Characteristics and likelihood of ongoing homelessness among unsheltered veterans

INTRODUCTION: Unsheltered homelessness is an important phenomenon yet difficult to study due to lack of data. The Veterans Health Administration administers a universal homelessness screener, which identifies housing status for Veterans screening positive for homelessness. METHODS: This study compared unsheltered and sheltered Veterans, assessed differences in rates of ongoing homelessness, and estimated a mixed-effect logistic regression model to examine the relationship between housing status and ongoing homelessness. RESULTS: Eleven percent of Veterans who screened positive for homelessness were unsheltered; 40% of those who rescreened were homeless six months later, compared with less than 20% of sheltered Veterans. Unsheltered Veterans were 2.7 times as likely to experience ongoing homelessness. DISCUSSION: Unsheltered Veterans differ from their sheltered counterparts-they are older, more likely to be male, less likely to have income-and may be good candidates for an intensive housing intervention. Future research will assess clinical characteristics and services utilization among this population

Predictive modeling of housing instability and homelessness in the Veterans Health Administration

OBJECTIVE: To develop and test predictive models of housing instability and homelessness based on responses to a brief screening instrument administered throughout the Veterans Health Administration (VHA). DATA SOURCES/STUDY SETTING: Electronic medical record data from 5.8 million Veterans who responded to the VHA's Homelessness Screening Clinical Reminder (HSCR) between October 2012 and September 2015. STUDY DESIGN: We randomly selected 80% of Veterans in our sample to develop predictive models. We evaluated the performance of both logistic regression and random forests—a machine learning algorithm—using the remaining 20% of cases. DATA COLLECTION/EXTRACTION METHODS: Data were extracted from two sources: VHA's Corporate Data Warehouse and National Homeless Registry. PRINCIPAL FINDINGS: Performance for all models was acceptable or better. Random forests models were more sensitive in predicting housing instability and homelessness than logistic regression, but less specific in predicting housing instability. Rates of positive screens for both outcomes were highest among Veterans in the top strata of model‐predicted risk. CONCLUSIONS: Predictive models based on medical record data can identify Veterans likely to report housing instability and homelessness, making the HSCR screening process more efficient and informing new engagement strategies. Our findings have implications for similar instruments in other health care systems.U.S. Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D), Grant/Award Number: IIR 13-334 (IIR 13-334 - U.S. Department of Veterans Affairs (VA) Health Services Research and Development (HSRD))Accepted manuscrip

Needles in a haystack: screening and healthcare system evidence for homelessness

Effectiveness of screening for homelessness in a large healthcare system was evaluated in terms of successfully referring and connecting patients with appropriate prevention or intervention services. Screening and healthcare services data from nearly 6 million U.S. military veterans were analyzed. Veterans either screened positive for current or risk of housing instability, or negative for both. Current living situation was used to validate results of screening. Administrative evidence for homelessness-related services was significantly higher among positive-screen veterans who accepted a referral for services compared to those who declined. Screening for current or risk of homelessness led to earlier identification, which led to earlier and more extensive service engagement

Accurate estimation of homologue-specific DNA concentration-ratios in cancer samples allows long-range haplotyping

Interpretation of allelic copy measurements at polymorphic markers in cancer samples presents distinctive challenges and opportunities. Due to frequent gross chromosomal alterations occurring in cancer (aneuploidy), many genomic regions are present at homologous-allele imbalance. Within such regions, the unequal contribution of alleles at heterozygous markers allows for direct phasing of the haplotype derived from each individual parent. In addition, genome-wide estimates of homologue specific copy- ratios (HSCRs) are important for interpretation of the cancer genome in terms of fixed integral copy-numbers. We describe HAPSEG, a probabilistic method to interpret bi- allelic marker data in cancer samples. HAPSEG operates by partitioning the genome into segments of distinct copy number and modeling the four distinct genotypes in each segment. We describe general methods for fitting these models to data which are suit- able for both SNP microarrays and massively parallel sequencing data. In addition, we demonstrate a specially tailored error-model for interpretation of systematic variations arising in microarray platforms. The ability to directly determine haplotypes from cancer samples represents an opportunity to expand reference panels of phased chromosomes, which may have general interest in various population genetic applications. In addition, this property may be exploited to interrogate the relationship between germline risk and cancer phenotype with greater sensitivity than is possible using unphased genotype. Finally, we exploit the statistical dependency of phased genotypes to enable the fitting of more elaborate sample-level error-model parameters, allowing more accurate estimation of HSCRs in cancer samples

