Tuesday 29 October 2013 - 1am PST
Women who experience physical, mental or sexual abuse at the hands of their partners have an increased likelihood of being food insecure. That's according to a new study out of the University of Houston Texas Obesity Research Center (TORC), which may prove valuable to those creating interventions for those populations.
"The bridge between the two issues is depression," said assistant professor and TORC researcher Daphne Hernandez. "Our study found that women experiencing intimate partner violence are more likely to be depressed, which impacts their ability to ensure a food-secure household."
According to the U.S. Department of Agriculture (USDA) Core Food Security Module, "food insecurity" reflects rationing, portion control and inability to offer families balanced meals.
Hernandez followed data from nearly 1,700 women involved in a romantic relationship (married or cohabitating with a partner) who also had experienced intimate partner violence (physical, mental and/or sexual).
She found that mothers who experienced intimate partner violence were at 44 percent greater odds of experiencing depression. Additionally, households in which mothers experienced depression were twice as likely to experience food insecurity.
"It appears that depression may impact mothers' motivation to obtain and prepare food due to their decreased appetite, mental and physical fatigue and feelings of being overwhelmed," she said. "Additionally the moms' feelings of helplessness, brought on by the violence they experienced, may challenged them to access the proper support."
Hernandez studies the impact of family dynamics on nutrition, health and obesity. She says few studies have examined how maternal health challenges impact a household's food security. The goal of this study was to increase the understanding of how the family environment and women's health impact the lives of families with young children. She says this information may prove valuable for those organizations charged with supporting families in times of crisis.
"What this means is that targeting issues central to women's health must become a priority in combating food insecurity," Hernandez said. "Providing mental health screenings at the time individuals apply for food assistance may help identify women who need interventions to keep them safe, mental healthy and food secure."
The study is published online in the Journal of Women's Health.
http://www.medicalnewstoday.com/releases/267980.php
Tuesday, October 29, 2013
Poverty in childhood linked to brain size
A new study suggests that poverty in early childhood appears to be associated with smaller brain volumes measured through imaging atschool age and early adolescence.
Poverty is known to be associated with a higher risk of poor cognitive outcomes and school performance, according to the study background.
Joan Luby, M.D., of the Washington University School of Medicine, St. Louis, and colleagues investigated the effect of poverty on brain development by examining white and cortical gray matter, as well as hippocampus and amygdala volumes in a group of children ages 6 to 12 years who were followed since preschool.
The 145 children were recruited from a larger group of children who participated in a preschooldepression study.
The authors reported that "exposure to poverty during early childhood is associated with smaller white mater, cortical gray matter, and hippocampal and amygdala volumes."
Study findings also indicate that the effects of poverty on hippocampal volume were mediated (influenced) by caregiving and stressful life events.
The study is published by JAMA Pediatrics, a JAMA Network publication.
Wednesday, October 23, 2013
NEJM on uninsured patients
@NEJM: An uninsured man is diagnosed w/ metastatic cancer. Like thousands of Americans, he will die for lack of insurance. http://t.co/jSMlwZe6fE
“Shocked” wouldn't be accurate, since we were accustomed to our uninsured patients' receiving inadequate medical care. “Saddened” wasn't right, either, only pecking at the edge of our response. And “disheartened” just smacked of victimhood. After hearing this story, we were neither shocked nor saddened nor disheartened. We were simply appalled.
We met Tommy Davis in our hospital's clinic for indigent persons in March 2013 (the name and date have been changed to protect the patient's privacy). He and his wife had been chronically uninsured despite working full-time jobs and were now facing disastrous consequences.
The week before this appointment, Mr. Davis had come to our emergency department with abdominal pain and obstipation. His examination, laboratory tests, and CT scan had cost him $10,000 (his entire life savings), and at evening's end he'd been sent home with a diagnosis of metastatic colon cancer.
The year before, he'd had similar symptoms and visited a primary care physician, who had taken a cursory history, told Mr. Davis he'd need insurance to be adequately evaluated, and billed him $200 for the appointment. Since Mr. Davis was poor and ineligible for Kentucky Medicaid, however, he'd simply used enemas until he was unable to defecate. By the time of his emergency department evaluation, he had a fully obstructed colon and widespread disease and chose to forgo treatment.
