Friends you are all invited! its a FREE event at the Newark Public Library.  We will have Latino artisans, authors, painters and a presentation on how to make “COQUITO” the Puerto Rican favorite beverage for the Holidays!  Te veo all!Slide1

Posted by: gmontealegre | December 6, 2014

NJ authorities want RED LIGHT program to become permanent!

Contact:
Press Information Office
973-733-8004
PressOffice@ci.newark.nj.us

New Official City of Newark Logo (2014)

MAYOR BARAKA, STATE SENATORS CODEY AND RICE, AND LAW ENFORCEMENT OFFICERS
CALL UPON STATE TO MAKE RED LIGHT PROGRAM PERMANENT
Press conference participants call on state legislators and governor to act before program’s December 16 expiration, citing reductions in crashes

Newark, New Jersey – December 5, 2014 – Newark Mayor Ras Baraka, State Senators Richard Codey and Ronald Rice, and other mayors, state legislators, local elected officials, law enforcement officials and New Jersey traffic safety advocates held a news conference today in the Municipal Council Chamber in City Hall in Newark to urge renewal of the state’s red light camera program. City Hall is located at 920 Broad Street.

Participants highlighted the effectiveness of the cameras at reducing dangerous driving, red light running and the resulting injuries, as well as the impact cameras have as law enforcement force multipliers for police departments across the state. A list of participants is given below.

“Project Red Light is doing exactly what it’s supposed to do. The presence of the cameras causes drivers to think twice before darting into an intersection after the light has turned red,” Mayor Baraka said. “This program provides us with a means to deter dangerous driving behaviors and hold those who do break the law accountable. The reduction in crashes is encouraging, and we want this trend to continue to make Newark a safer city for our residents and visitors alike. Working with our state partners, our law enforcement agencies, and our safety advocates, we can continue to transform Newark into a City we can all believe in.”

The City of Newark compiled and analyzed data from the seven intersections with four years of operation. It shows total crashes in 2014 were down significantly in four years, including right-angle crashes, which are considered the most deadly type of auto collision.

Total Accident Reduction (All Types): 63-percent reduction
Right-Angle Crashes: 92-percent reduction
Same-Direction Crashes (Rear-End): 56-percent reduction

The following intersections experienced a reduction in crashes in 2014, compared to the year prior to safety camera installation:

Raymond Boulevard and Raymond Plaza West: 82-percent reduction
Broad Street and Raymond Boulevard: 79-percent reduction
Raymond Boulevard, Market Street and Prospect Street: 75-percent reduction
Broad Street and Murray Street: 67-percent reduction
Broad Street and Market Street: 32-percent reduction
Mulberry Street and Market Street: 25-percent reduction
McCarter Highway and South Street: no crashes reported

According to New Jersey State Police, more than 500 crashes occurred statewide in 2013. Traffic safety cameras are used by law enforcement across the country to deter reckless driving that leads to crashes, while also modifying driver behavior.

-NEWARK-

For more information on the City of Newark, please visit our website

http://www.ci.newark.nj.uswww.twitter.com/cityofnewarknj

To visit the City of Newark’s official photo galleries:

https://www.flickr.com/photos/newarkpressoffice/sets
Participants in today’s press conference
Mayor Ras J. Baraka, Newark
State Senator Richard Codey, 27th Legislative District
State Senator Ronald C. Rice, 28th Legislative District
L. Grace Spencer, Assemblywoman, 29th Legislative District
Mayor Richard Gerbounka, Linden
Mayor Brian Wahler, Piscataway
Mayor Clifton Peoples, Union Township
City Councilor Joyce Waterman, Jersey City
Joe Chriscoulo, Business Administrator, Piscataway Township
Chief John Cook, Springfield
Chief Paul Morrison, Roselle Park
Janna Chernetz, Tri-State Transportation Campaign
Deputy Chief Howard Weimer, Monroe
Sgt. Mark Burton, Monroe
Lt. Mike Babulski, Linden
Director Don Zeiser, Union Township
William Dressel, Executive Director, New Jersey League of Municipalities

Posted by: gmontealegre | December 2, 2014

Santa Clauss coming to Linden Library on Thursday, Dec 11 – FREE

PRESS RELEASE

DATE: 11/28/14

FROM: Linden Free Public Library

RE:       A Visit with SantaSanta

Linden Library’s Visit from Santa

On Thursday, December 11, Santa Claus will pay a visit to the children of Linden. Parents may bring their children to the library between 3:00 p.m. and 4:30 p.m. to see Santa.

Children may talk with Santa, while parents take individual or family pictures with Santa.

A Library employee will also take a picture of your child. These pictures will be posted on our website, and families will be able to download and print them from the Linden Library Facebook page. Come and see Santa, and create your own holiday photos. In order to attend, you must come to the library before Dec. 11, and obtain a free ticket to this event. The Linden Public Library is located at 31 East Henry Street, off Wood Ave., at the corner of 7-Eleven. The Santa event will be held in the Columbia Bank Room on the third floor of the library. For more information, pick up a flyer at the library, or e-mail the Children’s Librarian, Karen Gray at: kgray@lindenpl.org

Posted by: gmontealegre | October 31, 2014

Day of the Dead Observances popularized

Things you need to create your ALTAR during your celebration of the Day of the Dead November 1 and November 2:

In many Latin American Countries November 1st and November 2nd have a special meaning.   For those who practice the Catholic faith, November 1st is celebrated as “All Saints Day,” a day to remember loved ones who have died and a day of prayer so their souls do not get stuck in purgatory.  A sort of group prayer to help give the dead the extra push to heaven.  But whether you believe that or not, this religious observance is being surpassed today more and more by an observance first popularized in Mexico – “DAY OF THE DEAD” – an extraordinary way to celebrate and remember the dead.  In Mexico observers create colorful and intriguing altars in their homes and/or public places depicting the lives of their dead.  They feature skeletons dressed as nurses, doctors, engineers, construction workers, etc.  to embody the kinds of occupations they held. Decorative skulls and brightly colored chrysanthemums are also present in the altars. This celebration is now creating a new phenomenon becoming our new Cinco de Mayo celebration in November.

