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A Map of Baseball Nation

A Map of Baseball Nation | National Population Health Grid |

"Fans may not list which team they favor on the census, but millions of them do make their preferences public on Facebook. Using aggregated data provided by the company, we were able to create an unprecedented look at the geography of baseball fandom, going down not only to the county level, as Facebook did in a nationwide map it released a few weeks ago, but also to ZIP codes."

Via Seth Dixon
Brian Altonen's insight:

Some of that red in Texas overlaps with Boston I hear.

Greg Russak's curator insight, April 29, 12:53 PM

Maps and baseball - a good combination!

Wyatt Wolf's curator insight, October 30, 7:46 PM

My favorite baseball team is the Philadelphia Phillies, here's everyone else's.

Global Speechwriter's comment, November 4, 2:52 AM
Jays? C'mon.

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Two technologies meant for each other

Two technologies meant for each other | National Population Health Grid |

When GIS was first promoted (not including the 1973-1993/4 pre-ArcView tools), it was very distinct from the similarly sounding technology term GPS.  Skillsets for each of these two were taught as two unique training sessions.  The GIS was slightly more adapted to research related work than GPS.  But GPS was more applicable and true in terms of its presentability.  These two technologies ultimately became somewhat dependent on each other.


The same was true for Remote Sensing (LS, SPOT, etc.) and a host of other technologies (SLAR, AVHRR, DEM) that make use of distance to make their observations, over large areas of space, usually out of sight of whomever and whatever is being observed.  Google Map and other public mapping software made RS/Aerial photography commonplace information sources.


The geographic information systems (GIS) now being popularized, ranging from simple modeling programs without the spatial mathematical capabilities, to truly complex GIS becoming quite popular in many fields.   



Brian Altonen's insight:

Another form of spatial analytics made popular in the 1990s was grid analytics.  With grid analysis, you can perform many of the same calculations made using GIS, in much less time depending upon how you program your analytics system.     


Such is the case with NPHG.     


NPHG is a unique polygon/grid analytics technique I developed that carries out the basic spatial analyses provided by GIS, but with less than 1/100th the required systems time and manpower that doing the same with GIS.  


NPHG provides you the first insights into whatever topics you choose to researched.  These insights can be automated and can be produced on a daily or weekly basis; for thousands to tens of thousands of metrics per year using just one system.  This information can presented in "Atlas form", which in turn is useful for determining the next steps you may to take to apply a more traditional, time consuming, but visually impacting GIS analyses technique.    


NPHG can also be used to produce results in video form, which in turn can be reviewed in the field.  The resolution of these videos is unlimited; most are presented as national images.  But the image resolution can be modified to as small an area as you want.  (A number of my earliest examples also consisted of aerial fly-over visualization techniques, with views of zooming in on a region and then back out programmed in as well.) 


The benefits of NPHG is that it functions without GIS and has minimal software requirements.  It can probably work in many data analysis and calculation work stations, but certain benefits from being on a more rapid, more effective parallel programming analytics setting such as Terabyte.    


The figures here represent three styles for mapping the new public health problem, "bioterrorism."  All three were produced by separate research teams, two of them at about the same time in post-9-11 history (the first map, and E979.*).      


The upper left (first) map is a detailed review of risk areas in the U.S. based on various population density, sociological, economic, pop culture, and human ecological and behavioral study results.  The lower right map is a lightly later summary of these findings generated at the state level.   Both of these were developing using a traditional GIS, based on appearances, probably from two of the chief competitors.  


The base maps and results each of these require using merged, recoded, combined, reclassified and reanalyzed spatial data.   This process usually takes time to format and perfect the presentation for, not to mention the time to pull in the data and engage in whatever root analyses are necessary. 


