Cities

Next of Kin Perceptions of Physician Responsiveness to Symptoms of Hospitalized Patients Near Death

Next of Kin Perceptions of Physician Responsiveness to Symptoms of Hospitalized Patients Near Death
Journal of Palliative Medicine, Volume 6, pages 531-541.

Cantor, J., Blustein, J., Carlson, M. & Gould, D.
01/01/2003

Many different medical providers visit critically ill patients during a hospitalization, and patients and family members may not feel any physician is truly in charge of care. This study explores whether perceiving that a physician was clearly in charge is associated with reports by surviving next of kin about the responsiveness of physicians to symptoms in hospitalized patients near the end of life. We conducted telephone interviews with surviving next of kin of adult patients (n = 1107) who died in one of five New York City teaching hospitals between April 1998 and June 1999 after a minimum 3-day inpatient stay. Next-of-kin ratings of whether physicians did "all they could" all or most of the time in response to patient pain, dyspnea, and affective distress (confusion, depression or emotional distress) were compared by whether the next of kin reported one or more physicians "clearly in charge" of care, adjusting for patient and next-of-kin characteristics. More than 80% of patients were reported to have experienced often serious pain, dyspnea, or affective distress. Physicians were rated as responsive to pain by 79.1% of respondents, to dyspnea by 84.9%, and to affective distress by 66.6%. Ratings of physician responsiveness to pain (p = 0.001) and affective distress (p = 0.001) were significantly lower among patients for whom no physician was seen as clearly in charge of care. This finding is consistent with the view that ensuring that a physician coordinates the care of seriously ill, hospitalized patients may improve symptom management. Further research is warranted to establish causality and identify optimal models of care.

Primary Care, Social Inequality, and Stroke Mortality in U.S. States--a Longitudinal Analysis, 1985-1995

Primary Care, Social Inequality, and Stroke Mortality in U.S. States--a Longitudinal Analysis, 1985-1995
Stroke Volume 34 Number 8, pages 1958-64.

Shi, L., Macinko, J., Starfield, B. & Politzer, R.
01/01/2003

BACKGROUND AND PURPOSE: The goal of this study was to test whether primary care reduces the impact of income inequality on stroke mortality. METHODS: This study used pooled time-series cross-sectional analysis of 11 years of state-level data (n=549). Analyses controlled for education levels, unemployment, racial/ethnic composition, and percent urban. Contemporaneous and time-lagged covariates were modeled. RESULTS: Primary care was negatively associated with stroke mortality in models including all covariates (P<0.0001). The impact of income inequality on stroke mortality was reduced in the presence of primary care (P<0.0001) but disappeared with the addition of covariates (P>0.05). CONCLUSIONS: In the absence of social policy that addresses sociodemographic determinants of health, primary care promotion may serve as a palliative strategy for combating stroke mortality and reducing the adverse impact of income inequality on health.

Public Infrastructure Service Flexibility for Response and Recovery in the September 11th, 2001 Attacks at the World Trade Center

Public Infrastructure Service Flexibility for Response and Recovery in the September 11th, 2001 Attacks at the World Trade Center
in Natural Hazards Research & Applications Information Center, Public Entity Risk Institute, and Institute for Civil Infrastructure Systems, Beyond September 11th: An Account of Post-Disaster Research. Special Publication #39. Boulder, CO: University of Colorado, Pp. 241-268.

Zimmerman, R.
01/01/2003

After the terrorist attacks on the World Trade Center in New York City on September 11, 2001, the ability to rapidly restore transportation, power, water, and environmental services to users was absolutely critical, especially to those involved in the immediate search, rescue, and recovery operations. What better way could infrastructure serve its users-both emergency workers and the general public-than to be able to respond quickly in a crisis? The ability to provide these services required a degree of flexibility, often unanticipated and unplanned, that only became apparent as the response efforts unfolded. The capability of basic infrastructure service providers to respond to public needs for transportation, energy, communication, water, sanitation, and solid waste removal after the September 11th attacks was to a great extent influenced by the flexibility of the initial infrastructure design and management functions to respond to normal system disruptions and to extreme, but not necessarily terrorist-related, events.