All commercialism aside – traditionalist will be building their altars to honor their dead.  Should you be interested it is simple and easy to do.  Set up a table and cover it with items that could include:  Pan de Muerto (dead of the death bread), pumpkins, water, food/drinks (those favored by the dead family members, friends, loved ones), decorative paper items, candles, incense, a crucifix, sugar cane skulls, pictures the dead, and bright orange, red, or yellow cempasuchil or chrysanthemums.  Its said that the chrysanthemums are spread on the sidewalk leading to the house where the altar is to help lead the way for the deceased.  The chrysanthemums show them the way.

Enjoy you Day of the Dead! 

IMG_5252 IMG_5253 IMG_5254 IMG_5255

Posted by: gmontealegre | October 29, 2014

Daylight Savings Time – Nov 2

Time to change your clocks this weekend!!

 

http://www.timeanddate.com/time/dst/events.html

Posted by: gmontealegre | October 20, 2014

“Big Data”

HOW ‘BIG DATA’ IS TRANSFORMING TODAY’S HEALTHCARE SECTOR
MEIR RINDE | OCTOBER 15, 2014

from Spotlight

Correlating patient data from a broad variety of sources can help reveal patterns of illness, identify individuals most likely to use emergency services, cut healthcare costs, and improve patient outcomes

Aneesh Chopra, former chief technology officer for the federal government, believes that the value of data sources grows exponentially as new ones are added.
The term “Big Data” seems to be everywhere these days. It’s being used to describe how marketers learn about shopper’s preferences, security organizations pinpoint potential risks, and demographers identify major trends. But nowhere does the use of big data have more potential to impact our quality of life than in healthcare.

As electronic medical records become the norm, and computers and mobile devices become ubiquitous, crunching large volumes of digital records to enhance healthcare decision-making is now possible.

Researchers are demonstrating how inventive uses of data can reveal patterns of illness that were previously obscure. Some hospitals in New Jersey, Pennsylvania, and other states are getting better at identifying and treating the sickest members of their communities. Insurance companies are tracking patient data as part of new schemes to reward doctors financially for keeping people well.

In point of fact, “Big Data” is used to cover a wide range of disparate activities enabled by information technology, whether they involve sifting through hundreds of millions of records or only a few thousand. It includes the “hot spotting” of frequent emergency-room users innovated by Dr. Jeffrey Brenner in Camden; a hospital workflow that makes sure diabetes patients get scheduled blood tests; a mapping project by Princeton economist Janet Currie that shows how home foreclosures lead to increased hospital admissions; and a smartphone app that lets users look up product recalls, among many other efforts.

Click to see full-sized image.
Big data boosters say the field has great promise, with the potential to focus limited resources in ways that will improve the quality of patients’ lives, prevent needless deaths, and cut costs. At the same time, the productive use of data and analytics still faces a number of challenges, some of them unique to healthcare.

Privacy, in particular, is a concern. Current privacy laws often hamper research. Yet, some of the most cutting-edge public health research efforts and commercial ventures seek to “mash up” multiple sets of health records. This can put patients’ information to uses they never envisioned, employing information in ways that makes people uncomfortable.

A variety of solutions have been proposed for different kinds of privacy challenges, ranging from updated state and federal legislation to computer systems that allow data to be queried without revealing the subjects’ identities.

PATTERNS, PREDICTION, SURVEILLANCE

Healthcare organizations and researchers have been collecting and analyzing computer data for decades, but big data has gained currency as a buzzword only in the past two to three years. Experts refer to a new “volume, variety and velocity of data” that has resulted from the automated or large-scale collection of information — for example, from a wearable heart monitor — that allows real-time tracking and response.

Dr. Farzad Mostashari, the former national coordinator for health information technology at the U.S. Department of Health and Human Services, cited an early instance of relatively small “big data” from his work detecting disease outbreaks in New York 15 years ago.

While working for the Centers for Disease Control, he learned about the fire department’s records of ambulance calls, which were categorized by the problem described by the caller. While the information was scientifically unreliable “dirty data,” in the aggregate it showed “beautiful” patterns, like increases in respiratory calls at certain times.

The data turned out to reveal surges in flu cases well before individual doctors could become aware that something unusual was happening, Mostashari explained during a big data conference at Princeton University earlier this year.

Big data boosters say the field has the potential to focus limited resources in ways that will improve the quality of patients’ lives

“That was kind of my first exposure to this idea that you could take data, which is now electronic, because we had some sort of transactional system — and the data is being collected for some totally other purpose, right, to dispatch an ambulance — but if you could reuse and repurpose it and look for patterns within it, it might be useful,” he said.

At the very least, ambulance-call data could serve as an early-warning system, allowing hospitals to prepare for higher patient volume and public officials to broadcast advice on how to avoid getting sick. But for Mostashari and many others, the greater goal of big data work is prediction. They want to know who is likely to get sick, weeks or months in advance, so that interventions can be put in place and tested for effectiveness, and causes of illness can be studied in detail.

Predictive analytics is in its infancy and its long-term utility is unclear. At the clinical level, the term has been used to describe systems that monitor a premature baby’s vital signs and give earlier warnings of a new infection, for example. In the future, a computer might automatically adjust the baby’s medicine without a nurse’s intervention.