The two E979 series map sets were produced using the NPHG algorithms, and took less than an hour to make all of maps, from scratch.  This mapped data was based on a review of data from about 0.5B EMR/EHR records for about 50M people.     The datapull  normally takes 5-15 minutes, the data crunch and mapping normally takes from 20 to 40 minutes.  75-100 separately analyses of E979 (total, by gender, by 4+ age groups, 10 E979 subgroups) can be completed in a day, producing just as many maps.    


The overlap noted for the findings in the sociological study and the NPHG EMR/EHR study is truly remarkable.     [A video I produced of it as well, is at ]


NPHG may be used for rapid surveillance and detection of unexpected spatial changes.  Any mathematical formula may be written to detect these changes (increased border differences, increased claims or diagnosis per 24 hr/per week, increased cost, significant changes in diagnosis rates over time and space).  NPHG can be used for the surveillance process; the slower GIS processing technologies can be used to further break down those regions where new risks are found to exist.

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All Foreign Diseases combined - YouTube IMG 1199 ForeignDiseases
Brian Altonen's insight:

This was produced from my spatial analysis of a combination of foreign born diseases that made their way into the country over the past decade at the time it was developed.  This information was based on regional aggregate EMR/EHR diagnostic data.   


The YouTube site that has this map video also has similar videomaps for other regions in the world, such as Africa, Japan, Russia, Australia.  These maps demonstrate distinct in-migration routes that are taken by different mechanisms for disease spread (anthropic versus zoonotic versus anthropozoonotic) from different countries.  Each country's ecological disease pattern does have some favorite in-migration routes.   


I don't recall how many diseases I merged for this project, but a typical part of the world had two series produced.  The first were primarily ecological diseases that came in, about 25-45 per region; the second were non-ecological, primarily human-based disease patterns such as culturally-bound syndromes, culturally-linked diseases and a few ecological diseases that are behavior related and not easily spread to others the victims may come in contact with in the United States.

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Measles outbreak: Michigan parents opt for vaccine waivers

Measles outbreak: Michigan parents opt for vaccine waivers | National Population Health Grid |
At least five people have measles in northern Michigan and others are being monitored.
Brian Altonen's insight:

From the article:  


"Michigan has one of the highest rates of vaccination waivers in the U.S. when it comes to its youngest school kids — a ranking that public health officials noted with frustration this week as they battled at least two vaccine-preventable diseases in two northern Michigan counties.


Last year, 5.9% kindergartners began the school year with waivers that exempt them from mandatory vaccines for school, according to a recent report by the U.S. Centers for Disease Control & Prevention.


Just three states — Oregon (7.1%), Idaho (6.4%), and Vermont (6.2%) — had higher rates of kindergartners whose parents opted them out of at least one vaccination, according to the CDC's report."


A related link for 25sec NHPG video of the national events (grid mapped, not age adjusted):


An up close version depicting the Pacific Northwest events.


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Applications. A Role of GIS for Managed Care.

Applications.  A Role of GIS for Managed Care. | National Population Health Grid |

APPLICATIONS OF NPHG Imagine for a moment that your are the principal investigator of a recurring outbreak problem or that your are put in change of surveillance for an incoming disease from an international border, or that you are a Director for a managed care plan, or a CEO trying to make your business provide other companies with a unique service of generating reports using its Big Data.  The map presented depicts one way to classify most postings on medical geography and health.  I use this logic to define my cultural health analytics for population health monitoring programs.

Brian Altonen's insight:

Currently, my personal/professional blog site ( receives about 300 hits per day, 200 visitors per day.  Most of these hits are deliberate.  Slightly more than half of them are to my medical geography and GIS pages.    


 This figure depicts the cultural medical geography research methodology I developed for analyzing the thousands of ICDs that exist in our EHRs/EMRs.   To produce a culturally aware, culturally sensitive program, one that surpasses any other program out there, you have to focus on culturally-bound and culturally-linked health concerns.  For the past decade or more, we have focused on the sociocultural inequities that exist, such as lower cancer screenings and lesser timely follow-ups for the more important, less interactive social classes that comprise the U.S. patient population.     


