According to traditional conceptualizations of the relationship between fear of falling and falls in older adults, fear of falling is considered to be predictive of falls because it leads to activity avoidance which, in turn, leads to de-conditioning that increases fall risk. The recent literature has begun to challenge such conceptualizations. Specifically, it has been argued that fear of falling and anxiety, in and of themselves, have a direct negative effect on balance. In this study we manipulated anxiety level by asking older research participants to walk either on the floor (low anxiety condition) or an elevated platform (high anxiety condition). Half the time participants carried a tray (dual tasking) and half the time they did not. Manipulation checks (involving heart rate, galvanic skin response, and self-reported anxiety measurement) confirmed that the experimental manipulation was successful in affecting anxiety level. The results demonstrate that the experimental manipulation (platform vs. floor) affected balance parameters and dual tasking performance with the platform condition resulting in a less stable gait. In addition, increased task demand (i.e., dual tasking) also had a negative effect on balance performance. Finally, the results demonstrate that the paper and pencil measures of fear can also predict balance performance (although the variance accounted for is small) even after controlling for medical risk factors for falling. Implications for models of fear of falling are discussed.
Disparities in type 1 diabetes related to use of technologies like continuous glucose monitors (CGMs) and utilization of diabetes care are pronounced based on socioeconomic status (SES), race, and ethnicity. However, systematic reports of perspectives from patients in vulnerable communities regarding barriers are limited. RESEARCH DESIGN AND METHODSTo better understand barriers, focus groups were conducted in Florida and California with adults $18 years old with type 1 diabetes with selection criteria including hospitalization for diabetic ketoacidosis, HbA 1c >9%, and/or receiving care at a Federally Qualified Health Center. Sixteen focus groups were conducted in English or Spanish with 86 adults (mean age 42 ± 16.2 years). Transcript themes and pre-focus group demographic survey data were analyzed. In order of frequency, barriers to diabetes technology and endocrinology care included: 1) provider level (negative provider encounters); 2) system level (financial coverage); and 3) individual level (preferences). RESULTSOver 50% of participants had not seen an endocrinologist in the past year or were only seen once including during hospital visits. In Florida, there was less technology use overall (38% used CGMs in FL and 63% in CA; 43% used pumps in FL and 69% in CA) and significant differences in pump use by SES (P 5 0.02 in FL; P 5 0.08 in CA) and race/ethnicity (P 5 0.01 in FL; P 5 0.80 in CA). In California, there were significant differences in CGM use by race/ethnicity (P 5 0.05 in CA; P 5 0.56 in FL) and education level (P 5 0.02 in CA; P 5 0.90 in FL). CONCLUSIONSThese findings provide novel insights into the experiences of vulnerable communities and demonstrate the need for multilevel interventions aimed at offsetting disparities in diabetes.Health outcomes in type 1 diabetes in the U.S. are profoundly shaped by socioeconomic status (SES), race, and ethnicity from childhood and throughout the life span. People living with type 1 diabetes from low SES households face elevated risks for suboptimal glycemic control, diabetic ketoacidosis (DKA), disease
SUMMARY We synthesize the literature on auditors' evaluation of, and reporting on, internal control over financial reporting (ICOFR), as required by the Sarbanes-Oxley Act. The purpose of the synthesis is (1) to provide information on how and how well auditors perform the task, which serves as feedback to the Public Company Accounting Oversight Board on implementation issues and problems related to auditors' application of the professional standards on ICOFR; and (2) to identify gaps in the current literature and fruitful areas of future research. Consistent with Auditing Standard No. 5, we delineate five phases of the ICOFR audit: (1) planning; (2) scoping; (3) testing; (4) evaluation; and (5) reporting. We structure our synthesis using a framework that classifies the determinants of performance in each phase into five broad areas: (a) the auditor's attributes, (b) the client's attributes, (c) the interaction between the auditor and the client, (d) task attributes, and (e) environmental attributes. Key contributions include providing an ICOFR tasks taxonomy, proposing a model of the determinants of performance for each task, evaluating auditors' performance of the tasks in our taxonomy, highlighting findings and gaps of importance to regulators, and providing a road map for future research.
This study examines the effects of audit partner tenure and audit partner changes on internal control reporting quality for large U.S. not‐for‐profit (NFP) organizations. Regulators contend that audit partners lose their objectivity over successive audits, reducing audit quality. A large body of research has examined this issue, primarily in non‐U.S. jurisdictions, with mixed results. We examine the associations between audit partner tenure and audit partner changes and the incidence of reported internal control deficiencies (ICDs), the quality of internal control reports (following PCAOB audit quality indicators), and the severity of reported ICDs. We find negative associations between audit partner tenure and the incidence of reported ICDs, the quality of internal control reports, and the severity of reported ICDs. Together, these findings indicate that internal control reporting quality deteriorates with audit partner tenure. However, we find no association between audit partner changes and internal control reporting, which is consistent with partners lacking client specific knowledge in their first year with a client. Finally, we find no association between either audit partner tenure or changes and the likelihood of remediation. Our findings contribute large‐sample U.S. evidence on the association between audit partner tenure and internal control reporting quality and provide useful information to government regulators, NFP boards charged with the oversight of the external auditor and internal controls, and NFP stakeholders.
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