortality, patients who went to the ICU were more likely to be younger, male, with newly diagnosed non-metastatic solid tumor or hematologic malignancy, and admitted from the emergency center to one of the surgical services. A palliative care consultation on admission was associated with a decreased likelihood of having an ICU stay. There were no differences in ethnicity, marital status, comorbidities, or insurance status between patients who did and did not utilize ICU services. Inpatient mortality probability models developed for the general population are inadequate in predicting in-hospital mortality for patients with cancer. The following characteristics that differed between the decedent study and high-risk cohort study can be considered in future research to predict risk of in-hospital mortality for patients with cancer: ethnicity, type and stage of malignancy, time since diagnosis, and having advance directives. Identifying those at risk can precipitate discussions in advance to ensure care remains appropriate and in accordance with the wishes of the patient and family.^