Healthcare Use and Outcomes of Homeless Patients: Multi-State Population-Based Analyses

Homelessness affects millions of Americans each year, and many homeless individuals have complex healthcare needs that place high demands on the United States healthcare system. This dissertation explores adverse health services utilization outcomes of the homeless population using the Healthcare Cost and Utilization Project’s 2014 State Inpatient Database and the State Emergency Department Database from Florida, Maryland, Massachusetts, and New York. The first paper, “Association between homelessness and opioid overdose and opioid-related hospital admissions/emergency department visits,” examines opioid overdose and opioid-related hospitalization/emergency department (ED) visit risks of homeless patients compared to a low-income housed comparison group. The study used multivariable linear probability models with hospital fixed effects for dichotomous outcomes. Outcomes were also stratified by sex and race/ethnicity. The study found that homeless patients had substantially higher risks for both outcomes, and the non-Hispanic white female homeless patients were particularly the highest risk group in this patient population. Implementing screenings for homelessness and opioid abuse may be critical for curbing the opioid epidemic in this population.The second paper, “Frequent emergency department use among homeless individuals: High risk of opioid-related diagnoses and adverse health services utilization outcomes,” compares opioid outcomes, mechanical ventilation, mortality, and hospitalizations of homeless patients who had 4 or more ED visits, 2-3 ED visits and 1 ED visit in 2014, and identifies predictors for higher rates of ED use. Multivariable linear probability models with hospital fixed effects were used for the main analyses and a negative binomial regression model with hospital fixed effects was used for predicting higher rates of ED use. The study revealed that homeless patients who are high ED users were more likely to be hospitalized and have other adverse outcomes. These findings encourage targeted interventions for the high-utilizer homeless population to reduce the burden of serious outcomes and costs for the patient and society.The third paper, “Association between homelessness and delivery hospitalization outcomes: a multi-state population-based study,” explores delivery hospitalization outcomes of pregnant homeless versus non-homeless women. This project used inpatient data from FL, MA and NY and overlap propensity-score weighing method and regression adjustment. Compared to non-homeless women treated within the same facility, homeless women had higher likelihoods of experiencing placental abnormalities, preterm labor and higher delivery hospitalization costs. A large majority of homeless women were treated in government-owned safety-net hospitals with lower average delivery costs compared to non-homeless women, who were mainly treated in not-for-profit hospitals. These findings highlight the importance of screening pregnant women for social needs, including homelessness, as well as developing policies that encourage partnerships between healthcare providers and community resources, such as local social housing programs.Taken together, all three papers highlight the adverse health outcomes of the homeless population and the need to quickly identify homeless patients and refer them to appropriate care

Nonlinear electrical impedance spectroscopy of viruses using very high electric fields created by nanogap electrodes

Our living sphere is constantly exposed to a wide range of pathogenic viruses, which can be either known, or of novel origin. Currently, there is no methodology for continuously monitoring the environment for viruses in general, much less a methodology that allows the rapid and sensitive identification of a wide variety of viruses responsible for communicable diseases. Traditional approaches, based on PCR and immunodetection systems, only detect known or specifically targeted viruses. We here describe a simple device that can potentially detect any virus between nanogap electrodes using nonlinear impedance spectroscopy. Three test viruses, differing in shape and size, were used to demonstrate the general applicability of this approach: baculovirus，tobacco mosaic virus, and influenza virus. We show that each of the virus types responded differently in the nanogap to changes in the electric field strength, and the impedance of the virus solutions differed depending both on virus type and virus concentration. These preliminary results show that the three virus types can be distinguished and their approximate concentrations determined. Although further studies are required, the proposed nonlinear impedance spectroscopy method may achieve a sensitivity comparable to that of more traditional, but less versatile, virus detection systems