We can also develop more aggressive programs designed to meet the needs of controversial immigrant populations.  We can also design programs meant to target specific communities and ethnic groups for their lower rates of child healthcare, cancer and behavioral health screenings, adult chronic disease management, and geriatric preventive care processes.  These public health and typical managed care activities are already required for most programs that are in place (although we often don't differentiate our outcomes based upon race due to missing data.)      


These two areas of health improvement add significantly to a culturally-targeted preventive care program.  With the right programs in place, they can even be routinely monitored on a monthly or quarterly basis.        


Due to their numbers in the U.S. population, the most important cultural groups we need to initiate these programs for are the African/African Americans (with nationality and regional distinctions) and the Hispanic/Latino/a population.  Different regions of the U.S. may have different emphases.  A single cultural group can have from 150 to more than 300 diagnoses and ICDs, V-codes and E-codes defined for this very complete method of EHR/EMR analysis of cultural health.    


If your agency, facility or managed care program were to initiate such an important cultural health evaluation and analysis program, could it be initiated by the time the next calendar year begins? the next fiscal year?        


If your program has an EMR/EHR in place and working, your group could have a quarterly report developed at set up for regular reporting by April 2015.    

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Bouttenouse Fever - YouTube BouttenouseFever 7 0803 0%
Brian Altonen's insight:

I mapped some of the rarest diseases associated with in-migration of infected people, animals, hosts or vectors a number of years ago, soonafter successfully mapping the in-migration pattern of west nile and using this to employ GIS in identifying the location of a positive testing nidus based on a grouping of host and human cases within a 5 square mile area.


This collection of my 3D videos includes coverage of the following fairly rare forms of geozoonotic diagnoses:    


Bouttenouse Fever  - 0:22    |   

North Asian Tick Fever - Asia-Russia  -  0:21    |   

Queensland Tick Typhus -   0:23    |   

Creutzfeld Jacob, IP - 0:29     |   

Crimean or Congo Fever - Asia - Russia  -  0:41     |   

Guama Fever - 0:29     |   

Yakatopox-  0:28     |   

Omsk Fever - 0:27    |    

Guinea Worm -0:25    |   

Ratbite fever, ip - 0:36    |    

Foreign zoonotic diseases (aggregrated, depicting in-migration routes)               

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E-codes and GIS

E-codes and GIS | National Population Health Grid |

E-codes have a long tradition of GIS utilization.  The first healthcare industry in the business sector to emphasize GIS use was emergent care and fire response.  This naturally led to the incorporation of GIS into studies of accident-prone settings and drug related histories, partly for public safety needs and partly for use in criminal investigations.  Emergent care and criminal investigation use of GIS are also the reason for the earliest grid mapping routines in use when ArcInfo was the primary tool, and Idrisi a close second in terms popularity.  Since 1996, E-codes have remained a major exploratory tool for investigative public health mapping, in particular for projects linked to some of the earliest terrorism, bioterrorism and disaster management work I developed models for in 2004, as a response to the growing number of homeland security programs then attracted to the new GIS..  

Brian Altonen's insight:

E-codes and V-codes provide information about population behavior and health that normally are never reviewed as a part of ICD spatial analyses.     


This E-code map map was produced using data produced during unique period of U.S. inmigrating refugees history.     


As expected, New York and its surrounding megalopolis area are high in terms of priorities regarding accidental gun mishaps.  There are slightly more  cases east of the Mississippi, than west of the Mississippi that are worth noting as well.  The wilderness parts of the U.S. where hunting is a way of life are not at all linked to accidental gun mishaps.  Large urban centers in Utah, the Northwest, California, Texas, Illinois and Indiana suggest this to be a human population related behavior.       


Some of the most important Ecodes evaluated with this process include child and older adult abuse, various childhood and teen social misbehavior activities,  suicide attempts, and the more socially important V-codes commonly used..   

The following serve as examples for Ecode and Vcode 3D videomaps.     