Mr. Davis had had an inkling that something was awry, but he'd been unable to pay for an evaluation. As his wife sobbed next to him in our examination room, he recounted his months of weight loss, the unbearable pain of his bowel movements, and his gnawing suspicion that he had cancer. “If we'd found it sooner,” he contended, “it would have made a difference. But now I'm just a dead man walking.”
For many of our patients, poverty alone limits access to care. We recently saw a man with AIDS and a full-body rash who couldn't afford bus fare to a dermatology appointment. We sometimes pay for our patients' medications because they are unable to cover even a $4 copayment. But a fair number of our patients — the medical “have-nots” — are denied basic services simply because they lack insurance, and our country's response to this problem has, at times, seemed toothless.
In our clinic, uninsured patients frequently find necessary care unobtainable. An obese 60-year-old woman with symptoms and signs of congestive heart failure was recently evaluated in the clinic. She couldn't afford the echocardiogram and evaluation for ischemic heart disease that most internists would have ordered, so furosemide treatment was initiated and adjusted to relieve her symptoms. This past spring, our colleagues saw a woman with a newly discovered lung nodule that was highly suspicious for cancer. She was referred to a thoracic surgeon, but he insisted that she first have a PET scan — a test for which she couldn't possibly pay.
However unconscionable we may find the story of Mr. Davis, a U.S. citizen who will die because he was uninsured, the literature suggests that it's a common tale. A 2009 study revealed a direct correlation between lack of insurance and increased mortality and suggested that nearly 45,000 American adults die each year because they have no medical coverage.1 And although we can't confidently argue that Mr. Davis would have survived had he been insured, research suggests that possibility; formerly uninsured adults given access to Oregon Medicaid were more likely than those who remained uninsured to have a usual place of care and a personal physician, to attend outpatient medical visits, and to receive recommended preventive care.2 Had Mr. Davis been insured, he might well have been offered timely and appropriate screening for colorectal cancer, and his abdominal pain and obstipation would surely have been urgently evaluated.
Elected officials bear a great deal of blame for the appalling vulnerability of the 22% of American adults who currently lack insurance. The Affordable Care Act (ACA) — the only legitimate legislative attempt to provide near-universal health coverage — remains under attack from some members of Congress, and our own two senators argue that enhancing marketplace competition and enacting tort reform will provide security enough for our nation's poor.
In discussing (and grieving over) what has happened to Mr. Davis and our many clinic patients whose health suffers for lack of insurance, we have considered our own obligations. As some congresspeople attempt to defund Obamacare, and as some states' governors and attorneys general deliberate over whether to implement health insurance exchanges and expand Medicaid eligibility, how can we as physicians ensure that the needs of patients like Mr. Davis are met?
First, we can honor our fundamental professional duty to help. Some have argued that the onus for providing access to health care rests on society at large rather than on individual physicians,3 yet the Hippocratic Oath compels us to treat the sick according to our ability and judgment and to keep them from harm and injustice. Even as we continue to hope for and work toward a future in which all Americans have health insurance, we believe it's our individual professional responsibility to treat people in need.
Second, we can familiarize ourselves with legislative details and educate our patients about proposed health care reforms. During our appointment with Mr. Davis, he worried aloud that under the ACA, “the government would tax him for not having insurance.” He was unaware (as many of our poor and uninsured patients may be) that under that law's final rule, he and his family would meet the eligibility criteria for Medicaid and hence have access to comprehensive and affordable care.
Finally, we can pressure our professional organizations to demand health care for all. The American College of Physicians, the American Medical Association, and the Society of General Internal Medicine have endorsed the principle of universal health care coverage yet have generally remained silent during years of political debate. Lack of insurance can be lethal, and we believe our professional community should treat inaccessible coverage as a public health catastrophe and stand behind people who are at risk.
Seventy percent of our clinic patients have no health insurance, and they are all frighteningly vulnerable; their care is erratic, they are disqualified from receiving certain preventive and screening measures, and their lack of resources prevents them from participating in the medical system. And this is not a community- or state-specific problem. A recent study showed that underinsured patients have higher mortality rates after myocardial infarction,4 and it is well documented that our country's uninsured present with later-stage cancers and more poorly controlled chronic diseases than do patients with insurance.5 We find it terribly and tragically inhumane that Mr. Davis and tens of thousands of other citizens of this wealthy country will die this year for lack of insurance.
Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.
This article was published on October 23, 2013, at NEJM.org.
SOURCE INFORMATION
From the Department of Medicine, University of Louisville School of Medicine, Louisville, KY.