Disparities in antidepressant use in pregnancy

Background: The American College of Obstetricians and Gynecologists and the American Psychiatric Association both recommend pharmacotherapy for perinatal depression when the benefits outweigh the risks. While minority adults are less likely to use antidepressant medications compared to Non-Hispanic Whites, whether this pattern occurs among pregnant women is unclear. Objective: We sought to determine the frequency of antidepressant medication use reported during ambulatory care visits for pregnant women and whether these rates varied by race. Methods: We combined the 2006–2010 National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS) to obtain nationally representative estimates of outpatient preventive care visits for pregnant women. We then obtained estimates of the prevalence of reported depression and antidepressant use during outpatient visits for pregnant women. To determine whether these estimates varied by race, we used multivariable logistic regression analyses accounting for survey design using SAS 9.2 (PROC SURVEYLOGISTIC) to estimate odds ratios of reported antidepressant use after adjustment for age, insurance status and region of the country. Results: Antidepressant use was reported during 2.2% of all outpatient visits for pregnant women. Providers indicated a depression diagnosis in 4.5% of visits. Among visits for depressed pregnant women, providers reported antidepressant use 25.4% of the time for all visits. Antidepressant use during pregnancy varied significantly by race/ethnicity. Among visits for Non-Hispanic White women, 3.1% included a code for antidepressant use vs. just 1.0% for Non-White women (P<0.0001). After adjustment for age, insurance status, and region of the country, this association persisted with Non-Hispanic White (vs. Non-White) pregnant women having higher odds of antidepressant use (adjusted OR 3.3, 95% CI 2.1, 5.3). Conclusion: Non-Hispanic White women were more likely than Non-White women to be using antidepressants during pregnancy. Whether differences in antidepressant use by race/ethnicity indicates over-treatment of non-Hispanic White women or under-treatment of minorities remains unclear. This disparity warrants investigation with the goal of optimizing maternal mental health while minimizing potential adverse sequelae of antidepressants on developing fetuses

Localization of three forms of gonadotropin-releasing hormone in the brain and pituitary of the self-fertilizing fish, Kryptolebias marmoratus

The localization of gonadotropin-releasing hormone (GnRH) in the brain and pituitary of the self-fertilizing mangrove killifish Kryptolebias marmoratus was examined by immunohistochemistry and in situ hybridization to understand its neuroendocrine system. The genome assembly of K. marmoratus did not have any sequence encoding GnRH1, but sequences encoding GnRH2 (chicken GnRH-II) and GnRH3 (salmon GnRH) were found. Therefore, GnRH1 was identified by in silico cloning. The deduced amino acid sequence of the K. marmoratus GnRH1 (mature peptide) was identical to that of the medaka GnRH. GnRH1 neurons were detected in the ventral part of the preoptic nucleus by immunohistochemistry and in situ hybridization, and GnRH1-immunoreactive (ir) fibers were observed throughout the brain. GnRH1-ir fibers were in close contact with luteinizing hormone (LH)-ir cells in the pituitary using double immunohistochemistry. GnRH2 neurons were detected in the midbrain tegmentum by immunohistochemistry and in situ hybridization. Although GnRH2-ir fibers were observed throughout the brain, they were not detected in the pituitary. GnRH3 neurons were detected in the lateral part of the ventral telencephalic area by both methods. GnRH3-ir fibers were observed throughout the brain, and a few GnRH3-ir fibers were in close contact with LH-ir cells in the pituitary. These results indicate that GnRH1 and possibly GnRH3 are responsible for gonadal maturation through LH secretion and that all three forms of GnRH function as neurotransmitters or neuromodulators in the brain of K. marmoratus

Healthcare Use and Outcomes of Homeless Patients: Multi-State Population-Based Analyses