Child Abuse by Kids -- ;


Young Child (<5) Pedestrian Accidents --


Offroad vehicle accidents -- ;


Suicide (part of a much larger project encompassing all age ranges as various age groups) --;


Inadequate material possession -- ;


Very Low Birthweight Babies -- ;


Terrorism -- ;

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Hidden STD Epidemic: 110 Million Infections in the US

Hidden STD Epidemic: 110 Million Infections in the US | National Population Health Grid |

Another use for NPHG

Brian Altonen's insight:

NPHG was designed to monitor, explain and predict national disease patterns.  It works in just minutes when managed by Teradata, within a Big Data setting.

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Dogs and Ebola risk, -- the Zoonosology of two Mid-20th C Russian Geographers

Dogs and Ebola risk, -- the Zoonosology of two Mid-20th C Russian Geographers | National Population Health Grid |

Animals help set the ecology for Ebolavirus in Africa.  In the US, wildlife is also a concern, but during these first few weeks we will focus our attention on pets, especially canine species.  

Brian Altonen's insight:

I produced a very comprehensive and to some, "alternative" presentation on zoonotic disease patterns.     


This is my page called "Zoonosis and Russian Medical Geography" at      .   


When I lived in Portland, we local geographers knew were on the Pacific Rim, and like any region trying to differentiate itself from the others, we used this concept to explain a little of the unique geography for the region.    


The Russian geographer,  Evgenii Nikanorovich Pavlovsky, is someone everyone needed to learn about.  Following the passing of Pavlovsky, a scientist by the name of A. (Anatoly?) Voronov continued his work, but also took a unique evolution based route to defining disease patterns.  (See that article V. M. Neronov, & P.D. Gunin.  1971. Structure of Natural Foci of Zoonotic Cutaneous Leishmaniasis and its Relationship to Regional Morphology"   Bull. Org. Mond. Sante / Bull. W. H. O., 44, 577-584) at ;)   


 During the 1980s, a very efficient team translated many of the Russian scientific journals and published these reviews as a unique series detailing the Russian philosophy of science, medicine and sociology.  This work demonstrated a value to the Russian macroecologic interpretation of zoonotic disease patterns.     


One of the most important concepts documented by Pavlovsky and Voronov was the metaecological take on disease patterns, in which three zones of disease potential are defined--the host, the pathogen/vector and the potential human victims.  These in turn were defined by physiography, land based plant and vector ecology, hydrogeography,  and other important natural resource concepts.     


The intersection of the three host-vector-human zones was defined as the most susceptible region.  I used this method to perform my 2000-4 studies of west nile ecology in New York, linking the species of vectors to particular canopy settings defined by tree species.   


With Ebola, to best understand the ecology and metaecology of the disease, both marcrogeographic and microgeographic or ecological interpretations have to be developed.  Both of these interpretations provide us with a more thorough report on how Ebola might behave, naturally within local ecological settings, and as a product of the local human ecology.  The canine and other domesticated animals capable of becoming infected form the link between these two disease ecology domains.

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Unidentified fever 'kills 13' in DR Congo in 10 days

Unidentified fever 'kills 13' in DR Congo in 10 days | National Population Health Grid |

If it is not Ebola, then what could this Congo Hemorrhagic Fever be?  


There are many possibilities in fact, and many of these were mapped a few years back . . . 

Brian Altonen's insight:


My collection of a couple dozen videos on Youtube, about


foreign born fevers:;


foreign diseases including hemorrhagic  fevers:




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Chicago Illness, Full Run of diffusion examples - YouTube ChicagoIllness Full 7 0808 Teaching Video 0%
Brian Altonen's insight:

There are two versions of the "Chicago Illness" that I developed videos for.  They were designed to present the  value of the NPHG method for disease investigation.   This is one of these two presentations.


The other is at;

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Ebola and the Present States of Surveillance

Ebola and the Present States of Surveillance | National Population Health Grid |

The Present States of Surveillance - the implementation of GIS and Remote Sensing in Spatial Epidemiology.     