Thursday, October 17, 2013
Food insecurity still a problem for many
America might be the bread basket of the world, but many Americans are hungry. Many families are coping with food insecurity, which means they are unable to acquire or are uncertain of having enough food to meet their needs because of insufficient money or other resources. The latest report from the U.S. Department of Agriculture on household food security paints a sobering picture:
- Almost 15 percent (17.6 million) of U.S. households were food insecure during 2012.
- Of these, 8.8 percent (10.7 million) of households had low food security, which means they must use coping strategies, such as eating less varied diets, participating in federal food assistance programs or relying on emergency food from community food pantries, to meet their food needs.
- In food-insecure households, 5.7 percent (7.0 million) had very low food security. Very low food security means food intake was disrupted and food intake was reduced because of limited resources — typically, for at least several days during 7 months of last year.
- Ten percent of households (3.9 million) were unable to provide adequate nutritious food for their children.
- An estimated 38 percent of households with very low food security included an adult with disability, such as being unable to work.
What is even more sobering is that the prevalence of food insecurity has remained unchanged — and at record levels — since 2007.
This resonates with me. I grew up with depression-era parents who experienced food insecurity. My father told me about growing up in a dirt-floor log cabin without running water. More often than not, their cupboards were bare. I also had a disabled brother who was unable to physically shop for and prepare meals and thus needed to rely on me and others for help. I was a preteen when the "War on Poverty" was declared in 1964 in the U.S.
Many causes contribute to poverty and hunger, including lack of jobs, lack of education, crime, broken families and disability. Federal programs to fight poverty include Medicare, Medicaid, the Civil Rights Act, as well as food programs including Women, Infants and Children, and the Supplemental Nutritional Assistance Program.
One can argue the pros and cons of a top-down government approach to solving hunger, but I don't want to get into the politics. Instead, I'd like to focus on what we can all to do to fight hunger. Here are a few simple steps you and I can take:
- Know your neighbor. Reach out to those around you who might be in need.
- Donate food whenever you shop. Many grocery stores put out collection bins — as do churches, workplaces and schools.
- Give money to food banks. Even small amounts go a long way.
- Volunteer your time. Sign up to make dinners at homeless shelters or senior centers, or deliver meals on wheels.
- Garden and donate. Give part of your harvest to your local food bank. If you don't have a garden, volunteer to help with a community plot dedicated to fighting hunger.
When you get beyond just thinking about the problem and begin actually doing something about it you can make a difference. You can start by adding your own suggestions to the list above.
There are many ways to fight hunger — please get involved.
Thank you,
Jennifer
http://www.mayoclinic.com/health/food-insecurity/MY02570/?6552299=1blog indexMayo Clinic products and servicesSunday, October 13, 2013
Why U.S. Health Care Is Obscenely Expensive, In 12 Charts
http://www.huffingtonpost.com/2013/10/03/health-care-costs-_n_3998425.html?utm_hp_ref=tw
The U.S. leads the world in health care spending, but we don't live very long, and going to the doctor is so expensive that we don't do it very often. So where is the money going?
Not toward obesity-related diseases or unnecessary tests and treatments, as the writer John Green pointed out in a recent video explainer. From Lipitor to childbirth to colonoscopies -- everything just costs a whole lot.
As congressional Republicans continue to keep the federal government closedfollowing misguided attempts to defund the most significant health care reform in decades, here are some illustrations of the wasteful spending.
Friday, October 11, 2013
Chester Eastside Ministries Report to Stakeholders - October 10, 2013
From the Chester Eastside Ministries Board
As God spoke through the prophet Isaiah (Isaiah 43:19) and promised to "do a new thing" in the life of the children of Israel during difficult times in their history, God has also spoken to Chester Eastside Ministries in the midst of dwindling resources and an aging building. The Board of Chester Eastside Ministries with assist from others is developing a Strategic Plan which will lead us into the future. New Things can happen in new ways through the power of The Spirit and we ask you to join us as we remain open to work in new ways.
Chester Eastside Ministries Report to Stakeholders
October 10, 2013
As of January 1, 2014, Chester Eastside Ministries will enter upon a new phase in its
many-year history of providing essential services to the people of Chester, as it becomes an independent organization. This report is an update on where we have come, where we stand, and the way forward.
By enabling people throughout Delaware and Chester Counties to serve others through their volunteer efforts, we have enriched the giver as well as those given to.
