Flu, Twitter, and the Future of Public Health Surveillance

Saw a really cool article about public health and social media. Actually, it was about flu and Twitter, titled, "Scientists Use Twitter to Track Flu Epidemics, How to Stay Healthy This Flu Season."

The take-away from this article isn't that scientists used Twitter to track flu. Although, o.k, that's important. The really important development is that scientists developed an algorithm to track public health activity via social media.

First, this thought: Realtime surveillance has been the dream of many public health authorities and researchers. Various models have developed to track diseases, primarily by tracking data submitted by hospital ERs. The University of Pittsburgh has an example of this with the RODDS Laboratory. (If you don't want to click the link, RODDS stands for Real-time Outbreak and Disease Surveillance System).

Second, this thought: I've been told that a true realtime surveillance system would be very difficult to establish in the U.S. in the absence of a single payer health insurance system. In other words, in countries where there is a single payer system, e.g. the government, all patient data are collected and aggregated by a central database system. Theoretically, such a single point of data entry allows realtime surveillance.

But, this article points to a wonderfully efficient, even elegant, way to do an end run around enormously expensive database systems that would have to be woven through the enormously tangled HIPAA regulations and the rules, regulations, and private market interests of the healthcare providers and the healthcare insurers.

To track the flu, scientists--lead biologist was Marcel Salanthe from Penn State U.--analyzed 70,000 Tweets about flu. The Tweet data were analyzed with CDC data on vaccinations. The authors observed patterns that showed crossover between flu outbreaks and vaccinations.

And how did they do this? They developed the algorithm. That's the beauty of their work. An algorithm like this can be used to surveil any number of public health threats. Quoting from "What Twitter Knows About Flu," quoting Salanthe, "You can observe how people feel about certain things in a real-world context....On Twitter, people talk about things that matter to them in a completely normal context."

No worries about confidentiality, no delving into private insurers' proprietary data, no laws and regulations to comply with--these data are voluntarily provided by people on Twitter, the world's most realtime forum.

Table Saw Safety

Here's a public health issue near and dear to my heart. Table saws. And, I have to admit, it has been a little too close to my heart, literally. And it goes like this:

I am home alone with the kids. They're getting along fabulously, so I decide to try to get a couple small projects done that have been hanging around the "shop" for too long. I cobbled together a step stool for my older daughter and a couple wooden trays for my wife.

Everything's going great and I'm moving along, full steam ahead. I'm like one of those extreme makeover guys. In fact, I'm impressed with how fast I'm working and how well it's going.

Now, as a rule, I ALWAYS unplug the tablesaw when I'm adjusting it.

ALWAYS. Except tonight. And I'm fully cognizant, aware, that I'm not bothering to unplug.

My younger daughter, who was about four years old at the time, wanders in during a lull. I'm absentmindedly talking to her. I'm measuring the distance from the blade to the fence. And I hear the most terrifying words in any language:

"Daddy? What's this?"

The tablesaw screams to life, the wind created by the blade rushes underneath the palm of my left hand, she bolts, I shout "OH MY GOD!" and yank the cord out of the wall.

To our credit, neither of us cried.

I made a huge, huge mistake in not unplugging the machine before I started to work around it. But I gotta tell ya--I don't want one of the new saws considered by the Consumer Product Safety Commission earlier this month.

If you're a woodworker you've seen the videos:


On the other hand (is that a pun?) I'm a shoestring woodworker. Adding the extra expense of the SawStop to a table saw for me certainly would make it safer. I'd not even own one.

Concussions in young athletes

Saw an article that got my attention, being that I'm the dad to a few young athletes. "Athlete concussions eyed," an AP article published October 6, 2011 mentions PA House Bill 200, which if passed would be:

"An Act establishing standards for managing concussions and traumatic brain injuries to student athletes; assigning duties to the Department of Health and the Department of Education; and imposing penalties."

The sponsor, Rep. Tim Briggs, is quoted as saying "Over the years, the mentality of head injuries in sports wsa to shake it of and get back in the game..." And I think most people who've been involved with sports know exactly what he's talking about. Like a neighbor, whose sixth grade son was dinged in a football game and the coach put him back in. "You'd better check him," a friend told his mom, "He's not o.k." And his mom did, and she pulled him off the field, and the coach was angry and her son was angry and she did the right thing. It was his third concussion in three years of 'little kid' football.

What I don't understand is why it takes legislation to put the brakes on this attitude. There was something of a controversy a few months ago when a local high school girl lacrosse player sustained a seriously damaging concussion--and the coaching establishment closed ranks to say that girls lacrosse players don't wear helmets because helmets aren't a part of the game, and properly coached players don't need helmets.