A Flowchart used to assign levels of engagement in the Medical GIS process.    


Normal Ranks 1 to 9 (1=low; 9=high performance and success; 10 = ideal theoretically rank.     


Status, in this illustration is almost 6.   Although this score is based on interviews etc. analyses completed a half year ago  These assignments are based on the forms of software/programming required for each step and its uses, i.e. presentation and/or utilization, levels of spatial math, spatial representation, and analytic tools/methods used.  Note: last month's second review demonstrated considerable progress.     


Improvements in accuracy, presentability, complexity, dimensionality, utilization, and predictability are some of the major changes required for each step.     


To effectively deal with Ebola, the higher end agencies are working close to levels 7 and 8, and testing at levels 8 and 9.

Brian Altonen's insight:

A reiteration of the value and importance of having an operational (not experimental) GIS in use for regular (ongoing, daily) disease surveillance.      


You can bet the quality of GIS use is going to rise considerably in the next year once the epidemic months for Ebola, Chikungunya, MIRS (SARS), Asiatic Flu, Measles, Mumps, Pinta, Dengue, Cholera, Bubonic Plague, Tick-born Fevers, and even Bedbugs has passed.      


The real question is how effectively can developmental teams produce GIS's that can be operate locally around the country.     


In a survey I developed to query into the value of GIS to epidemiological research and surveillance programs, I found a higher understanding of its applications than expected (40% instead of just 20% familiarity).  But the level of GIS implementation nationally and internationally remains at about 5.5 on a scale from 1 to 10.   [A theoretical '10' can operate hundreds of diseases (300+) nationally, per single sql/report run, per day, with pre-specified groupings based on risk patterns and ecological types. . . which I reviewed elsewhere.]


To successfully manage something as ecological, international, fast moving and deadly as Ebola, we need to reach level 9.  Even a level 8 might suffice for now.

Brian Altonen's curator insight, July 2, 1:19 PM

The circled level is where we need to be for outbreaks like those of Ebola and other foreign born emerging diseases.  Research stations and facilities at major headquarters no doubt have these technologies in place.  Where we are lacking is at the infrastructure level and the lack of engagement in upgrading our software and skillsets.  


     In some ways, this reminds critics of what happened due to the natural disasters we experienced over the recent years.  There were a number events we were "unprepared for", resulting in limited recognition, delayed response, and inadequate long term follow up for these events .


     The point here is that we should use cases like these as lessons, that very well could prepare us for a repeat in these same events next year, but with worse consequences.  


     This year's spatial epidemiological events--ebola, chikungunya, polio in the Middle East, the polio-like condition in California, the measles outbreaks and other immunized diseases in the U.S., and most recently Whooping Cough (is mumps, rubella, or diphtheria next?)-- demonstrate better systems should be put in in place at regional and local levels.  These systems should match the level most of the better standard system in health care are at currently (Levels 6) and be able to progress rapidly to levels 7 and 8 (begin to employ NLCD, grid, DEM, RS, NIR, vector-NDWI, RADAR, LiDAR, live LS or equivalents), and even 9 (prediction/accurate risk assignment) for the most advanced.  


     The technology we need to accomplish this goal exists right now.  Only human behaviors can be used to explain why Medical GIS, as a profession, has not reached its fullest potential.


     Those companies and health care organizations that start right now will become the local Innovators and Supporters.  Those that wait, but ultimately find a way in are Early Followers.  


     Which pack does your company or healthcare group belong to?


      I am currently trying to document our participation and rate of implementation, including with this ANONYMOUS survey,


     described at:


     and directly accessible at:



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Vectors or Victims? Docs Slam Rumors That Migrants Carry Disease

Vectors or Victims? Docs Slam Rumors That Migrants Carry Disease | National Population Health Grid |

"Doctors say they are concerned about false rumors and “hysteria” that the unaccompanied children coming across the border from Mexico into Texas are carrying diseases such as Ebola and dengue fever."  