In these data-driven days, our supporters as well as funding organizations ask the
question: Is it doing any good? We know from countless comments from the people whose lives we have touched that yes, a great deal of good. Young people have gotten their start in our afterschool program and gone on to college and, in one case, doctoral study. And we continue to seek more systematic evidence of the effects of our work.
Research findings on the After-school Program have documented the positive impact of
the program. Behavior problems became less, and self-esteem, work habits, and positive social behavior improved. The positive trends steadily improved, the longer youth were in the program. School grades also improved over the course of the program with no one having less than a “B” by the end of the year.
Evaluations of the Parents First program have found gains in parenting practices,
increased educational activity at home, and constructive engagement with teachers. Children showed gains in vocabulary, reading and math skills, and discipline. These gains were still evident months after the end of the program.
Currently, Chester Eastside Ministries raises approximately 70% of its revenue for
programs and base operations, the remainder being provided by the Presbytery. The condition of the aging building, which is owned by the Presbytery, has been an object of growing concern.
Where we stand today.
After-School Program
This program provides everything from homework help to healthy recreation for 30
children aged 6 to12. To the children, many of the activities may seem to be just a fun time with their peers. In reality, they are developing the kinds of qualities, such as a “can do” attitude, leadership and cooperation, persistence on task, and resilience, that can make the difference between success and failure in school and beyond.
and crafts, swimming, and special trips. In particular, it means a widening of horizons beyond the child’s immediate world.
The report below covers where we have come, where things now stand, and our way forward. As you will see on page 2, our programs are being reopened in this coming week. It will take a while to get settled in our new quarters; but we are confident about the future. We greatly appreciate the support and encouragement that we have received from a great number of individuals, churches and organizations. Please pass this statement on to others who may be interested. And please let your church or other organizations know that we are in need of their continued support. Also, please contact Rev. Bernice Warren if you have any questions or to invite us to meet with your Outreach Committee or other groups (RevBerniceWarren@
As God spoke through the prophet Isaiah (Isaiah 43:19) and promised to "do a new thing" in the life of the children of Israel during difficult times in their history, God has also spoken to Chester Eastside Ministries in the midst of dwindling resources and an aging building. The Board of Chester Eastside Ministries with assist from others is developing a Strategic Plan which will lead us into the future. New Things can happen in new ways through the power of The Spirit and we ask you to join us as we remain open to work in new ways.
Chester Eastside Ministries Report to Stakeholders
October 10, 2013
As of January 1, 2014, Chester Eastside Ministries will enter upon a new phase in its
many-year history of providing essential services to the people of Chester, as it becomes an independent organization. This report is an update on where we have come, where we stand, and the way forward.
Where we have come.
Chester Eastside Ministries has for many years fulfilled a necessary and most urgently
needed
function in Chester, in order to realize its Christian mission. Its provision
of emergency food and clothing to those in want, education and cultural enrichment
to help young and old realize their full potential, its nurture of the spirit,
and its forthright advocacy for social justice are well known and valued in
Chester and far beyond its borders. Chester Eastside Ministries has for many years fulfilled a necessary and most urgently
By enabling people throughout Delaware and Chester Counties to serve others through their volunteer efforts, we have enriched the giver as well as those given to.
A
critical factor in our ability to fulfill this role over the years has been the
support of the
Presbytery
of Philadelphia, including the former church building out of which we have
operated. In recent years, this support has declined significantly, at a time
when the Presbytery was facing major economic challenges of its own.In these data-driven days, our supporters as well as funding organizations ask the
question: Is it doing any good? We know from countless comments from the people whose lives we have touched that yes, a great deal of good. Young people have gotten their start in our afterschool program and gone on to college and, in one case, doctoral study. And we continue to seek more systematic evidence of the effects of our work.
Research findings on the After-school Program have documented the positive impact of
the program. Behavior problems became less, and self-esteem, work habits, and positive social behavior improved. The positive trends steadily improved, the longer youth were in the program. School grades also improved over the course of the program with no one having less than a “B” by the end of the year.
Evaluations of the Parents First program have found gains in parenting practices,
increased educational activity at home, and constructive engagement with teachers. Children showed gains in vocabulary, reading and math skills, and discipline. These gains were still evident months after the end of the program.
Currently, Chester Eastside Ministries raises approximately 70% of its revenue for
programs and base operations, the remainder being provided by the Presbytery. The condition of the aging building, which is owned by the Presbytery, has been an object of growing concern.
