Tied into this was an increasing number of impoverished and runaway children, teenagers, and young adults, which created a new substratum of the homeless population (street children or street youth).In 2015, the United States reported that there were 564,708 homeless people within its borders, one of the higher reported figures worldwide.Housing First is an initiative to help homeless people reintegrate into society, and out of homeless shelters. It was initiated by the federal governments Interagency Council on Homelessness. It asks cities to come up with a plan to end chronic homelessness. In this direction, there is the belief that if homeless people are given independent housing to start, with some proper social supports, then there would be no need for emergency homeless shelters, which it considers a good outcome. However this is a controversial position.There is evidence that the Housing First program works more efficiently than Treatment First programs. Studies show that having the stability of housing through the Housing First program will encourage homeless people to focus on other struggles they are facing, such as substance abuse. Meanwhile, Treatment First programs promote an "all or nothing" approach which require clients to participate in programs applicable to their struggles as a condition for housing assistance. Treatment First utilizes a less individualistic approach than Housing First and solutions are created under one standard rather than fit to each clients specific needs.
Renal medullary carcinoma is a rare type of cancer that affects the kidney. It tends to be aggressive, difficult to treat, and is often metastatic at the time of diagnosis. Most individuals with this type of cancer have sickle cell trait or rarely sickle cell disease, suggesting that the sickle cell trait may be a risk factor for this type of cancer. Signs and symptoms
In a case series of 34 patients, Davis and colleagues reported the following signs and symptoms:
macroscopically visible (gross) hematuria (60%)
abdominal or back/flank pain (50%)
significant weight loss (25%)Other researchers have reported a palpable renal mass or enlarged lymph nodes. Causes
The etiology of renal medullary carcinoma is still not completely understood. However, the majority of individuals diagnosed with this type of cancer have had sickle cell trait, in which the person carries one normal copy of the hemoglobin A gene (HbA) and one copy of the hemoglobin A gene harboring the genetic mutation found in sickle cell disease (HbS). These individuals do not have sickle cell disease but can manifest symptoms such as kidney damage over the course of their lives. The other genetic or environmental factors that contribute to the risk of renal medullary carcinoma are unknown. Mechanism
The finding that virtually all people affected by renal medullary carcinoma carry at least one copy of the HbS mutation suggests that sickle cell trait somehow predisposes to this type of cancer. The precise mechanism is unknown, but red blood cells with a sickle cell configuration have been identified in pathology specimens.