Source:  NBC News.  Maggie Fox. (dated July 9, 2014).  "Vectors or Victims? Docs Slam Rumors That Migrants Carry Disease"



Brian Altonen's insight:

As is often the case, concerns, fear and even panic arise with some of the worst logic.   The fear may be right and have good reasons for its existence, but unless we consider the alternatives for how else it might apply, we could result in two series of negative historical epidemiology events--ignoring the original claim because it is misapplied, and missing the boat as how to better apply it.  


NPHG mapping doesn't support the claim that in-migrating from Mexico and lower parts of the Americas  in unlikely to bring in diseases for us to be concerned with. 


Ecological fallacy is when you believe your observations and deductions pertain to a much larger area or population.  Such is the case for those arguing these "false rumors."


The support for the "possibility" (a term we should even consider removing from this sentence)  that in-migration patterns do not increase the risk of behaviors and disease coming in from other areas, peoples and culture is absurd.  We can try arguing the point that immunizable diseases is not a concern, because we can simply provide these as soon as they come in, although many underprivileged classes in this country also in need of these medicines will most certain fell neglected, and rightfully so (see news video -;).


The article is right in stating the concerns about dengue fever are overrated (see video), and my Ebola work is appearing to show that this is also unlikely to be linked to Mexico in-migration, as much as Caribbean or Natural Animal in-migrating patterns.


The argument that sufficient quarantine and public health monitoring strategies are in place only holds for those who enter this country legally.  


The real indicators here are the presence of in-migrated diseases from countries to the south, such as the most obscurest of ICDs with a well-defined cultural relationship--Chiclero's Ear and Pinta.


But we can add more to this if need be.  Vibrio cholera outbreaks from a strain bred in Peru, Brazilian blastomycosis, and venezuelan encephalitis.


As I recently demonstrated on one of my ScoopIt! pages about Ebola, the most likely route of entry naturally is via the Caribbean and/or South to Central American route, through the eastern Texas-Mexico border, directed Northnortheastward.  The human in-migration route, more likely, involves major airplanes and airports linked to Africa, for direct transmission, London for indirect.




Dengue, at;


El Tor cholera at;(demonstrates a nidus in the NYC area, due to rule outs and high density of cases, but the major localized cluster in the Southwest)


Brazilian Blastomycosis,


Chiclero's Ear (route very strongly demonstrated),


Pinta, using an earlier and very unique presentation technique, at


Venezuelan Encephalitis,


Disease distributions in the US for ICDs linked to Middle and South America,


My coverage of the disease in-migration for numerous parts of the world:




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Medical staff warned: Keep your mouths shut about illegal immigrants or face arrest

Medical staff warned: Keep your mouths shut about illegal immigrants or face arrest | National Population Health Grid |
A government-contracted security force threatened to arrest doctors and nurses if they divulged any information about the contagion threat at a refugee camp housing illegal alien children at Lackland Air Force Base in San Antonio, Texas, sources say.
Brian Altonen's insight:

This seems very much counter to what everyone is taught in healthcare.     


    Quite a while ago, some years back, my models said there was a path coming into this country via Texas for infectious disease migration.  A large part of this root is dictated by population densities, proximity of urban settings and well used travel routes, mostly by land and water, less frequently by airplane.  The key indicators of such a route existing are the distributions of the rarest diseases from down south in the heart of the U.S..  


    For example, pinta and chiclero's ulcer spatial behaviors showed exceptional peaking in seasonal work regions of the country.  The influx of common seasonal host-vector patterns from the south define east coast routes better than midwestern U.S. routes, but nevertheless there are some repeated midwest south to north patterns.  A Brazilian fungal condition and a uniquely ecological vibrio from the coasts of Peru have also demonstrated these patterns, with tendency to travel inland via a midwestern pattern, not a directly northward coastal pattern.


