Violence as a Deterrent for Shelter Usage Among Persons Experiencing Homelessness in Detroit: a Mixed Methods Study

Introduction: Persons experiencing homelessness (PEH) are hospitalized at rates four times higher than the US average and face significantly worse health outcomes, particularly for those residing in cities with harsh winters. Fear of violence or theft is frequently cited as a deterrent to emergency-based shelter usage among PEH; however, there is little research assessing its effects on health and safety among PEH. This project qualitatively assesses violence as a deterrent to emergency shelter usage. Methods: A semi-structured interview guide was designed to assess experiences with, and fear of, shelter-based violence among PEH and the effect of shelter-based violence on mental and physical health. Data were analyzed through conventional content analysis. Results: Preliminary results suggest that shelter-based theft and violence are associated with cyclic exacerbation of negative health outcomes. All participants reported experiences with theft or violence in shelters, with descriptions of resultant lack of sleep or anxiety-related behaviors. A majority (66%) of participants cited fear of shelter-based violence or crime as a reason for foregoing shelter usage. Conclusions: Experiences with, and fear of shelter-based violence have a negative health impact on PEH in Detroit, exacerbated by our seasonally severe weather. It is necessary, as healthcare providers, to understand these health implications in order to deliver high-quality care to PEH. The findings will inform continuing medical education on strategies to improve quality of care for PEH. Data will also inform design and implementation of targeted safety interventions in local emergency shelters to reduce barriers to using shelters

C-Mpl Is Expressed on Osteoblasts and Osteoclasts and Is Important in Regulating Skeletal Homeostasis

C-Mpl is the receptor for thrombopoietin (TPO), the main megakaryocyte (MK) growth factor, and c-Mpl is believed to be expressed on cells of the hematopoietic lineage. As MKs have been shown to enhance bone formation, it may be expected that mice in which c-Mpl was globally knocked out (c-Mpl(-/-) mice) would have decreased bone mass because they have fewer MKs. Instead, c-Mpl(-/-) mice have a higher bone mass than WT controls. Using c-Mpl(-/-) mice we investigated the basis for this discrepancy and discovered that c-Mpl is expressed on both osteoblasts (OBs) and osteoclasts (OCs), an unexpected finding that prompted us to examine further how c-Mpl regulates bone. Static and dynamic bone histomorphometry parameters suggest that c-Mpl deficiency results in a net gain in bone volume with increases in OBs and OCs. In vitro, a higher percentage of c-Mpl(-/-) OBs were in active phases of the cell cycle, leading to an increased number of OBs. No difference in OB differentiation was observed in vitro as examined by real-time PCR and functional assays. In co-culture systems, which allow for the interaction between OBs and OC progenitors, c-Mpl(-/-) OBs enhanced osteoclastogenesis. Two of the major signaling pathways by which OBs regulate osteoclastogenesis, MCSF/OPG/RANKL and EphrinB2-EphB2/B4, were unaffected in c-Mpl(-/-) OBs. These data provide new findings for the role of MKs and c-Mpl expression in bone and may provide insight into the homeostatic regulation of bone mass as well as bone loss diseases such as osteoporosis