RESUMEN
Background Evidence is limited on whether homeless individuals who visit emergency departments (EDs) share similar clinical characteristics as individuals from private households who, upon examination, require emergency health services beyond preventative healthcare. While the literature is rich with studies on homeless persons in the ED, a comprehensive assessment of similarities and differences with other social groups is lacking. Consequently, there is a gap in knowledge as it pertains to the appropriate approaches that will further support the development of targeted healthcare and emergency health services for the homeless person. Aim The goal is to provide a framework for targeted interventions that hospitals can develop based on behavioral, health, and social characteristics and, in the process, better meet the healthcare needs of homeless patients. Methods Data were collected from the records of 85,350 patients in the National Hospital Ambulatory Medical Care Survey (NHAMCS) database who visited the ED between the years of 2013 and 2016; each patient was classified as having either a private residence, living in a nursing home, or homeless (n = 83,446, n = 1,459, and n = 925, respectively). Results Cluster analysis of the data confirmed that individuals with multiple comorbidities, as well as substance abuse or dependency, regardless of residence type, were more likely to have recurrent ED visits within 72 hours. Nominal regression analyses revealed that cluster membership generated from ED data could predict patient residence and suggest that substance abuse and depression can predict 72-hour ED visit recurrence. Conclusion Cluster analyses have the potential to reveal social health and group characteristics and can support targeted solutions respective to group individualities in the ED.
RESUMEN
In songbirds, learning to sing is a highly social process that likely involves social reward. Here, we tested the hypothesis that during song learning, the reward value of hearing a particular song predicts the degree to which that song will ultimately be learned. We measured the early song preferences of young male zebra finches (Taeniopygia guttata) in an operant key-pressing assay; each of two keys was associated with a higher likelihood of playing the song of the father or that of another familiar adult ("neighbor"). To minimize the effects of exposure on learning, we implemented a novel reinforcement schedule that allowed us to detect preferences while balancing exposure to each song. On average, the juveniles significantly preferred the father's song early during song learning, before actual singing occurs in this species. When they reached adulthood, all the birds copied the father's song. The accuracy with which the father's song was imitated was positively correlated with the peak strength of the preference for the father's song during the sensitive period of song learning. Our results show that preference for the song of a chosen tutor, in this case the father, predicted vocal learning during development.