    The San Antonio to central Texas and then northward, further northward and then eastward route is implied by these spatial diffusion patterns.


   It is very disconcerting when politics and political decisions outweigh preventive health priorities.  These behaviors are perhaps the exact reason for many of the midwestern outbreaks that recur with diphtheria in the Rockies, measles in Indiana and Illinois, and the mumps and whooping cough problems that seem to be growing across this country.     


   What next?  Rubella?  Diphtheria? Spinal meningitis?  Polio?     


   Are all of these recent outbreaks due mostly to political decisions?! (or indecisiveness?)   


    An important thing to note is that the mapping of cases suggests a travel and diffusion process for infectious childhood diseases is already happening . . .   








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No cure for brokenhearted: Research finds time doesn’t heal heartbreak

No cure for brokenhearted: Research finds time doesn’t heal heartbreak | National Population Health Grid |
A disturbing condition, known as the 'broken heart syndrome,' doesn’t necessarily heal with time, researchers at the University of Aberdeen have found. There is no treatment for the disorder, which was previously thought to recover in due course.
Brian Altonen's insight:

A comparison of population pyramid renderings of national data on this ICD demonstrates an age-gender distribution more like another older population psychological/emotionally based condition--Munchausen's.    


For more, read the article this is linked to, then see:       


There are a number of videos of these results I produced.      




And the past ScoopIt!    ;     

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Nationally Mapping Children's Health, Medical Care and Abuse

Nationally Mapping Children's Health, Medical Care and Abuse | National Population Health Grid |

The following link is to a site where the video map you see and the next ten in this series are devoted to Child's health related issues -- .  

Brian Altonen's insight:

Reviewed in this series are    


Child Neglect     

Childhood Sexual Abuse     

Childhood Immunizations Refused     

Shaken Baby     

Physical Child Abuse     

Child Neglect     

Crack Baby Syndrome     

Fetal Exposure to Narcotics     

Shaken Baby     


and a series of Homelessness, broken down into 7 age range specific subgroups.     


Each Video is amount one minute in length.  The homelessness series around about 25 seconds each.     

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Great Meaningful Use Short List

Great Meaningful Use Short List | National Population Health Grid |
Seeing the legislative process first hand I must admit that it’s a bit overwhelming to see the volume of legislation that they put out which is all done in this pretty cryptic legalese and full of pages of useless recaps and other fluff. I guess that’s why I found this abbreviated list of meaningful use criteria so nice:
Brian Altonen's insight:

The following listing of requirements for MU (Meaningful Use) is barely touching the basics.  


Let's look at it from the patient's side - - - assume for a minute I am someone with a chronic disease that needs an institution's care.  


My condition is continuous and lifelong--is it worth going to a place that cannot manage even the most basic pieces of my health information?  


Will my health itself be jeopardized?  How about my quality of life? or friendships?  


What if my boss knew I had this medical condition, but never told me he or she knew?  Then what?  


What happens if I have to go to the emergency room one day while at work?  What happens when the staff learning of my medical history due to this event?  Does my workspace even provide me with the bare essential needed should an emergency arise while I am there?  Did my HR provide me with the best healthcare insurance options?  Are the places my insurance covers at the better end of the spectrum, or the worst possible end?


Each on the following basic requirements has to be met for your agency or clinic or workspace or hospital to be considered physically and mentally healthy and safe, and all into the investment processes required for preventive care. 


So agencies and facilities that continue to bicker about these problems of meeting requirements and deadlines are telling me, their patient, that they are not into offering the best choice of services.  


What I do next is plain and simple--leave.    They should be de-accredited of course, but so much political complaints and threats about these actions only leaves with all of our health-related, emotional and legal guards completely down.


If your health care facility cannot engage in these basic tasks, your health is at risk.