Danish Researchers Supersize Big Data, Analyze Nation’s Full Patient Registry
Working with medical records for more than 6 million people, Danish scientists uncover unknown disease patterns that could ultimately improve healthcare worldwide
In the United States, researchers can only dream of the ultimate health database — one that contains complete electronic records spanning decades for all Americans, allowing analysis of long-terms patterns of illness.

Read More ▶
A number of organizations are also researching ways to predict and prevent hospital readmissions, which are used as a measure of health quality. Providers with high readmission rates can be penalized by Medicare.

Geisinger Health System in Pennsylvania, an innovator in the advanced use of data, has studied the characteristics of readmitted patients and identified risk factors such as pulmonary disease, heart failure, and advanced age. Among patients with those factors, who also had a previous admission in the past year, fully half will die or end up back in the hospital within 30 days of being discharged, according to Dr. Jonathan Darer, Geisinger’s chief innovation officer.

But though Geisinger uses staff calls, robocalls, and home health visits to monitor certain sets of newly discharged patients, the organization is so far not using its findings on readmissions in a meaningful way, Darer said during a recent NJ Spotlight webinar on big data. It continues to analyze a long list of variables, including the patient’s home situation and other factors, in an effort to refine its predictive power.

Meanwhile Brenner, who has won plaudits and awards for pioneering uses of patient health records, criticizes health IT advocates who he calls “obsessed” with prediction. Instead of focusing on possible future illness, he says healthcare organizations should get better at surveillance, drilling down into data and building systems that alert them to current patients’ problems.

“So we want to know, ‘Tell me which person is going to be hospitalized three months from now so I can call them on the phone.’ Meanwhile, the hospital is full of sick people who’ve been back over and over and over,” Brenner said during the Princeton conference. “Or, this month there’s a women in Camden who’s been to the emergency room three times for sexually transmitted disease. No one is going to call her, no one is going to follow up, her primary care provider is unaware of it. So that’s a failure to surveil data.”

Brenner is best known for treating poor, chronically ill “super-utilizers” who generate astronomical medical costs. His organization, the Camden Coalition of Healthcare Providers, identifies them by looking at maps of ambulance calls or hospital admission records, or simply by asking doctors. Nurses and social workers visit those people and find out what they need — reminders to take medications, drug rehabilitation, or better housing, for example — and make sure they get it rather than repeatedly going to the emergency room for help.

Mostashari cited a similar effort at a San Diego hospital system that received a grant from the federal Beacon Community program to make better use of information technology. He said it achieved $8 million in savings by focusing on just 32 high-cost patients, including one woman who was continually calling for ambulances, according to the system’s records.

“They’d had 100 ambulance dispatches going to her house, and not a single transport,” he recalled. “No one had stopped to say, ‘And what happens when you go to her house?’ They said, ‘Usually we make her a sandwich.’ So they got her Meals on Wheels. It’s a lot cheaper than scrambling a rig.”

Click to see full-sized image.
Beacon hospital and others have also succeeded in improving health outcomes by installing and exploiting better communication and records systems. These may let ambulances send information about a patient ahead to the hospital, or keep a primary-care doctor in the loop when a patient sees another provider or visits the ER.

Such improvements are essential for the new accountable care organizations, or ACOs, that have sprung up since the passage of the Affordable Care Act. Hospitals and doctors in ACOs are paid for making sure members of their community undergo scheduled tests and stay well, particularly people with chronic conditions. Such systems require electronic health records, which often can be configured to send alerts to doctors, nurses, or even patients when gaps in care arise.

Digitizing ‘Bundles’ of Medical Procedures To Ensure Patients Get Complete Care
Geisinger Health System built a computer-based system that alerts nurses and other health practitioners when patients need to come in for tests, reducing so-called care gaps
Geisinger Health System began digitizing health records at its hospitals in rural Pennsylvania in the mid-1990s, well before most other providers. The system, which includes both providers and health plans, then created bundles of clinical care processes — a set of steps for every patient with a particular medical condition — and used its electronic records database as part of a reengineered workflow to make sure every step was followed.

Read More ▶
At Geisinger, doctors design care bundles for target populations, such as people with diabetes. A bundle includes specific items — vaccinations, blood-pressure readings, and glucose tests, for example — that nurses order up, or that the computer automatically turns into work orders for providers. In population after population — people with diabetes, coronary disease, osteoporosis, and other conditions — the system has resulted in better patient outcomes, Darer said.

MASHING UP DATA

Beyond the clinical setting, careful analysis of large datasets can also reveal global patterns of disease and help policymakers decide how to channel resources.

Optum, a leading health analytics firm, has done large-scale hot spotting for a number of states, including Maryland, which has been working to make its Medicaid program more efficient. For example, Optum discovered a high rate of emergency-room admissions for colds, a relatively minor illness, and found that one hospital accounted for most of the visits, said Dr. Lewis Sandy, the senior vice president for parent company UnitedHealth Group.

With that information, the state could encourage the hospital and those patients to manage their colds using less expensive alternatives to the emergency room.

In New Jersey the company created a statewide map down to the level of census tracts showing the prevalence of diabetes. That could be used to identify problems such as food deserts, where healthy food is hard to find, and drive improvements in program like Medicare and Medicaid, Sandy said.

“It’s not just data from the healthcare delivery system. You can actually use data from personal health records, patient surveys, from publicly available data, for example, from the U.S. Census, or from other government programs,” Sandy said during the NJ Spotlight webinar. “This information can be brought together to bring knowledge and insight to improve public health programs.”

At the cutting edge of big data mashups, developers combine public data with mobile devices to show where health problems are happening in real time.