Where we stand today.
On
September 24, Chester Eastside Ministries and the Presbyterian Community
Ministries
of the Delaware Valley (PCMDV), the body created by the Philadelphia Presbytery
in 2007 to oversee its urban mission programs, agreed to terminate their
current relationship. In order to assist us in making a smooth transition to
our new status, PCMDV has agreed to allow Chester Eastside Ministries to
continue to use its tax-exempt status under 501(c)(3) and its registration with
the Pennsylvania Bureau of Charitable Organizations, until such time as Chester
Eastside Ministries is able to acquire these on its own.
In
mid-September, Chester Eastside Ministries faced a different challenge: The
building it has occupied for many years has been found to have major structural
problems, moving the Trustees of the Presbytery to close it to further use
pending an assessment of the potential for salvaging parts of the property.
This forced us to seek other locations to carry on our programs in the interim.
Aside from the disruption of the ongoing emergency food and clothing programs
that serve hundreds, this new crisis came just as our after-school and adult education
programs and Parents First, the workshop series for parents of children in the
early grades, were about to begin.
We are happy to report that, thanks to the generous support from other Chester
We are happy to report that, thanks to the generous support from other Chester
organizations,
we have found “foster homes” for all our major programs, and they will all soon
be up and running. The Food and Clothing Ministries and the After-School
Program will be operating out of St. Paul’s Episcopal Church, located a short
distance away on East 9th Street.
We will also have the use of office space there. Parents First will be at the Boys and Girls Club of Chester. The Adult Ed/GED Program is up and running at the Chester Student Center, at West 9th and Kerlin Streets.
The way forward.
While coping with these immediate challenges, Chester Eastside Ministries has been
We will also have the use of office space there. Parents First will be at the Boys and Girls Club of Chester. The Adult Ed/GED Program is up and running at the Chester Student Center, at West 9th and Kerlin Streets.
The way forward.
While coping with these immediate challenges, Chester Eastside Ministries has been
engaged
in long-term strategic planning so that it can continue to pursue its mission
and develop its potential in new ways. This work has been aided by Jim Leming,
a private consultant.
A major first step has been to revisit our mission statement and make sure that it
A major first step has been to revisit our mission statement and make sure that it
expresses
what we do, what we don’t do, and what is distinctive about CEM.
Three
task forces, made up of Board members and stakeholders, have been at work since
summer on these strategic imperatives:
Operations
and oversight.
o Organizing
our resources for maximum effectiveness.
o Delegation
of responsibilities and accountability.
o Creation
and documentation of standard procedures.
o Obtaining
and organizing data regarding our programs and their impact on target populations.
o Managing our volunteer resources.
o Managing our volunteer resources.
Outreach
and collaboration.
o
Networking
with stakeholders and potential partners.
o
Formulating
our message and spreading it through means ranging from direct contacts to mass
media.
Building
and funding issues.
o Researching potential future sites, including the possibility of using structurally sound parts of the present building.
o Developing strategies for generating sustainable sources of revenue
o Researching potential future sites, including the possibility of using structurally sound parts of the present building.
o Developing strategies for generating sustainable sources of revenue
Our
many stakeholders and supporters will continue to play a critical role as we
move
into
a new phase of our long history as an essential resource to the people of
Chester.
Program descriptions:
Food and Clothing Ministries
The longest running of all our programs, the Food Ministry provides an essential service
to
an average of 200 adults and children per month. It is one of the largest such
operations in Delaware County. Beyond providing bags of groceries, including
fresh produce, the Food Ministry is a welcoming place, offering a cup of
coffee, a hot meal, and a word of support to people, many of whom feel
abandoned and alone.Food and Clothing Ministries
The longest running of all our programs, the Food Ministry provides an essential service
The
Clothing Ministry is another essential service for those most in need. Again,
the
human
touch is in many ways as important as the tangible service. It is often through
the Food and Clothing Ministries that people learn about other programs
at Chester Eastside Ministries, programs that not only accept people whatever
their circumstances but help them fulfill their true potential.After-School Program
This program provides everything from homework help to healthy recreation for 30
children aged 6 to12. To the children, many of the activities may seem to be just a fun time with their peers. In reality, they are developing the kinds of qualities, such as a “can do” attitude, leadership and cooperation, persistence on task, and resilience, that can make the difference between success and failure in school and beyond.