Homelessness affects millions of Americans each year, and many homeless individuals have complex healthcare needs that place high demands on the United States healthcare system. This dissertation explores adverse health services utilization outcomes of the homeless population using the Healthcare Cost and Utilization Project’s 2014 State Inpatient Database and the State Emergency Department Database from Florida, Maryland, Massachusetts, and New York. The first paper, “Association between homelessness and opioid overdose and opioid-related hospital admissions/emergency department visits,” examines opioid overdose and opioid-related hospitalization/emergency department (ED) visit risks of homeless patients compared to a low-income housed comparison group. The study used multivariable linear probability models with hospital fixed effects for dichotomous outcomes. Outcomes were also stratified by sex and race/ethnicity. The study found that homeless patients had substantially higher risks for both outcomes, and the non-Hispanic white female homeless patients were particularly the highest risk group in this patient population. Implementing screenings for homelessness and opioid abuse may be critical for curbing the opioid epidemic in this population.The second paper, “Frequent emergency department use among homeless individuals: High risk of opioid-related diagnoses and adverse health services utilization outcomes,” compares opioid outcomes, mechanical ventilation, mortality, and hospitalizations of homeless patients who had 4 or more ED visits, 2-3 ED visits and 1 ED visit in 2014, and identifies predictors for higher rates of ED use. Multivariable linear probability models with hospital fixed effects were used for the main analyses and a negative binomial regression model with hospital fixed effects was used for predicting higher rates of ED use. The study revealed that homeless patients who are high ED users were more likely to be hospitalized and have other adverse outcomes. These findings encourage targeted interventions for the high-utilizer homeless population to reduce the burden of serious outcomes and costs for the patient and society.The third paper, “Association between homelessness and delivery hospitalization outcomes: a multi-state population-based study,” explores delivery hospitalization outcomes of pregnant homeless versus non-homeless women. This project used inpatient data from FL, MA and NY and overlap propensity-score weighing method and regression adjustment. Compared to non-homeless women treated within the same facility, homeless women had higher likelihoods of experiencing placental abnormalities, preterm labor and higher delivery hospitalization costs. A large majority of homeless women were treated in government-owned safety-net hospitals with lower average delivery costs compared to non-homeless women, who were mainly treated in not-for-profit hospitals. These findings highlight the importance of screening pregnant women for social needs, including homelessness, as well as developing policies that encourage partnerships between healthcare providers and community resources, such as local social housing programs.Taken together, all three papers highlight the adverse health outcomes of the homeless population and the need to quickly identify homeless patients and refer them to appropriate care

Editorial: Perspectives for the Next Generation of Virus Research: Spearheading the Use of Innovative Technologies and Methodologies

Infectious diseases are associated with approximately 20% of global mortality, with viral diseases causing about one third of these deaths. Besides newly emerging and re-emerging viral infections will continue to pose a threat to human survival globally. In this case scientific advances have greatly been increased to defend against those pathogens. For example, rapid genomic sequencing, proteomics, epigenomics, nanotechnology, and other advanced tools are being applied to detect viruses at the point of care and to track their spread within human populations as well as to understand virus-host interaction and virus induced pathogenesis. From rapid identification of new viruses to prevention with vaccination and treatment with effective therapeutics, biomedical research has continuously provided tools to meet the constant threat of emerging viral pathogens. Despite these advances, each new disease brings unique challenges to scientists every year. So we must stay at the cutting edge of scientific discovery, working energetically to develop new tools to combat the ever-changing threats they pose. Our research topic highlights such advanced and new technology based virus research which definitely bolsters the researcher's ability to tackle emerging, re-emerging and stable viral pathogens. We are credulous that the papers including in the e-books will be beneficial to the experts in the field to understand the molecular, immunological, ecological and clinical aspects of the next generation researches for the prevention and control of infectious diseases caused by viruses

Perspectives for the Next Generation of Virus Research: Spearheading the Use of Innovative Technologies and Methodologies

Infectious diseases are associated with approximately 20% of global mortality, with viral diseases causing about one third of these deaths. Besides newly emerging and re-emerging viral infections will continue to pose a threat to human survival globally. In this case scientific advances have greatly been increased to defend against those pathogens. For example, rapid genomic sequencing, proteomics, epigenomics, nanotechnology, and other advanced tools are being applied to detect viruses at the point of care and to track their spread within human populations as well as to understand virus-host interaction and virus induced pathogenesis. From rapid identification of new viruses to prevention with vaccination and treatment with effective therapeutics, biomedical research has continuously provided tools to meet the constant threat of emerging viral pathogens. Despite these advances, each new disease brings unique challenges to scientists every year. So we must stay at the cutting edge of scientific discovery, working energetically to develop new tools to combat the ever-changing threats they pose. Our research topic highlights such advanced and new technology based virus research which definitely bolsters the researcher's ability to tackle emerging, re-emerging and stable viral pathogens. We are credulous that the papers including in the e-books will be beneficial to the experts in the field to understand the molecular, immunological, ecological and clinical aspects of the next generation researches for the prevention and control of infectious diseases caused by viruses