To help people with respiratory conditions, the company Propeller Health created a device that attaches to an inhaler and uses publicly funded GPS signals to record where and when it is used, giving the patient a precise electronic record. In addition, officials in Louisville, Kentucky used the aggregate data to map out the worst locations for respiratory problems in their city and to examine how they corresponded to environmental factors. They then redeployed city resources to reduce air pollution.

Aneesh Chopra, the former chief technology officer for the federal government, cited the Louisville trial as an example of a project that can illuminate a health problem by generating and drawing on multiple sources of data.

“From a mathematical standpoint, the value of data isn’t one source itself — ‘Hey, this is a GPS source.’ It’s the mashup of multiple sources,” Chopra told the audience at the Princeton conference. “Adding one more data source on your proprietary data source doesn’t create value in a linear fashion, but actually creates value in an exponential fashion. So keep thinking about ways you can enhance or enrich your data with external data that is increasingly open.”

Greater openness about cost data is the goal of another growing movement within the healthcare sector. Insurance companies, either voluntarily or under legislative mandate, are increasingly releasing data on the actual amounts patients pay for different medical procedures, as well as measures of their outcomes.

More than a dozen states have or are creating all-payer claims databases (APCDs) so they can better understand the costs and quality of their healthcare systems. At the national level, three large insurers have given the Health Care Cost Institute cost data that consumers will be able to search using an online tool, and the organization recently won access to national Medicare claims data. Several universities have licensed the massive HCCI dataset so their faculty and students can use it for big data research.

BLURRY PRIVACY LINES

The ubiquity of electronic data collection and the power of high-speed computer analysis have created a remarkably rich resource for innovation, but have also challenged established notions of privacy and even the definition of health data.

A frequently cited example of the dangers of big data comes from a New York Times article about analytics efforts at Target, the department store chain. By analyzing purchases, the company can determine with fairly high certainty if a customer is pregnant, and then will send her coupons for baby-related products. In the widely publicized incident, an angry father complained that the store should not be sending his teenage daughter such advertisements, only to apologize later after he learned she actually was pregnant.

Target did not have access to the young woman’s medical records, but did have her purchase history and potentially a wealth of financial, demographic, and other information obtained from data brokers and public sources. It was thus able to discern facts that had been known only to the woman and possibly her doctor.

“A big part of the big data project is not just analyzing information, it’s creating information,” Julie Brill, a commissioner of the Federal Trade Commission, said at the Princeton conference. “From innocuous retail purchases, health information is created.”

Brill said the federal government set up rules to protect consumers’ confidential information in the 1990s through the Health Insurance Portability and Accountability Act (HIPAA), the Fair Credit Reporting Act, and other legislation, but the laws do not address a newer generation of companies and products that have sprung up since then.

Brill raised the spectre of companies using proprietary and public data to learn whether a specific individual has diabetes, cancer, or mental illness, possibly when the person is ignorant of his or her condition. Using information on car ownership and other data, search firms have guessed that families are obese or diabetic and asked them to join a medical trials, discomfiting some of those contacted, she said. Wearable devices like Fitbits record a user’s physical activity, but the person may not have complete control over how the data is used.

Even as privacy experts warn about gaps in legal protections, others chafe at existing restrictions that require patients to give explicit consent for most uses of their personal health information.

Janet Currie is the Henry Putnam Professor of Economics and Public Affairs at Princeton University and the Director of Princeton’s Center for Health and Well Being.
Princeton’s Currie has mashed up data from different sources to gain new insights. In addition to analyzing the relationship between foreclosures and poor health, another of her studies show correlations between flu season and premature birth.

In addition, the requirement that researchers use only deidentified data, from which names and other details have been removed, makes it difficult to do longitudinal studies that track super-utilizers or to review the effects of a drug over time, said Joel Cantor, director of the Center for State Health Policy at Rutgers.

For such projects a researcher needs to have all the hospital admission data for each particular person being studied. The deidentification efforts required exceed what understaffed and underfunded state agencies can do, he said.

“They said they no longer have the capacity to do that. We’re asking for too much,” Cantor said during the Princeton University conference.

A number of reforms and new systems have been suggested to ameliorate both privacy gaps and access problems.

To respond to concerns about how patient data is used, “baseline privacy legislation” is needed at the federal level, Brill said, while acknowledging such laws are not currently in the offing. HIPAA and other legislation could be amended to recognize that health data exists in places beyond clinical and insurance databases. Sound data management practices, risk analysis, privacy officers, and audits must be standard at any firm that handles sensitive information, she and other experts said.

To prevent privacy rules from handicapping data analysis, government agencies could use computer systems that let researchers submit statistical queries and get answers without possessing the data, said Edward Felten, a professor of computer science and public affairs at Princeton. Brill said the U.S. Census uses such a system and could serve as a model for others.

As for the use of personal information outside of traditional healthcare settings, Chopra argues for engaging patients and teaching them how to view their own data. He advocates a control-panel model in which people are encouraged to actively decide how they want their data used and can easily opt out of giving access.

Others argue more aggressively for releasing data, while using institutional review boards or ethics review committees to weigh the potential benefits and risks.

A recent Health Affairs article on ethical concerns in predictive analytics said patients should be included in the early stages of big data projects, but developers also “should be allowed to use already collected patient data without explicit consent, provided that they comply with federal regulations regarding research on human subjects and the privacy of health information.”

Meir Rinde is a freelance writer based in Philadelphia..

