No description available.

Devalued homes and weakened economic conditions of 2008 led to lost property tax revenues, more vacant and abandoned properties, and destabilized neighborhoods. The first Neighborhood Stabilization Program (NSP1) was a federal intervention designed to mitigate the damage of the recession, but there is scant evidence of program effectiveness. A phenomenological study, using a method outlined by Moustakas, answered questions on the benefits and barriers of NSP1 as perceived by stakeholders in a Mid-Atlantic city. Stakeholders included nonprofit housing advocates, residents, business partners, and government officials. Theories of collaborative governance and community stakeholders were used to guide the investigation of NSP1 processes and stakeholders' perceptions. Ten stakeholders responded to 9 compound interview questions derived from the research question and 4 subquestions in semi-structured interviews. Responses were transcribed, verified for accuracy, and then coded and analyzed for recurring themes. Five prominent themes emerged: (1) challenges with NSP1 guidelines, (2) importance of partner capacity, (3) positive results in targeted neighborhoods, (4) city's approach to community development, and (5) sustaining positive results. Findings were that NSP1's benefits for residents outweighed procedural barriers and NSP1's short duration still yielded positive results in neighborhoods. This study has policy and social change implications for all stakeholders involved. Recommendations include continuous city involvement to stabilize neighborhoods during future recessions and better entrepreneurial strategies to integrate private and non-profit stakeholders in all phases of collaborative governance.

Although women offenders face barriers to successful reentry into their communities, as yet, no research has explored their experiences in accessing health care reentry services. Medicaid enrollment, the process of applying for Medicaid coverage, can be offered as a health care reentry service. Women offenders in jails have shorter sentencing times compared to those in prison, which presents Medicaid enrollment opportunities before release. The Second Chance Act provides the opportunity for reentry services, and the Affordable Care Act provides the opportunity for Medicaid coverage for women offenders. This phenomenological study explored the attitudes of women offenders about Medicaid enrollment and coverage. The conceptual framework for this study was the Andersen's behavioral model. Interviews were conducted with 11 women offenders who were randomly recruited, spoke English, had a minimum of a 6th grade education, and were not on restriction based on jail policy. Data were collected and coded to develop themes for analysis and interpretation. Most participants had an adequate understanding of the purpose of Medicaid coverage and had favorable perceptions of Medicaid enrollment. Barriers to Medicaid enrollment were identified: a lack of language proficiency, denial of coverage, poor health literacy, and a lack of understanding of health information. Facilitators to Medicaid enrollment were identified: providing a translator, being treated with respect as a person to reduce stigma, and assistance with enrollment forms. These findings can contribute to positive social change. Jails have the chance to address these barriers and incorporate the facilitators to make it simpler for women offenders to enroll in Medicaid before released from jail.

No description available.

No description available.

Cape Town is a city with a complex housing problem due to the apartheid planning and the design of the current housing programs. Apartheid planning has segregated the city, leading to a more divided and spread out city. With the current affordable housing programs, most houses are being built in poorly located areas, resulting in inhabitants feeling more separated and isolated from the city center. To develop a more integrated society, the concept of Inclusionary housing has had a growing appeal in South Africa. The purpose of the study was to examine the concept of inclusionary housing and how it can be implemented in Cape Town to fight segregation and housing inequalities. Interviews were conducted with various stakeholders from the private sector, public sector, NGO’s and academics with the aim to provide their perspectives on inclusionary housing and to answer the question if inclusionary housing is the right tool to help Cape Town become a more integrated city. A closer investigation was made on a specific development project in Sea Point where an inclusionary housing pilot project was going to be implemented. The majority of stakeholders agree that getting an inclusionary housing policy in place in Cape Town is a step in the right direction towards a more integrated and affordable city. / Kapstaden har ett mycket komplicerat bostadsproblem på grund av det tidigare apartheidsystemet samt utformningen av de nuvarande bostadsprogrammen för låginkomsttagare. Apartheidsystemet har lett till en uppdelad och segregerad stad. Med de nuvarande bostadsprogrammen byggs de flesta bostäder i sämre belägna områden, vilket leder till att invånarna känner sig mer separerade och isolerade från stadens centrum. För att utveckla ett mer integrerat samhälle har konceptet Inclusionary housing fått en växande uppmärksamhet i Sydafrika. Syftet med denna studie var att undersöka konceptet inclusionary housing och besvara frågan hur det kan implementeras i Kapstaden för att bekämpa segregering och den rådande bostadsbristen. Intervjuer genomfördes med olika intressenter från den privata sektorn, den offentliga sektorn, icke-statliga organisationer och akademiker med syftet att ge sina perspektiv på inclusionary housing samt besvara frågan om inclusionary housing är det rätta verktyget för att hjälpa Kapstaden att bli en mer integrerad stad. En närmare undersökning gjordes av ett specifikt bostadsprojekt i Sea Point där inclusionary housing skulle implementeras.  Majoriteten av intressenterna är överens om att ett implementerade av en inclusionary housing policy i Kapstaden är ett steg i rätt riktning mot en mer integrerad och prisvärd stad med avseende på boende.