Response, Restoration and Recovery: September 11 and New York City's Digital Networks

Response, Restoration and Recovery: September 11 and New York City's Digital Networks
in A. Micahel Noll ed., Crisis Communications, Allen and Littlefield,

Moss, M.
01/01/2003

This chapter examines the role of digital communications networks during and after the September 11, 2001, attack on the World Trade Center. Digital networks in New York City played a vital role in all three phases of this catastrophe: initial response, interim restoration, and long-term recovery. Mitchell L Moss and Anthony Townsend conclude that during each of these phases, the digital network infrastructure, while the most fragile of all urban networks, demonstrated remarkable resiliency in serving the citizens of the city and the nation.

School Budgeting and School Performance: The Impact of New York City’s Performance Driven Budgeting Initiative

School Budgeting and School Performance: The Impact of New York City’s Performance Driven Budgeting Initiative
Journal of Education Finance, Volume 28, Number 3, pages 403-424.

Stiefel, L., Schwartz, A.E., Kim, D.Y. & Portas, C.
01/01/2003

Performance Driven Budgeting (PDB) is a school-based budgeting initiative that was instituted in a select group of New York City schools beginning in the 1997-1998 school year. This paper analyzes the impact of the initiative on student test scores in the fourth and fifth grades and on spending patterns. Using school-level data provided by the New York City Board of Education, we construct a panel dataset of 609 elementary and middle schools over a span of four years, 1995-96 through 1998-99. To analyze the impact of the initiative we estimate school production function models that incorporate school fixed effects and an indicator for participation in PDB. After controlling for these and other student-body characteristics, we find that PDB had a positive effect on some student test scores and led to a change in the mix of spending, but not its level.

Test Score Gaps in New York State Schools: What do Fourth and Eighth Grade Results Show?

Test Score Gaps in New York State Schools: What do Fourth and Eighth Grade Results Show?
Condition Report, Education Finance Research Consortium, New York State Education Department, Fall

Chellman, C., Schwartz, A.E. & Stiefel, L.
01/01/2003

This report analyzes performance gaps by race/ethnicity, income and gender in New York State schools using fourth and eighth grade math and English language test results. Their results highlight the legacy of racial segregation where many schools have too few whites or non-whites to allow a meaningful calculation of the subgroup test performance or test score ‘gap’ between schools. Even with a minimum sub-group size of six, only 45.7% of elementary schools had enough whites or non-whites to calculate gaps. Findings indicate that the gaps do differ substantially; gaps between racially segregated schools are over 2.5 times greater than gaps in mixed schools.

The Collapse of the World Trade Center: Learning from Urban Disasters

The Collapse of the World Trade Center: Learning from Urban Disasters
(with C. Restrepo, doctoral candidate at NYU Wagner), in Natural Hazards Research & Applications Information Center, Public Entity Risk Institute, and Institute for Civil Infrastructure Systems, Beyond September 11th: An Account of Post-Disaster Research. Special Publication #39. Boulder, CO: University of Colorado, pp. 49-80.

Zimmerman, R.
01/01/2003

The collapse of the World Trade Center in New York City on September 11, 2001, was one of the worst urban disasters in the history of the United States. Almost 3,000 people perished as a result of the disaster. The economy was dealt a severe blow, the consequences of which are still felt today. When the World Trade Center was first built, its approximately 1.25 million square meters of office space accommodated about 40-50,000 people (Extreme Events Mitigation Task Force, 2002, p. 52). The number of telephone lines installed in the towers was similar to that found in cities such as Cincinnati or Copenhagen1. The collapse of the World Trade Center raised a large number of research questions related to understanding what happened on that day,
why the buildings collapsed, how agencies and individuals responded to the event, how civil infrastructure systems were affected, and how the lessons learned can be used to prevent similar disasters from happening.