HOW ‘BIG DATA’ IS TRANSFORMING TODAY’S HEALTHCARE SECTOR
MEIR RINDE | OCTOBER 15, 2014

from Spotlight

Correlating patient data from a broad variety of sources can help reveal patterns of illness, identify individuals most likely to use emergency services, cut healthcare costs, and improve patient outcomes

Aneesh Chopra, former chief technology officer for the federal government, believes that the value of data sources grows exponentially as new ones are added.
The term “Big Data” seems to be everywhere these days. It’s being used to describe how marketers learn about shopper’s preferences, security organizations pinpoint potential risks, and demographers identify major trends. But nowhere does the use of big data have more potential to impact our quality of life than in healthcare.

As electronic medical records become the norm, and computers and mobile devices become ubiquitous, crunching large volumes of digital records to enhance healthcare decision-making is now possible.

Researchers are demonstrating how inventive uses of data can reveal patterns of illness that were previously obscure. Some hospitals in New Jersey, Pennsylvania, and other states are getting better at identifying and treating the sickest members of their communities. Insurance companies are tracking patient data as part of new schemes to reward doctors financially for keeping people well.

In point of fact, “Big Data” is used to cover a wide range of disparate activities enabled by information technology, whether they involve sifting through hundreds of millions of records or only a few thousand. It includes the “hot spotting” of frequent emergency-room users innovated by Dr. Jeffrey Brenner in Camden; a hospital workflow that makes sure diabetes patients get scheduled blood tests; a mapping project by Princeton economist Janet Currie that shows how home foreclosures lead to increased hospital admissions; and a smartphone app that lets users look up product recalls, among many other efforts.
Click to see full-sized image.
Big data boosters say the field has great promise, with the potential to focus limited resources in ways that will improve the quality of patients’ lives, prevent needless deaths, and cut costs. At the same time, the productive use of data and analytics still faces a number of challenges, some of them unique to healthcare.

Privacy, in particular, is a concern. Current privacy laws often hamper research. Yet, some of the most cutting-edge public health research efforts and commercial ventures seek to “mash up” multiple sets of health records. This can put patients’ information to uses they never envisioned, employing information in ways that makes people uncomfortable.

A variety of solutions have been proposed for different kinds of privacy challenges, ranging from updated state and federal legislation to computer systems that allow data to be queried without revealing the subjects’ identities.

PATTERNS, PREDICTION, SURVEILLANCE

Healthcare organizations and researchers have been collecting and analyzing computer data for decades, but big data has gained currency as a buzzword only in the past two to three years. Experts refer to a new “volume, variety and velocity of data” that has resulted from the automated or large-scale collection of information — for example, from a wearable heart monitor — that allows real-time tracking and response.

Dr. Farzad Mostashari, the former national coordinator for health information technology at the U.S. Department of Health and Human Services, cited an early instance of relatively small “big data” from his work detecting disease outbreaks in New York 15 years ago.

While working for the Centers for Disease Control, he learned about the fire department’s records of ambulance calls, which were categorized by the problem described by the caller. While the information was scientifically unreliable “dirty data,” in the aggregate it showed “beautiful” patterns, like increases in respiratory calls at certain times.

The data turned out to reveal surges in flu cases well before individual doctors could become aware that something unusual was happening, Mostashari explained during a big data conference at Princeton University earlier this year.

Big data boosters say the field has the potential to focus limited resources in ways that will improve the quality of patients’ lives

“That was kind of my first exposure to this idea that you could take data, which is now electronic, because we had some sort of transactional system — and the data is being collected for some totally other purpose, right, to dispatch an ambulance — but if you could reuse and repurpose it and look for patterns within it, it might be useful,” he said.

At the very least, ambulance-call data could serve as an early-warning system, allowing hospitals to prepare for higher patient volume and public officials to broadcast advice on how to avoid getting sick. But for Mostashari and many others, the greater goal of big data work is prediction. They want to know who is likely to get sick, weeks or months in advance, so that interventions can be put in place and tested for effectiveness, and causes of illness can be studied in detail.

Predictive analytics is in its infancy and its long-term utility is unclear. At the clinical level, the term has been used to describe systems that monitor a premature baby’s vital signs and give earlier warnings of a new infection, for example. In the future, a computer might automatically adjust the baby’s medicine without a nurse’s intervention.

Danish Researchers Supersize Big Data, Analyze Nation’s Full Patient Registry
Working with medical records for more than 6 million people, Danish scientists uncover unknown disease patterns that could ultimately improve healthcare worldwide
In the United States, researchers can only dream of the ultimate health database — one that contains complete electronic records spanning decades for all Americans, allowing analysis of long-terms patterns of illness.

Read More ▶
A number of organizations are also researching ways to predict and prevent hospital readmissions, which are used as a measure of health quality. Providers with high readmission rates can be penalized by Medicare.

Geisinger Health System in Pennsylvania, an innovator in the advanced use of data, has studied the characteristics of readmitted patients and identified risk factors such as pulmonary disease, heart failure, and advanced age. Among patients with those factors, who also had a previous admission in the past year, fully half will die or end up back in the hospital within 30 days of being discharged, according to Dr. Jonathan Darer, Geisinger’s chief innovation officer.

But though Geisinger uses staff calls, robocalls, and home health visits to monitor certain sets of newly discharged patients, the organization is so far not using its findings on readmissions in a meaningful way, Darer said during a recent NJ Spotlight webinar on big data. It continues to analyze a long list of variables, including the patient’s home situation and other factors, in an effort to refine its predictive power.

Meanwhile Brenner, who has won plaudits and awards for pioneering uses of patient health records, criticizes health IT advocates who he calls “obsessed” with prediction. Instead of focusing on possible future illness, he says healthcare organizations should get better at surveillance, drilling down into data and building systems that alert them to current patients’ problems.