The purpose of this case study is to describe and analyze the City Mission's project to construct and manage socially sustainable housing in Farsta Strand. This is done by analyzing the project and its intended model from a social and economic sustainability perspective. The methods used to collect data in this qualitative study include a compilation of literature review, document analysis, and interview study. The study subject in Farsta Strand was investigated in a case study where project developers from the Stockholm City Mission and two researchers were interviewed to gain an understanding of the project's purpose, design, context, and background. In addition to the two selected sustainability dimensions, social and economic sustainability, the theoretical background of the study is based on a developed theoretical framework. This framework consists of analysis questions partly based on previous research reports related to the project's previous design. The formulated analysis questions were based on the revised project model and were then included in the interview guide for the interview with representatives from the Stockholm City Mission. The obtained answers served as the starting point for the analysis and discussion from a social and economic perspective. Even though the study subject has not been constructed and the model has not been previously tested, the study addresses its purpose of creating long-term housing solutions of good quality for households that face challenges in accessing the regular housing market. Furthermore, the study results suggest that the project can potentially achieve its purpose based on the two sustainability dimensions. From a social sustainability perspective, the project can create conditions for households to improve their living situation over time by offering a collective housing solution that includes, among other things, first-hand contracts with adjusted rents. Simultaneously, the study demonstrates from an economic sustainability perspective that the project can offer long-term conditions for property owners to adopt the model, which is a prerequisite for the purpose of the model to be achieved. / Syftet med denna fallstudie är att beskriva och analysera Stadsmissionens projekt att bygga och förvalta socialt hållbara bostäder i Farsta Strand. Detta görs genom att analysera projektet med dess tänkta modell utifrån ett socialt och ekonomiskt hållbarhetsperspektiv. Metoderna som använts för att samla in data i denna kvalitativa studie är en sammanställning av litteraturgenomgång, dokumentstudie och intervjustudie. Studieobjektet i Farsta Strand undersöktes i en fallstudie där projektutvecklare från Stockholms Stadsmission och två forskare intervjuades i syfte att skapa förståelse för projektets syfte, utformning, kontext och bakgrund. Utöver de två valda hållbarhetsdimensionerna, social och ekonomisk hållbarhet, utgörs studiens teoretiska bakgrund på ett framtaget teoretiskt ramverk. Detta ramverk utgörs av analysfrågor som delvis baseras på tidigare forskningsrapport kopplat till projektets tidigare utformning. De framtagna analysfrågorna baserades på den omarbetade projektmodellen och ingick sedan i den intervjuguide för intervjun med representanter från Stockholms Stadsmission. Svaren som erhölls utgjorde utgångspunkten för analysen och diskussionen utifrån ett socialt och ekonomiskt perspektiv. Trots att studieobjektet inte är uppfört och att modellen inte tidigare är beprövad svarar studien på sitt syfte med att skapa långsiktiga boendelösningar av god kvalitet för hushåll som har det svårt att komma in på den ordinarie bostadsmarknaden. Vidare resulterar studien att projektet kan tänkas uppnå sitt syfte utifrån de två hållbarhetsdimensionerna. Ur ett socialt hållbarhetsperspektiv kan projektet genom att erbjuda en kollektiv boendelösning som bland annat innefattar förstahandskontrakt med anpassade hyror skapa förutsättningar för hushållen att förbättra sin livssituation över tid. Samtidigt visar studien ur ett ekonomiskt hållbarhetsperspektiv att projektet kan erbjuda långsiktiga förutsättningar för fastighetsägare att ta efter modellen, vilket är en förutsättning för att syftet med modellen ska uppnås.

