Financial Services Segregation: Improving Access to Financial Services for Recent Latino Immigrants

This paper outlines elements of demand for financial services among recent Latino immigrants, summarizes key factors contributing to their financial segregation, and describes products, services and administrative practices that have been used successfully by depository institutions. Throughout the research and paper particular attention has been paid to the New England region.Remittances, Latin American immigrants, Banking, Best Practices, Anti-Money Laundering, Terrorist Financing, USA Inmigrantes Latinoamericanos, banca, Mejores Practicas, anti lavado de dinero, financiamiento de terroristas, USA

Diagnostic accuracy of calculated serum osmolarity to predict dehydration in older people: adding value to pathology lab reports

Objectives: To assess which osmolarity equation best predicts directly measured serum/plasma osmolality and whether its use could add value to routine blood test results through screening for dehydration in older people. Design: Diagnostic accuracy study Participants: Older people (≥65 years) in 5 cohorts: Dietary Strategies for Healthy Ageing in Europe (NU-AGE, living in the community), Dehydration Recognition In our Elders (DRIE, living in residential care), Fortes (admitted to acute medical care), Sjöstrand (emergency room) or Pfortmueller cohorts (hospitalised with liver cirrhosis). Reference standard for hydration status: Directly measured serum/plasma osmolality: current dehydration (serum osmolality >300mOsm/kg), impending/current dehydration (≥295mOsm/kg). Index tests: 39 osmolarity equations calculated using serum indices from the same blood draw as directly measured osmolality. Results: Across five cohorts 595 older people were included, of whom 19% were dehydrated (directly measured osmolality >300mOsm/kg). Of 39 osmolarity equations, five showed reasonable agreement with directly measured osmolality and three had good predictive accuracy in subgroups with diabetes and poor renal function. Two equations were characterized by narrower limits of agreement, low levels of differential bias and good diagnostic accuracy in ROC plots (areas under the curve >0.8). The best equation was osmolarity =1.86 × (Na+ + K+) + 1.15 × glucose + urea + 14 (all measured in mmol/L). It appeared useful in people aged ≥65 years with and without diabetes, poor renal function, dehydration, in men and women, with a range of ages, health, cognitive and functional status. Conclusions: Some commonly used osmolarity equations work poorly, and should not be used. Given costs and prevalence of dehydration in older people we suggest use of the best formula by pathology laboratories using a cutpoint of 295mOsm/L (sensitivity 85%, specificity 59%), to report dehydration risk opportunistically when serum glucose, urea and electrolytes are measured for other reasons in older adults

Particle motion and stain removal during simulated abrasive tooth cleaning

Stain removal from teeth is important both to prevent decay and for appearance. This is usually achieved using a filament-based toothbrush with a toothpaste consisting of abrasive particles in a carrier fluid. This work has been carried out to examine how these abrasive particles interact with the filaments and cause material removal from a stain layer on the surface of a tooth. It is important to understand this mechanism as while maximum cleaning efficiency is required, this must not be accompanied by damage to the enamel or dentine substrate. In this work simple abrasive scratch tests were used to investigate stain removal mechanism of two abrasive particles commonly used in tooth cleaning, silica and perlite. Silica particles are granular in shape and very different to perlite particles, which are flat and have thicknesses many times smaller than their width. Initially visualisation studies were carried out with perlite particles to study how they are entrained into a filament/counterface contact. Results were compared with previous studies using silica. Reciprocating scratch tests were then run to study how many filaments have a particle trapped at one moment and are involved in the cleaning process. Stain removal tests were then carried out in a similar manner to establish cleaning rates with the two particle types. Perlite particles were found to be less abrasive than silica. This was because of their shape and how they were entrained into the filament contacts and loaded against a counterface. With both particles subsurface damage during stain removal was found to be minimal. A simple model was built to predict stain removal rates with silica particles, which gave results that correlated well with the experimental data

Assessment of a self-reported Drinks Diary for the estimation of drinks intake by care home residents: Fluid Intake Study in the Elderly (FISE)

Objectives: We evaluated the accuracy of a newly developed self-completed Drinks Diary in care home residents and compared it with direct observation and fluid intake charts. Design: Observational study. Setting: Residential care homes in Norfolk, UK. Participants: 22 elderly people (18 women, mean age 86.6 years SD 8.6, 12 with MMSE scores <27). Measurements: Participants recorded their own drinks intake over 24 hours using the Drinks Diary while care staff used the homes’ usual fluid intake chart to record drinks intake. These records were compared with drinks intake assessed by researcher direct observation (reference method), during waking hours (6am to 10pm), while drinks taken from 10pm to 6am were self-reported and checked with staff. Results: Drinks intake assessed by the Drinks Diary was highly correlated with researcher direct observation (Pearson correlation coefficient r=0.93, p<0.001, mean difference -163ml/day) while few staff-completed fluid charts were returned and correlation was low (r=0.122, p=0.818, mean difference 702ml/day). The Drinks Diary classified 19 of 22 participants correctly as drinking enough or not using both the European Food Safety Authority and US recommendations. Conclusion: The Drinks Diary estimate of drinks intake was comparable with direct observation and more accurate (and reliably completed) than staff records. The Drinks Diary can provide a reliable estimate of drinks intake in elderly care home residents physically and cognitively able to complete it. It may be useful for researchers, care staff and practitioners needing to monitor drinks intake of elderly people, to help them avoid dehydration

Etiology of nocturia response in men with diminished bladder capacity

Aims: To test the hypothesis that patients with nocturia owing to diminished global or nocturnal bladder capacity improve via increased bladder capacity. Methods: This is a retrospective analysis of voiding diaries completed at a VA urology clinic between 2008-2017. Inclusion required patients aged at least 18 years, male, undergoing treatment for nocturia, and having completed at least two 24-hour voiding diaries >= 1 month apart. Patients were divided into two cohorts: responders (any decline in nocturia) and non-responders (no change or any increase in nocturia). Patients were further sub-stratified as having low global bladder capacity (maximum voided volume [MVV] = 200 mL). Wilcoxon rank-sum was applied with a Bonferroni correction to test significance. Results: Forty pre- and post-treatment diaries from 27 patients, and 19 pre- and post-treatment diaries from 17 patients were identified as having low global and low nocturnal bladder capacity, respectively. Nocturia responders with low global bladder capacity demonstrated significant decline compared to non-responders in nocturnal urine volume (NUV) (-140 vs +75, P < 0.01) and nocturnal bladder capacity index (NBCi) (-0.59 vs +0.23, P < 0.01). Patients with low nocturnal bladder capacity similarly demonstrated decreased NUV (-30 vs +160, P = 0.04) and NBCi (-1.4 vs +0.33, P < 0.01). There was no significant change in MVV or NMVV for either group. Conclusions: Treatment directed at lowering nocturnal urine production and enabling patients to consistently void at capacity is a rational strategy to treat nocturia in patients with low bladder capacity