The Property Tax, Land Use and Land Use Regulation

The Property Tax, Land Use and Land Use Regulation
Edward Elgar Publishing,

Netzer, D., ed.
01/01/2003

This comprehensive volume of essays by respected scholars in economics and public finance explores the connections among the property tax, land use and regulation. The authors examine the idea that the property tax is used as a partial substitute for land use regulation and other policies designed to affect how land is utilized. Like many economists, the contributors see some type of property taxation as a more efficient means of helping to shape land use. Some of the essays analyze a conventional property tax, while others consider radically different systems of property taxation.

Following an introduction by the book's editor Dick Netzer, the first paper sets the stage by modeling taxes on land and buildings in the context of a dynamic model of real estate markets. The remaining papers examine how various tax mechanisms and non-tax alternatives to regulating and determining land use, such as zoning and private neighborhood associations, complement or substitute for one another. Urban planners and economists interested in local public finance will welcome this wide-ranging review and analysis.

Dick Netzer, a leading public finance economist specializing in state and local issues and urban government, is professor emeritus of economics and public administration at the Wagner Graduate School of Public Service, New York University. He organized a conference sponsored by the Lincoln Institute in Scottsdale, Arizona, in January 2002 and edited the papers presented at that conference for this volume.

 

Welfare Reform in Philadelphia: Implementation, Effects, and Experiences of Poor Families and Neighborhoods

Welfare Reform in Philadelphia: Implementation, Effects, and Experiences of Poor Families and Neighborhoods
MDRC,

Michalopoulos, C., Edin, K., Fink, B., Iandriscina, M., Polit, D., Polyne, J..& Verma, N.
01/01/2003

The 1996 welfare reform law called for profound changes in welfare policy, including a five-year time limit on federally funded cash assistance (known as Temporary Assistance for Needy Families, or TANF), stricter work requirements, and greater flexibility for states in designing and managing programs. The law's supporters hoped that it would spark innovation and reduce welfare use; critics feared that it would lead to cuts in benefits and to widespread suffering. Whether the reform succeeds or fails depends largely on what happens in big cities, where poverty and welfare receipt are most concentrated. This report - one of a series from MDRC's Project on Devolution and Urban Change - examines the specific ways in which reform unfolded in Philadelphia. The study uses field research, state records, surveys and ethnographic interviews of welfare recipients, and indicators of social and economic trends to assess TANF's implementation and effects. Because of the strong economy and ample funding for services in the late 1990s, the study captures welfare reform in the best of times but focuses on the poorest families and neighborhoods.

What Have We Learned from HUDs Moving to Opportunity Program?

What Have We Learned from HUDs Moving to Opportunity Program?
In John M. Goering and Judith D. Feins, eds., Choosing a Better Life? A Social Experiment in Leaving Poverty Behind: Evaluation of the Moving to Opportunity Program. Washington, DC: Urban Institute Press,

Ellen, I.G. & Turner, M.
01/01/2003

As the centerpiece of policymakers' efforts to "deconcentrate" poverty in urban America, the Moving to Opportunity (MTO) project gave roughly 4,600 volunteer families the chance to move out of public housing projects in deeply impoverished neighborhoods in five cities-Baltimore, Boston, Chicago, Los Angeles, and New York. Researchers wanted to find out to what extent moving out of a poor neighborhood into a better-off area would improve the lives of public housing families. Choosing a Better Life? is the first distillation of years of research on the MTO project, the largest rigorously designed social experiment to investigate the consequences of moving low-income public housing residents to low-poverty neighborhoods. In this book, leading social scientists and policy experts examine the legislative and political foundations of the project, analyze the effects of MTO on lives of the families involved, and explore lessons learned from this important piece of U.S. social policy.

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