Chapter 1 presents the backgrounds and research questions of the dissertation project. Although everyone hopes to die with dignity, a “good death” is often privileged. Inequality in end-of-life care in the United States is striking; older minorities are 3 times more likely to receive intrusive care and experience hospital readmission and less likely to use hospice care and die at home. With the hope to address disparities in end-of-life outcomes, as part of the Affordable Care Act, Medicare expanded its benefit and started to reimburse end-of-life care planning services from 2016. This dissertation examines the roles of health insurance policy and its advocated intervention in ensuring person-centered dying experiences in the United States and the public readiness for establishing a similar end-of-life care policy in China. The second chapter examines whether physician–patient advance care planning (ACP) discussions, the “intervention” embedded in the policy, is effective at prompting end-of-life care planning behaviors and improving end-of-life experiences. I also studied the heterogenous effects by race and ethnicity. I used exit data about 7,282 deceased Medicare-eligible respondents from the Health and Retirement Study (HRS) from 2012 to 2020, a nationally representative biennial survey of U.S. older adults. I conducted latent class analysis to identify different end-of-life experiences and used multinomial logistic regression models to study the relationship between having ACP discussions with doctors and different end-of-life experiences in full and stratified samples by race and ethnicity. Then I used path analyses to test whether completing legal documentation initiated by ACP services explains the effectiveness of the intervention. The results show three types of end-of-life experiences among White, Black, and Hispanic older adults; significant effects of end-of-life care discussions with doctors on uncomfortable dying experiences and extensive use of invasive treatments in the older White population; and the partial mediating role of completion of legal health care documents on the relationship between ACP discussions and end-of-life outcomes. This study identified the limited effectiveness of physician–patient ACP discussions among minority older adults and emphasizes the importance of quality, content (e.g., to cover legal documentation during the conversation), and cultural appropriateness of ACP consultations led by doctors. The third chapter examines the heterogenous intent-to-treat effect of the Medicare policy on older adults’ motivation to plan for care by exploiting policy intervention as a natural experiment. Taking advantage of the longitudinal nature of the HRS, I used core data with 47,982 observations nested in 15,647 individuals across 9 years (2012–2020). I used two quasi-experimental models—interrupted time series analysis and difference-in-difference—to study the care-planning outcomes before and after the policy implementation between older adults eligible or not eligible for Medicare. I studied the heterogenous effects in stratified samples by race and ethnicity, immigration background, and socioeconomic status proxied by education and wealth. I used coarsened exact matching to address the potential bias of the comparison group not being the ideal counterfactual control unit. I found that in the total population, the Medicare policy was associated with a significant increase in the proportion of older adults who completed a living will and designated a durable power of attorney for health care, but not having an ACP conversation. Furthermore, although there were immediate positive policy effects, the increases in ACP outcomes driven by the ACA Medicare benefit expansion were not sustained. Finally, I found no evidence that the ACA Medicare benefit expansion was effective in improving the rates of ACP among Black, Hispanic, Asian, Native American, or non-U.S.-born older adults. I also identified heterogeneous policy effects by socioeconomic status. I discuss promising recommendations for health care policy and practice to improve the participation rate of end-of-life care planning. Chapter 4 explores the feasibility of encouraging physicians to discuss end-of-life care wishes with older patients in China. Knowledge of a medical diagnosis is critical for end-of-life decision making. However, a patient’s right to know their diagnosis is neither guaranteed nor protected by law in China. Doctors typically inform family members of the patient’s illness diagnosis and prognosis and let them decide whether to disclose this information to the patient. This study examined middle-aged and older Chinese adults’ preferences for disclosing their and significant others’ diagnoses and whether sociodemographic, economic, and cultural factors were associated with these preferences. The research team surveyed 571 adults aged 50 or older in Shanghai from 2021 to 2022. The outcome measures are preferences for diagnosis disclosures, including whether and to whom diagnoses should be disclosed. I characterized preference types using latent class analysis and estimated multinomial logistic regression to identify the covariates associated with each preference type. Three latent classes were identified. The transparent group (34%) believed patients, whether self or a significant other, should be informed of their diagnoses. The contradictory group (50%) held conflicting attitudes; they preferred to know their diagnosis but preferred that significant others not be informed of their diagnoses. The avoidant group (16%) preferred not to know their diagnosis or to disclose significant others’ diagnoses to them. Familism attitudes were positively associated with holding contradictory views. Experiences with hospitalization and medical decision-making for family members were associated with holding transparent views. I discuss the importance of illness disclosure for honoring patients’ autonomous decision-making.

Last years, lead time, flexibility, cost, and quality have become significant factors for the manufacturing industry. This also applies to gears, which could be manufactured using hobbing and grinding. Fixing systems are used to precisely center and fully fix gears to reach high quality. These are expensive and not flexible which requires a new one for each gear dimension. This limits the production of prototypes and so new product for the market. Developing a 3D concept for affordable and flexible fixing is the purpose. Through literature research, analyzing the current process, discussions with the company, desk research, and benchmarking, requirements are made for the new concept. Then brainstorming sessions are done to come up with new concepts. The concepts are analyzed, discussed with the company, and combined into two better concepts. Even though the higher flexibility of the other concept, the robustness of the winning concept “CoNut”. The principle is that only a few parts have to be changed instead of the whole system. The concept is further developed in 3D, where design for cost and manufacturing are applied. Finally, test procedures are drafted to validate the concept against therequirements. While some require a prototype, others are already validated by using the 3D model. Ultimately, an affordable and more flexible fixing system is developed as a 3D concept, by using a structural design process, which is likely to meet all the requirements. Since the model is cheaper and easier to change within meeting the other requirements, the purpose is reached.

No description available.