The Homeless of Massachusetts: An Analysis of the 1990 U.S. Census S-Night Data

This article, which examines epidemiological and policy correlates of homeless populations in 351 Massachusetts towns and cities, is based on an analysis of data from the 1990 U.S. census. It reviews the reliability of the most recent census data, reports findings on the distribution and characteristics of homeless persons in Massachusetts, and presents preliminary correlational findings on the impact of key demographic conditions and policies. The report includes a meta-analysis of several studies that monitored the Census Bureaus street counts. It is estimated that 42.6 percent of the homeless on the streets in selected urban areas were counted by the census. This finding, as well as the results of a regression model that accounted for 68 percent of the variation in street rates in twenty Massachusetts cities with populations of more than 50,000, was used to compute adjusted rates for the remaining towns and cities. Overall adjusted rates for Massachusetts, Boston, and selected areas compared well with independent estimates and counts. The study suggests that at least 10,155 Massachusetts residents were homeless in 1990

Changing Patterns of Acute Psychiatric Hospitalization under a Public Managed Care Program

This study evaluates changes in patterns of acute psychiatric hospitalization under Massachusetts\u27 Medicaid-funded Mental Health and Substance Abuse (MMHSA) carve-out program. The data consists of the Case Mix Database, for FY 1996 and FY 1997, compiled by the state\u27s Division of Health Care Finance and Policy, on all acute hospital episodes in the state. Key comparisons involve hospital utilization during the nine months preceding the 1996 implementation of the current expanded carve-out program and the subsequent 15 months of its implementation. Secondary comparisons are made between patients funded by the state\u27s two major Medicaid programs, its behavioral carve-out and its contracted HMOs, as well as with other cohorts. Key variables include demographic and diagnostic measures, length of stay and recidivism, source of referral, insurance, socioeconomic characteristicso f zip code of residence,a nd transfers between programs. Findings include lower than anticipated rates of transfer from the free-care program to the behavioral carve-out program and higher than average and increasing levels of recidivism for patients in the behavioral carve-out program. The final model, based on a Cox regression analysis, correctly predicts 62.9% of the rehospitalization experience, a statistically significant portion of which was attributable to type of insurance coverage. The study also shows that neither the carve-out nor the HMO model of managed care are clearly superior one another

Patterns of Residential Mobility of People with Schizophrenia: Multi-level Tests of Downward Geographic Drift

This study tests the geographic drift hypothesis that the negative SES-MI correlation results from individuals first developing conditions such as schizophrenia and then moving frequently because of their disability to low income and urban areas, and to neighborhoods with high concentrations of SMI persons. This is a secondary analysis of hospital records of 1,667,956 individuals in Massachusetts, USA, between 1994 and 2000. It employs a longitudinal cohort design and techniques of multi-level modeling. Downward geographic drift of those with schizophrenia was found to be small, but greater than other groups examined. The small level of drift was best explained by pre-existing socioeconomic conditions, and only secondarily by a diagnosis of schizophrenia, and this was true across a wide spectrum of diagnostic and demographic groups. Study hypotheses were largely supported, with downward drift confirmed, and with stronger evidence for low SES as a cause rather than a consequence of geographic drift

Estimating Homeless Populations through Structural Equation Modeling

This article overviews the results from a test of a model of homeless populations throughout the 3,141 counties of the United States. The data were extracted from the 1990 Census, a Census Bureau survey of its enumerators at completion of the census, and other governmental sources. The model was tested using the generally weighted least squares algorithm, as implemented under the Extended LISREL model. It was found that urbanization, servicetization, McKinney funding, and systematic error arising out of more vigilant enumeration efforts in urban areas, collectively explained 80% of the variation in rates of homelessness. The model was then used to correct for enumeration error and to estimate the actual levels of homelessness in both 1990 and 1995. The 1990 estimates were compared with the results of independent estimates for selected localities. After the adjustment for uneven enumeration efforts, the model suggests that a population of 479 thousand homeless persons in 1990, had declined to 383 thousand by 1995