High-speed civil transport flight- and propulsion-control technological issues

Technology advances required in the flight and propulsion control system disciplines to develop a high speed civil transport (HSCT) are identified. The mission and requirements of the transport and major flight and propulsion control technology issues are discussed. Each issue is ranked and, for each issue, a plan for technology readiness is given. Certain features are unique and dominate control system design. These features include the high temperature environment, large flexible aircraft, control-configured empennage, minimizing control margins, and high availability and excellent maintainability. The failure to resolve most high-priority issues can prevent the transport from achieving its goals. The flow-time for hardware may require stimulus, since market forces may be insufficient to ensure timely production. Flight and propulsion control technology will contribute to takeoff gross weight reduction. Similar technology advances are necessary also to ensure flight safety for the transport. The certification basis of the HSCT must be negotiated between airplane manufacturers and government regulators. Efficient, quality design of the transport will require an integrated set of design tools that support the entire engineering design team

Comparing the utilization and cost of health services between veterans experiencing brief and ongoing episodes of housing instability

Housing instability is associated with costly patterns of health and behavioral health service use. However, little prior research has examined patterns of service use associated with higher costs among those experiencing ongoing housing instability. To address this gap, we compared inpatient and outpatient medical and behavioral health service utilization and costs between veterans experiencing brief and ongoing episodes of housing instability. We used data from a brief screening instrument for homelessness and housing instability that has been implemented throughout the US Department of Veterans Affairs (VA) health care system to identify a national sample of veterans experiencing housing instability. Veterans were classified as experiencing either brief or ongoing housing instability, based on two consecutive responses to the instrument, and we used a series of two-part regression models to conduct adjusted comparisons of costs between veterans experiencing brief and ongoing episodes of housing instability. Among 5794 veterans screening positive for housing instability, 4934 (85%) were experiencing brief and 860 (15%) ongoing instability. The average total annual incremental cost associated with ongoing versus brief episodes of housing instability was estimated at $7573, with the bulk of this difference found in inpatient services. Cost differences resulted more from a higher probability of service use among those experiencing ongoing episodes of housing instability than from higher costs among service users. Our findings suggest that VA programmatic efforts aimed at preventing extended episodes of housing instability could potentially result in substantial cost offsets for the VA health care system.This study was supported by funding from the Department of Veterans Affairs (VA) Health Services Research & Development (HSR&D) grant IIR 13-334-3 and from the VA National Center on Homelessness Among Veterans

The importance of socio-demographic indicators in regional disparities in turkey, 1990-1994

The aim of this study is to test the relative importance of the socio-demographic versus economic variables in discriminating the inter-regional differences in Turkey in 1990-94. Our findings show that the "socio-demographic" variables are much more significant than the "economic" variables. Among the socio-demographic variables, especially those variables related with the fertility and the size of household, and the female education such as the "female literacy ratio" and "female schooling ratio in high school", are the most effective variables rather than the economic variables, in the explanation of the differences between the regions in Turkey. Moreover, among the economic variables, the variables such as the "ratio of non-agricultural active population" are the more significant than the "GDP per capita" which is widely used as an ultimate indicator of socio-economic development. In this study, discriminant and factor analyses, and logistic regression are applied in total of five different methods. The tests are carried out for the seven regions of Turkey as defined by the State Institute of Statistics. Subsequently the analyses are repeated by combining these seven regions into three regions and two regions. Our above stated findings were always consistent in each of these tests. Our data sources are the various publications of State Institute of Statistics (SIS) and State Planning Organization (SPO). The regional data are the unweighted arithmetic mean of the respective provinces. Key words: Regional disparity, Socio-demographic variables, Economic variables, Discriminant anlysis, Logistic regression, and Factor analysis.

Enteric Neurospheres Are Not Specific to Neural Crest Cultures: Implications for Neural Stem Cell Therapies

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited

The universal K3 surface of genus 14 via cubic fourfolds

Using the isomorphism between the moduli space of polarized K3 surfaces of genus 14 and the moduli space of special cubic fourfolds of discriminant 26, we establish the rationality of the universal K3 surface of genus 14. Precisely, we show that the universal K3 surface of genus 14 is a projective bundle over a certain moduli space of nodal scrolls in P^5, whose rationality we prove using a degenerate version of Mukai's structure theorem for curves of genus 8.Comment: 20 pages. Final version, to appear in the Journal de Mathematiques Pures et Appliquee