The rational boggles the mind. Good coaching won't deflect an errant ball the way a helmet will.

So legislation like HB200 (the PA Senate has a similiar bill in SB200), which puts the responsibility on the coaches, apparently IS necessary.

Stroke Treatment in Pennsylvania

A few years ago I worked on a report on stroke prevention, treatment, and rehabilitation. It was a good report, and had the input and endorsement of some of the top stroke doctors in Pennsylvania (probably in the country). Here's the report, Brain Defense: A Stroke Prevention and Treatment Strategy for Pennsylvania.

Just saw today that PA House Bill 1400, which was introduced earlier this month, addresses strokes:

"Establishing a Statewide stroke system of care by recognizing primary stroke centers and directing the creation of emergency medical services training and transport protocols."

I'd kind of like to think that the sponsors took a look at our report. Or at least that Health committee staff did.

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A Public Policy Dish on the Private Market Menu

I got an email the other day from a college intern who is working on a project to tie regional capital markets to local businesses that are unable to secure bank loans.

In getting his project off the ground, it was recommended to him that he contact our agency to find out how we go about starting large research projects.

Yes, it's true: I work for a public policy research agency, and am not particularly experienced in the workings of private capital markets.

However, the agency has a 75 year history of addressing (attacking?) any and all research topics handed to us. Can the availability and distribution of private capital be particularly different from the availability and distribution of public resources?

The more I think about it, the more it becomes apparent that the essentials of public policy research are indeed applicable to private market. At least, when applied with a broad paintbrush.

Here's what I told him he should do:

Because we’re a government agency that works with public policy and legal issues, our way of conducting research might differ from how you’d do it in the private capital market sector. For one thing, we frequently work with volunteer advisors who dontate their time and resources...

...there are some basic steps we follow.

1. We assign a project manager who directs and coordinates the staff work.
2. The project manager comes up with a work plan, or an outline, that will meet the objectives of the assignment (i.e., the resolution).
3. The project manager divides the work among the staff—because we’re a small agency, there are usually no more than three people on a project, including the project manager. If there’s going to be a lot of data involved, there will be someone assigned to gather data and work with it to make it usable. We’ll look at the data from different perspectives, create tables, charts, etc.

I think this might be where you’re looking for some pointers. The first step is to identify your focus as clearly as possible, then find as many relevant data sources as possible. Because we do public policy work, there are usually (not always) existing public databases that we can access. For example, the CDC has tons of health data on its websites. The Census Bureau has a huge amount of data that are publicly available. Some databases are open to the public but charge fees. Some databases are not publicly accessible, but since we’re a state agency, we can usually get access.

If I were to research regional capital markets and small businesses, I’d look at the U.S. Small Business Administration, the Pennsylvania Small Business Development Centers, the Federal Reserve Banks, the PA Dept. of Community and Economic Development, Pennsylvania Industrial Development Corporations, the Pennsylvania Chamber of Business and Industry, regional Chambers of Commerce, and Councils of Government from around the state. Each of these can probably give you leads to the next step along the way. Also, there are a lot of public policy organizations that are involved in local and regional economic development. The Pennsylvania Economy League, the Allegheny Conference on Community Development are two of the larger ones. I think if you were to survey areas around the state where the economy is in poor shape, you’ll find a regional or local development group that’s interested in what you’re doing.

I’d search places like these and see what data they have, and contact them to find out who would be able to answer questions, not just about the data, but also tap them for advice, ideas, recommendations on how to solve the issues you’re working with. I’ve found that the people who are experts in their fields are a) good at communicating their expertise, and b) are eager to share their expertise. If you get several of them, they might agree to teleconference together on the topic.

Another important point: chances are, someone else has already written a report/white paper/study about regional capital markets. The Federal Reserve Banks publish regular journals on a variety of topics, which probably include articles on what you’re looking for. University websites will link to journals and articles written by professors. If you have access to the research databases like AccessPA, EBSCO (probably through the college library) you should definitely check for journal articles on regional capital markets.

We almost always do a review of what other states are doing in the topic area we’re studying. The first step would be to identify states with similar profiles. Usually, these are the same states, regardless of what you’re studying: New York, Ohio, Illinois, Massachusetts, New Jersey. (in other words, Rust Belt states). Their state government websites might have links to state agencies that are interested in regional markets and business development.

Thus, as I responded and pondered the responding, I was reminded that we're experts in building research projects, in building groups of experts, and in communicating the experts' advice and recommendations.

Is the private market world really so different that what we "bring to the table" wouldn't fit the menu?