Review of \u3cem\u3eMental Health and Social Policy. Beyond Managed Care\u3c/em\u3e (6th ed.). David Mechanic, Donna D. McAlpine, and David A. Rochefort. Reviewed by Christopher G. Hudson

David Mechanic, Donna D. McAlpine, and David A. Rochefort, Mental Health and Social Policy: Beyond Managed Care (6th ed.). Pearson (2014). $120.47 (paperback)

The Social Class and Mental Illness Correlation: Implications of the Research for Policy and Practice

Ongoing efforts to unravel the causal issues involved in the correlation between socioeconomic status and mental illness suggest that the hypothesis of a recursive or interactive relationship may be the most tenable, at least with the psychoses. Implications of this research are explored, with particular attention paid to the mental health costs of economic policies, the principles with which states allocate mental health resources, and the use of this knowledge-base in service planning

Churning in the Human Services: Nefarious Practice or Policy of \u27Creative Destruction\u27?

This article examines churning as it manifests in organizational systems within the human services. Churning is conceptualized as a four-part iterative process consisting of (1) an intentional or unintentional initiative or shock to a system that (2) results in enhanced turbulence as adaptive capacities of the system fail to match demands of the initiative. This mismatch leads to successive bifurcations and termination of relationships between agents within the system and, finally, (3) the selection of “winners” and the extrusion of “losers” from the system and (4) the subsequent reorganization of winners and losers. Variables governing outcomes, both benign and malignant, are also discussed

A de Finetti Representation Theorem for Quantum Process Tomography

In quantum process tomography, it is possible to express the experimenter's prior information as a sequence of quantum operations, i.e., trace-preserving completely positive maps. In analogy to de Finetti's concept of exchangeability for probability distributions, we give a definition of exchangeability for sequences of quantum operations. We then state and prove a representation theorem for such exchangeable sequences. The theorem leads to a simple characterization of admissible priors for quantum process tomography and solves to a Bayesian's satisfaction the problem of an unknown quantum operation.Comment: 10 page

Mitochondrial DNA changes in pedunculopontine cholinergic neurons in Parkinson’s disease

In Parkinson’s disease (PD), mitochondrial dysfunction associates with nigral dopaminergic neuronal loss. Cholinergic neuronal loss co-occurs, particularly within a brainstem structure, the pedunculopontine nucleus (PPN). We isolated single cholinergic neurons from post-mortem PPNs of aged controls and PD patients. Mitochondrial DNA (mtDNA) copy number and mtDNA deletions were increased significantly in PD patients compared to controls. Furthermore, compared to controls the PD patients had significantly more PPN cholinergic neurons containing mtDNA deletion levels exceeding 60%, a level associated with deleterious effects on oxidative phosphorylation. The current results differ from studies reporting mtDNA depletion in nigral dopaminergic neurons of PD patients

High-Resolution Optical Coherence Tomography Retinal Imaging: A Case Series Illustrating Potential and Limitations

Purpose. To present a series of retinal disease cases that were imaged by spectral domain optical coherence tomography (SD-OCT) in order to illustrate the potential and limitations of this new imaging modality. Methods. The series comprised four selected cases (one case each) of age-related macular degeneration (ARMD), diabetic retinopathy (DR), central retinal artery occlusion (CRAO), and branch retinal vein occlusion (BRVO). Patients were imaged using the Heidelberg Spectralis (Heidelberg Engineering, Germany) in SD-OCT mode. Patients also underwent digital fundus photography and clinical assessment. Results. SD-OCT imaging of a case of age-related macular degeneration revealed a subfoveal choroidal neovascular membrane with detachment of the retinal pigment epithelium (RPE) and neurosensory retina. Using SD-OCT, the cases of DR and BRVO both exhibited macular edema with cystoid spaces visible in the outer retina. Conclusions. The ability of SD-OCT to clearly and objectively elucidate subtle morphological changes within the retinal layers provides information that can be used to formulate diagnoses with greater confidence