Adult Education/GED
Typically,
ten adults attend each session of our adult literacy and GED program. The GED
(General Education Development) tests allow a person who has dropped out of
school to earn a high school diploma or its equivalent. A number of people who
have earned their GED have gone on to attend post-graduate programs. There are
some who are still working on basic reading and math skills.
One
of the features of the Chester Eastside Ministries Adult Ed program is a
one-page summary of the day’s news. It is useful in giving students an
opportunity to link what they are learning in class with breaking news, sports,
and weather that they pick up on TV and radio. The news summary is shared with
other programs and teachers who request it.
Parents First
This
ten-week workshop series helps 20 to 25 parents of children in grades
prekindergarten through three to support their children’s success in school. It
has been shown to bring about changes in parenting practices and involvement in
the children’s education, as well as, students’ progress in school.
Summer Day Camp
Through
this program, 40 children are afforded a wide range of activities, including
artsand crafts, swimming, and special trips. In particular, it means a widening of horizons beyond the child’s immediate world.
Thursday, October 10, 2013
Data Discrimination Means the Poor May Experience a Different Internet - MIT Tech Review
A Microsoft researcher proposes “big data due process” so citizens can learn how data analytics were used against them.
Data analytics are being used to implement a subtle form of discrimination, while anonymous data sets can be mined to reveal health data and other private information, a Microsoft researcher warned this morning at MIT Technology Review’s EmTechconference.
Kate Crawford, principal researcher at Microsoft Research, argued that these problems could be addressed with new legal approaches to the use of personal data.
In a new paper, she and a colleague propose a system of “due process” that would give people more legal rights to understand how data analytics are used in determinations made against them, such as denial of health insurance or a job. “It’s the very start of a conversation about how to do this better,” Crawford, who is also a visiting professor at the MIT Center for Civic Media, said in an interview before the event. “People think ‘big data’ avoids the problem of discrimination, because you are dealing with big data sets, but in fact big data is being used for more and more precise forms of discrimination—a form of data redlining.”
During her talk this morning, Crawford added that with big data, “you will never know what those discriminations are, and I think that’s where the concern begins.”
Health data is particularly vulnerable, the researcher says. Search terms for disease symptoms, online purchases of medical supplies, and even the RFID tags on drug packaging can provide websites and retailers with information about a person’s health.
As Crawford and Jason Schultz, a professor at New York University Law School, wrote in their paper: “When these data sets are cross-referenced with traditional health information, as big data is designed to do, it is possible to generate a detailed picture about a person’s health, including information a person may never have disclosed to a health provider.”
And a recent Cambridge University study, which Crawford alluded to during her talk, found that “highly sensitive personal attributes”— including sexual orientation, personality traits, use of addictive substances, and even parental separation—are highly predictable by analyzing what people click on to indicate they “like” on Facebook. The study analyzed the “likes” of 58,000 Facebook users.
Similarly, purchasing histories, tweets, and demographic, location, and other information gathered about individual Web users, when combined with data from other sources, can result in new kinds of profiles that an employer or landlord might use to deny someone a job or an apartment.
In response to such risks, the paper’s authors propose a legal framework they call “big data due process.” Under this concept, a person who has been subject to some determination—whether denial of health insurance, rejection of a job or housing application, or an arrest—would have the right to learn how big data analytics were used.
This would entail the sorts of disclosure and cross-examination rights that are already enshrined in the legal systems of the United States and many other nations. “Before there can be greater social acceptance of big data’s role in decision-making, especially within government, it must also appear fair, and have an acceptable degree of predictability, transparency, and rationality,” the authors write.
Data analytics can also get things deeply wrong, Crawford notes. Even the formerly successful use of Google search terms to identify flu outbreaks failed last year, when actual cases fell far short of predictions. Increased flu-related media coverage and chatter about the flu in social media were mistaken for signs of people complaining they were sick, leading to the overestimates. “This is where social media data can get complicated,” Crawford said.
And there can be more basic flaws in what data tells us. For example, after Hurricane Sandy, there were few tweets from hard-hit areas away from Manhattan. “If we start to use social media data sets to take the pulse of a nation or understand a crisis—or actually use it to deploy resources—we are getting a skewed picture of what is happening,” Crawford warned in her talk.