“So we want to know, ‘Tell me which person is going to be hospitalized three months from now so I can call them on the phone.’ Meanwhile, the hospital is full of sick people who’ve been back over and over and over,” Brenner said during the Princeton conference. “Or, this month there’s a women in Camden who’s been to the emergency room three times for sexually transmitted disease. No one is going to call her, no one is going to follow up, her primary care provider is unaware of it. So that’s a failure to surveil data.”

Brenner is best known for treating poor, chronically ill “super-utilizers” who generate astronomical medical costs. His organization, the Camden Coalition of Healthcare Providers, identifies them by looking at maps of ambulance calls or hospital admission records, or simply by asking doctors. Nurses and social workers visit those people and find out what they need — reminders to take medications, drug rehabilitation, or better housing, for example — and make sure they get it rather than repeatedly going to the emergency room for help.

Mostashari cited a similar effort at a San Diego hospital system that received a grant from the federal Beacon Community program to make better use of information technology. He said it achieved $8 million in savings by focusing on just 32 high-cost patients, including one woman who was continually calling for ambulances, according to the system’s records.

“They’d had 100 ambulance dispatches going to her house, and not a single transport,” he recalled. “No one had stopped to say, ‘And what happens when you go to her house?’ They said, ‘Usually we make her a sandwich.’ So they got her Meals on Wheels. It’s a lot cheaper than scrambling a rig.”
Click to see full-sized image.
Beacon hospital and others have also succeeded in improving health outcomes by installing and exploiting better communication and records systems. These may let ambulances send information about a patient ahead to the hospital, or keep a primary-care doctor in the loop when a patient sees another provider or visits the ER.

Such improvements are essential for the new accountable care organizations, or ACOs, that have sprung up since the passage of the Affordable Care Act. Hospitals and doctors in ACOs are paid for making sure members of their community undergo scheduled tests and stay well, particularly people with chronic conditions. Such systems require electronic health records, which often can be configured to send alerts to doctors, nurses, or even patients when gaps in care arise.

Digitizing ‘Bundles’ of Medical Procedures To Ensure Patients Get Complete Care
Geisinger Health System built a computer-based system that alerts nurses and other health practitioners when patients need to come in for tests, reducing so-called care gaps
Geisinger Health System began digitizing health records at its hospitals in rural Pennsylvania in the mid-1990s, well before most other providers. The system, which includes both providers and health plans, then created bundles of clinical care processes — a set of steps for every patient with a particular medical condition — and used its electronic records database as part of a reengineered workflow to make sure every step was followed.

Read More ▶
At Geisinger, doctors design care bundles for target populations, such as people with diabetes. A bundle includes specific items — vaccinations, blood-pressure readings, and glucose tests, for example — that nurses order up, or that the computer automatically turns into work orders for providers. In population after population — people with diabetes, coronary disease, osteoporosis, and other conditions — the system has resulted in better patient outcomes, Darer said.

MASHING UP DATA

Beyond the clinical setting, careful analysis of large datasets can also reveal global patterns of disease and help policymakers decide how to channel resources.

Optum, a leading health analytics firm, has done large-scale hot spotting for a number of states, including Maryland, which has been working to make its Medicaid program more efficient. For example, Optum discovered a high rate of emergency-room admissions for colds, a relatively minor illness, and found that one hospital accounted for most of the visits, said Dr. Lewis Sandy, the senior vice president for parent company UnitedHealth Group.

With that information, the state could encourage the hospital and those patients to manage their colds using less expensive alternatives to the emergency room.

In New Jersey the company created a statewide map down to the level of census tracts showing the prevalence of diabetes. That could be used to identify problems such as food deserts, where healthy food is hard to find, and drive improvements in program like Medicare and Medicaid, Sandy said.

“It’s not just data from the healthcare delivery system. You can actually use data from personal health records, patient surveys, from publicly available data, for example, from the U.S. Census, or from other government programs,” Sandy said during the NJ Spotlight webinar. “This information can be brought together to bring knowledge and insight to improve public health programs.”

At the cutting edge of big data mashups, developers combine public data with mobile devices to show where health problems are happening in real time.

To help people with respiratory conditions, the company Propeller Health created a device that attaches to an inhaler and uses publicly funded GPS signals to record where and when it is used, giving the patient a precise electronic record. In addition, officials in Louisville, Kentucky used the aggregate data to map out the worst locations for respiratory problems in their city and to examine how they corresponded to environmental factors. They then redeployed city resources to reduce air pollution.

Aneesh Chopra, the former chief technology officer for the federal government, cited the Louisville trial as an example of a project that can illuminate a health problem by generating and drawing on multiple sources of data.

“From a mathematical standpoint, the value of data isn’t one source itself — ‘Hey, this is a GPS source.’ It’s the mashup of multiple sources,” Chopra told the audience at the Princeton conference. “Adding one more data source on your proprietary data source doesn’t create value in a linear fashion, but actually creates value in an exponential fashion. So keep thinking about ways you can enhance or enrich your data with external data that is increasingly open.”

Greater openness about cost data is the goal of another growing movement within the healthcare sector. Insurance companies, either voluntarily or under legislative mandate, are increasingly releasing data on the actual amounts patients pay for different medical procedures, as well as measures of their outcomes.

More than a dozen states have or are creating all-payer claims databases (APCDs) so they can better understand the costs and quality of their healthcare systems. At the national level, three large insurers have given the Health Care Cost Institute cost data that consumers will be able to search using an online tool, and the organization recently won access to national Medicare claims data. Several universities have licensed the massive HCCI dataset so their faculty and students can use it for big data research.

BLURRY PRIVACY LINES

The ubiquity of electronic data collection and the power of high-speed computer analysis have created a remarkably rich resource for innovation, but have also challenged established notions of privacy and even the definition of health data.