Tuesday, October 1, 2013
A professor learns how to change his methods to open source
https://opensource.com/education/13/9/open-source-teaching-methods?sc_cid=70160000000bgaxAAA
Image by opensource.com
At the age of 77, I have published my first eBook and have a MOOC. These were not endeavors I ever intended to undertake.
I wanted to write Forms for a Future—a book about the civic discussions we need to have to have a future worthy of living. So, in the fall of 2007, after a 15 year absence from the world of education, I negotiated an adjunct position in the Honors College, figuring a small undergraduate class would help focus my attention. The course met three times a week and had three required full length textbooks.
I was not prepared for what I found upon my return.
My students were all Millennials; one gentleman in particular always attended class with an ear bud in one ear. So, I asked him:
What are you hearing in your left ear?
Music.
What about in your right ear?
The class.
Why?
I learn better that way.
Would that work for anyone else?
Yes.
Then he turned the table. In a very sincere tone, he asked: Do you find that disrespectful sir?
I replied: No, not now. But, I had to ask.
This conversation reflects a lot of changes in how students learn and how teachers can teach. Now, in my class, there are no textbooks. Classes are virtual. There are no lectures. And, all substantive material is delivered online. Students write, comment, and challenge each other throughout the semester, meeting one day a week in person for a moderated exchange of ideas.
But, using open source material is not just a course design, it is also a methodology for pedagogy. My course structure allows the identical material to be delivered to students who are physically present or remote, in real or virtual time, with or without direct access to me, for either free or for credit. We can learn from our students how to teach, by learning what they learn from how we teach. This level of mutual engagement is the truly exciting part. We need them as much as they need us.
These changes in the way the classroom operates prompted me to reflect on the evolution of my teaching style: from classroom lectures and printed books to using interactive iBooks and MOOCs. The trasition was not as sudden as it may seem. Looking back, an experience I had 25 years ago was an indicator of the changes coming to education.
At that time, the University where I was a professor had three sections of Introductory Psychology to serve 350 students each. The classes met at 9am, 11am, and 1pm and was taught by a team of instructors. Each delivered their take on a specialty of psychology, gave a multiple-choice machine scored exam, and was gone.
Needless to say, the students did not like the course. Their instructors were highly critical of their attitudes and motivations for taking the course, and the atmosphere was one of competing agendas, not mutual engagement. It was like the year I substituted for a professor on sabbatical. That fall semester was awful; there was so little engagement of any kind. At first I blamed the students. Then, I entertained the idea that if we were going to herd students into "educational feeding lots," it might also be my responsibility to change the way we teach in order to engage them.
That following spring semester, I spent the very first day of class standing in the middle of the peanut gallery at the second row from the back. From there, I told the story of the 1964 Genovese murder case in New York in which 38 bystanders did nothing; I teased them about being nameless. In the students' syllabus for this course I included material for making a large name tag. Then, for the next five classes I encouraged the students to hang them around their necks. It was in the next class they realized I had persuaded nearly all of them to wear their name tags using the five principles of social influence described in their textbook.
Every class involved experiencing in some way the core concepts of social psychology. By the end of the semester, there were more students in the room than enrolled in the course. They were bringing their friends to class! The experiment had caused a bit of excitement, so the Chair asked me to give a colloquium on my teaching methods. By the end of the year, however, the consensus was that I had pandered the students; that this was something only I could do.
I now realize what we did not fully understand then: it was not the performance that was responsible for the outcome, it was the composition. I had a new score; one that focused on the students as learners, not on me as a teacher.
As scholars, we believe knowledge belongs in the public domain. Creating a way for students to experience the concepts they are learning in the classroom is a form of scholarship. It should be public knowledge. Open source teaching and learning makes that possible. Flipping the traditional classroom focuses on the engagement of the student with the material, not with the performer.
When I finally returned to the classroom in 2007, I realized once again that it was my responsibility to change the way I teach in order to engage the students. To my surprise, it is much easier to have higher levels of student engagement with the digital technologies of the 21st Century. Now, I have choices. Occasionally, I will perform (he speaks!), but mostly I watch my students perform the composition I've set out for them. Now, my teaching is much more personal. Best of all, it is simply more fun.
The open source technologies of today are more respectful; they allow students to do their work in the time and space that best fits their life and their circumstances—which for many includes a job. Socially, they are more collaborative and participatory. Technically, they allow efficient access to material that is more inclusive, comprehensive, engaging and up-to-date.