A frequently cited example of the dangers of big data comes from a New York Times article about analytics efforts at Target, the department store chain. By analyzing purchases, the company can determine with fairly high certainty if a customer is pregnant, and then will send her coupons for baby-related products. In the widely publicized incident, an angry father complained that the store should not be sending his teenage daughter such advertisements, only to apologize later after he learned she actually was pregnant.

Target did not have access to the young woman’s medical records, but did have her purchase history and potentially a wealth of financial, demographic, and other information obtained from data brokers and public sources. It was thus able to discern facts that had been known only to the woman and possibly her doctor.

“A big part of the big data project is not just analyzing information, it’s creating information,” Julie Brill, a commissioner of the Federal Trade Commission, said at the Princeton conference. “From innocuous retail purchases, health information is created.”

Brill said the federal government set up rules to protect consumers’ confidential information in the 1990s through the Health Insurance Portability and Accountability Act (HIPAA), the Fair Credit Reporting Act, and other legislation, but the laws do not address a newer generation of companies and products that have sprung up since then.

Brill raised the spectre of companies using proprietary and public data to learn whether a specific individual has diabetes, cancer, or mental illness, possibly when the person is ignorant of his or her condition. Using information on car ownership and other data, search firms have guessed that families are obese or diabetic and asked them to join a medical trials, discomfiting some of those contacted, she said. Wearable devices like Fitbits record a user’s physical activity, but the person may not have complete control over how the data is used.

Even as privacy experts warn about gaps in legal protections, others chafe at existing restrictions that require patients to give explicit consent for most uses of their personal health information.
Janet Currie is the Henry Putnam Professor of Economics and Public Affairs at Princeton University and the Director of Princeton’s Center for Health and Well Being.
Princeton’s Currie has mashed up data from different sources to gain new insights. In addition to analyzing the relationship between foreclosures and poor health, another of her studies show correlations between flu season and premature birth.

In addition, the requirement that researchers use only deidentified data, from which names and other details have been removed, makes it difficult to do longitudinal studies that track super-utilizers or to review the effects of a drug over time, said Joel Cantor, director of the Center for State Health Policy at Rutgers.

For such projects a researcher needs to have all the hospital admission data for each particular person being studied. The deidentification efforts required exceed what understaffed and underfunded state agencies can do, he said.

“They said they no longer have the capacity to do that. We’re asking for too much,” Cantor said during the Princeton University conference.

A number of reforms and new systems have been suggested to ameliorate both privacy gaps and access problems.

To respond to concerns about how patient data is used, “baseline privacy legislation” is needed at the federal level, Brill said, while acknowledging such laws are not currently in the offing. HIPAA and other legislation could be amended to recognize that health data exists in places beyond clinical and insurance databases. Sound data management practices, risk analysis, privacy officers, and audits must be standard at any firm that handles sensitive information, she and other experts said.

To prevent privacy rules from handicapping data analysis, government agencies could use computer systems that let researchers submit statistical queries and get answers without possessing the data, said Edward Felten, a professor of computer science and public affairs at Princeton. Brill said the U.S. Census uses such a system and could serve as a model for others.

As for the use of personal information outside of traditional healthcare settings, Chopra argues for engaging patients and teaching them how to view their own data. He advocates a control-panel model in which people are encouraged to actively decide how they want their data used and can easily opt out of giving access.

Others argue more aggressively for releasing data, while using institutional review boards or ethics review committees to weigh the potential benefits and risks.

A recent Health Affairs article on ethical concerns in predictive analytics said patients should be included in the early stages of big data projects, but developers also “should be allowed to use already collected patient data without explicit consent, provided that they comply with federal regulations regarding research on human subjects and the privacy of health information.”

Meir Rinde is a freelance writer based in Philadelphia..

Study Shows Changing Migration Flows between Latin America, Caribbean and European Union

Belgium – A European Union (EU)-funded IOM study released today on migratory flows in Latin America and the Caribbean (LAC), and between LAC and the EU, shows a marked increase in migration from the EU to LAC and a marked decrease in the number of LAC migrants entering the EU.

The study attributes the shift to the economic crisis affecting the EU, and in particular Spain, the main destination country for LAC nationals.

According to the report, in 2008 and 2009, more than 107,000 Europeans, including dual nationals, left their home countries to live in a LAC country.  Most went to Brazil, Argentina, Venezuela and Mexico. The main source countries were Spain (47,701), Germany (20,926), Netherlands (17,168) and Italy (15,701).

According to the report, the largest group were young, single Spanish and Portuguese men with higher levels of education in social sciences or civil engineering, who emigrated to LAC countries hoping to advance their careers.

While the study confirms that migratory flows from LAC countries to the EU have gradually increased since 2000, they decreased from a peak of some 400,000 in 2006 to 229,000 in 2009.

But it notes that almost 4.29 million people from LAC countries still reside in the EU, notably in Spain, the United Kingdom, the Netherlands, Italy and France, and almost 1.25 million EU citizens are currently living in LAC countries.

The study also highlights the importance of intra-regional migration. It notes that over four million migrants residing in LAC come from another country in the region. Most come from Colombia, Nicaragua, Paraguay, Haiti, Chile, Argentina and Bolivia.

The main countries of destination for intra-regional migrants are Argentina, Venezuela, Costa Rica and the Dominican Republic.

Touching on the link between migration and development, the study notes that women in particular have been pioneers in migration from LAC to the EU, and the remittances they send back to their families in their home countries have been essential to development in the region.

Remittances from the EU to the Community of Latin American and Caribbean States (CELAC) reached USD 7.25 billion in 2010. Those from CELAC to the EU were USD 4.66 billion.

Remittance flows inside the CELAC region reached USD 4.57 billion in 2010, with Colombia, Nicaragua and Paraguay benefiting most from remittances sent by their nationals working in Venezuela, Costa Rica and Argentina.