Thankfully, I did change my focus... and much more. My book is now finished: Forums for a Future. Find it for free as a MOOC on USF Canvas.net.
Health Insurance Exchanges Fulfill Both Liberal and Conservative Goals - HBR
http://blogs.hbr.org/2013/10/health-insurance-exchanges-fulfill-both-liberal-and-conservative-goals/?utm_source=Socialflow&utm_medium=Tweet&utm_campaign=Socialflow
by Henry J. Aaron and Kevin Lucia | 8:00 AM October 1, 2013
by Henry J. Aaron and Kevin Lucia | 8:00 AM October 1, 2013
The new health insurance market places—the exchanges set up under Obamacare—have become the hot health policy topic. Will they work or won’t they? The focus is on the near term. And no one should doubt that what happens in the next few months is extremely important—as former cabinet officer Wilbur Cohen said, good policy is 1% inspiration and 99% implementation. Vital though near-term effectiveness is, the exchanges hold a longer-term potential—they can help reshape the organization, delivery, and financing of insurance. Simply put, we think that the health insurance exchange—supported at various times by both liberals and conservatives—may well fulfill the health reform dreams of both. To see why, one need only recall what conservatives and liberals want.
Conservatives want people to be free to choose the insurance plan that best matches their preferences. They want insurers to compete with one another on the basis of price and service. They are convinced that if people can shop freely for the plans they want and insurers must compete actively for their business, everyone will gain: customers will get coverage that matches their preferences, and insurers will become more cost- and quality-conscious than they now are. Conservatives also recognize that many people will need financial help in order to afford health insurance, and they have embraced such aid.
Liberals want universal coverage. While they accept competition, they believe that regulations are also necessary to hold down the growth of health care spending and promote the adoption of improved modes of delivering care. Liberals believe that market pressures, by themselves, will be too weak to prevent hospitals, doctors, and other providers from sustaining what economists call ‘rent seeking’ activities. Left to voluntary action, system-wide reforms, such as the adoption of health information technology and new provider payment practices that lower costs and increase quality of care, will proceed with glacial slowness.
The health insurance exchanges have the potential to fulfill the hopes of both conservatives and liberals. By design, the exchanges will intensify competition by requiring insurers to offer the full range of plans to customers. By providing software and counseling, the exchanges will help consumers make informed comparisons among these offerings. The exchanges will initially serve only individuals and employees of companies with no more than 50 employees. But in 2016 the exchanges will open to companies with 51 to 100 employees. In 2017, they may open up to still larger businesses and to state and local governments. If the exchanges do a good job, most businesses may well be glad to rid themselves of administering a vexatious form of compensation that has nothing to do with their main business activities. If and when that happens, the exchanges will have become the instrument for realizing the conservative dream—free individual choice and tough, head-to-head competition among health insurers.
To do a good job the exchanges have at hand a number of important regulatory powers along lines that liberals have long endorsed. To prevent information overload, the exchanges can protect consumers from being overwhelmed with plans that have no meaningful difference. The exchanges can require insurers to offer certain standardized plans so that customers can easily compare price and service. They can set standards for the quality of care paid for by plans, bar plans that do not meet quality or price standards, and selectively contract with those that do. They can post data on the quality of care provided by hospitals, physicians, and others. They can advertise such information to help consumers make informed choices or, more aggressively, require plans to offer incentives for people to use high-quality, low-cost health care services and providers. Exchanges could also create incentives for insurers to encourage or require providers to apply research findings from analyses of comparative effectiveness.
In addition, the Affordable Care Act has set in motion a large number of pilot programs, experiments, and demonstration projects involving new methods of paying for care and organizing providers. These innovations include bundled payments and accountable care organizations. Not all of these innovations will succeed. But if some do, the exchanges will be in a position to encourage or require their adoption. And if exchanges cover a sizable fraction of the insured population, they will have the clout to change the delivery system. (For further discussion, see our Perspective article entitled “Only the Beginning – What’s Next at the Health Insurance Exchanges?” in the September 26, 2013 New England Journal of Medicine.)
Many conservatives still decry the ACA. Many liberals still regret that health reform did not include a public option or was not Medicare for all. We think that conservatives and liberals alike are failing to see that the ACA holds the seeds of fulfillment for the core objectives each has long sought.
Follow the Leading Health Care Innovation insight center on Twitter @HBRhealth. E-mail us athealtheditors@hbr.org, and sign up to receive updates here.
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