The report, “Migratory routes and dynamics among Latin America and Caribbean countries (LAC) and between LAC and the European Union,” is intended to serve as a primary reference to further understanding of migratory dynamics, characteristics and trends in and between the two regions.

The study is published as part of a project: “Strengthening the dialogue and cooperation between the European Union (EU) and Latin America and the Caribbean (LAC) to establish management models on migration and development policies” implemented by IOM, in partnership with the International and Ibero American Foundation for Administration and Public Policy (FIIAPP).

Posted by: gmontealegre | September 8, 2014

LATIN AMERICAN IMPACT ON THE FOOD WE EAT – Reception Sept 18

Edible History:

How Latin American Food Evolved and Transformed the World

Food and cooking are at the heart of every culture. Latin American food ways incorporate cacao beans indigenous, European, African and Asian influences. This year’s exhibit looks at the history and cultures of Latin America though the lens of food. It explores the origins of its cuisines; examines the economic, cultural and political impact that major Latin American foodstuffs – cacao, potatoes, peanuts, corn, etc. – have had worldwide; and looks at the ways in which Latin American food has influenced cuisine in the United States.

OPENING RECEPTION
September 18 Thursday, 6 pm Centennial Hall

Culinary historian, chef and author, Maricel Presilla will present the keynote address at the opening of the 2014 Hispanic Heritage Celebration. Dr. Presilla is the chef and co-owner of Cucharamama and Zafra, two pan-Latin restaurants in Hoboken, New Jersey. She is also the president of Gran Cacao Company, a Latin American food research and marketing company. Her books, The New Taste of Chocolate: A Cultural and Natural History of Cacao and Gran Cocina Latina: The Food of Latin America, narrate the cultural history of chocolate and explore the vast culinary landscape of the Latin world. Dr. Presilla’s talk will be followed by a musical performance and previews of upcoming Edible History programs.

For additional information, please call 973–733–7772 (Sala Hispanoamericana) or email ibetancourt@npl.org.

The Newark Public Library – 5 Washington St. – Newark, NJ – http://www.npl.org
__________________________
Directions to the Newark Library: http://www.npl.org/Pages/AboutLibrary/directions.html

Please feel free to share this information with your personal and professional networks.

WE LOOK FORWARD TO SEEING YOU AT THE LIBRARY ON SEPT 18!

Ingrid Betancourt
Director, NJ Hispanic Research & Information Center
@ The Newark Public Library
5 Washington Street
Newark, NJ 07102
973.733.3637
973.733.5759 -fax
http://www.npl.org
njhric.npl.org

For Immediate Release: Contact: Steve Schapiro
August 29, 2014 609.530.4280

Motorists should expect more traffic on Pulaski alternate routes
with the start of school next week
Commuters encouraged to adjust travel times
and consider alternate routes and modes

(Trenton) – New Jersey Department of Transportation (NJDOT) officials today issued a reminder that school will be back in session next week, and with the Pulaski Skyway northbound lanes closed for rehabilitation there could be additional traffic on the alternate routes.

Motorists are encouraged to use public transit, start their trip earlier to avoid the peak hours, or take the New Jersey Turnpike Extension for a faster trip.
Public Transit
This is the best way to avoid lane closure impacts and increased traffic congestion. In addition to existing bus, rail and ferry service, NJ Transit has added capacity on rail and bus routes. Commuters arriving at Hoboken Terminal via NJ Transit rail or bus have multiple options. Visit http://www.njtransit.com/images/stationmaps/63samap.jpg

Rail:
· Additional train trips or seating capacity is available on the Morris & Essex, Raritan Valley, and North Jersey Coast lines
· Hudson-Bergen Light Rail operates daily from 5 a.m. to 1 a.m.. For information visit http://www.njtransit.com

Bus:
· There is capacity on the Route 22 Express Bus #95 to Newark Penn Station
· NJ Transit expanded midday service on Bus #119 from Bayonne to Jersey City where customers can access PATH, or continue on to Hoboken and Manhattan.
· Check http://www.njtransit.com for schedule information.

Ferry Service:
For ferry service from Atlantic Highlands or Belford to Jersey City, Hoboken, or Manhattan visit http://www.nywaterway.com or http://www.seastreak.com

Alternate Routes
· The eastbound shoulder of the New Jersey Turnpike Newark Bay-Hudson County Extension (I-78), Exits 14-14C, is used as a travel lane during peak hours (6 a.m. to 10 a.m. and 3 p.m. to 7 p.m. weekdays.) Overhead signs indicate when the shoulder is open for traffic.
· An Adaptive Signal System helps northbound traffic flow on Route 1&9 and Route 440.

Pulaski Skyway Ramp Closures—follow detours
· The Kearny and Broadway center ramps are closed on the Skyway. Follow detour signs.
· In Newark, the ramps from Raymond Boulevard to the NJ Turnpike at Exit 15E and
Doremus Avenue are closed. Use the Foundry Street detour.

Stay informed
Commuters should learn the multiple public transportation options and alternate driving routes that are available to them, and be prepared to try several options to find the route or mode of travel that best meets their needs while minimizing inconvenience.
NJDOT has developed a webpage dedicated to the $1 billion Pulaski Skyway rehabilitation project at http://www.pulaskiskyway.com, where a video to familiarize motorists and residents with the project is posted. The video is also on You Tube – search “Pulaski Skyway.”
Follow the project on Twitter @skywayrehab and get up to the minute information on traffic conditions in and around the Skyway at http://www.511nj.org, where a widget will enable a visitor to cut through all the other traffic information on the site and focus in on the Skyway region.

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