The 15 core criteria, presented in an abbreviated format, are:
1. Use computerized physician order entry (CPOE);
2. Implement drug-drug and drug-allergy interaction checks;
3. Generate and transmit permissible prescriptions electronically;
4. Record demographics;
5. Maintain an up-to-date problem list of current and active diagnoses;
6. Maintain active medication list;
7. Maintain active medication allergy list;
8. Record, chart changes in vital signs;
9. Record smoking status for patients age 13 or older;
10. Implement one clinical decision support rule;
11. Report ambulatory clinical quality measures;
12. Provide patients with an electronic copy of their health information, upon request;
13. Provide clinical summaries for patients for each office visit;
14. Demonstrate capability to exchange key clinical information;
15. Protect electronic health information.

Five additional criteria, of the provider’s choosing, must be selected from a menu of 10 that include entering test results into an EHR as structured data, maintaining lists of patients with specific conditions, and submitting information to immunization registries ...[Read more at the above link]

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California Encephalitis - YouTube California Encephalitis

Brian Altonen's insight:

Several months ago, cases of a suspected polio-like disease erupted in children in California.  This was one of the possible diagnoses for these events at the time.  Even though the disease mapped here is called California Encephalitis, its greater numbers and density appear throughout the eastern U.S.  This west to east migration is fairly common for diseases with strong dependency upon human carriers.      


Diseases that travel west to east are very important to disease geographers because they demonstrate the role latitude and weather/climate play on the disease ecology.  This enables a more efficient GIS to be developed for monitoring these events in the future.    


There are several very latitude-specific ICDs in the United States.  The expected climate-latitude dependent conditions or diagnoses like Guilliane-Barre, Cold induced vasodilation, and Cold Temperature (Cold antibody)-induced Hemolytic anemia do not demonstrate this anticipated latitude defined spatial distribution.  Many vector and animal host diseases are latitude linked.  The define the possible routes for a theoretical Ebola migration into the U.S. as part of the natural history, latitude defines two natural boundaries to its diffusion northward/northnortheastward, and westnorthwestward out of Texas. 

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Cuban doctor contracts Ebola in S.Leone

Cuban doctor contracts Ebola in S.Leone | National Population Health Grid |
A Cuban doctor infected with Ebola in Sierra Leone became the latest of nearly 600 health workers to have contracted the virus, amid fresh warnings that the fight against the disease is far from over. The deadliest outbreak of Ebola ever has now killed 5,420 people and infected 15,145, according to new World Health Organization figures Wednesday, with Sierra Leone seeing the steepest increase in new cases. Cuba has played a large role in intensifying global efforts to fight the outbreak in the three worst-hit countries of Liberia, Sierra Leone and Guinea, sending around 250 nurses and doctors to the region with another 450 to come. Felix Baez Sarria, one of about 165 Cuban medics in Sierra Leone, is being treated in a Red Cross centre near Freetown, his boss told AFP on Wednesday.
Brian Altonen's insight:

Another reminder to keep our eyes on Cuba.  A few weeks ago I posted a warning about this.  The map above comes from a map that I drew up in late June/early July trying to define the most ecologically friendly pathways for all that are involved with nature to follow or abide by.   


There are several places in the Caribbean that I proposed Ebolavirus as having the natural ecology needed to for this disease replant itself on new terrain.      


The natural requirements for Ebola are a potential bat as a host and carrier, small animals to help provide a stable zoonotic environment, warm climate closer to tropical than warm temperate and natural host-vector-carrier routes that exist within the required climatic settings.  A carrier host most similar to those that are involved in Africa had to be identified.  The fruit-eating bat noted on this illustration fulfilled that ecological requirement.    


So why hasn't this move yet happened? (as far as we know).   


The major barrier between Africa and the Americas --the ocean--protects us for now.   Once that border is crossed, however, it becomes harder to predict what parts of the United States and elsewhere will be most influenced.  The Caribbean and perhaps some of mainland Middle and South America might more effectively meet certain ecological needs.    


A few weeks ago I noted that Cuba is a small area with just the right zoogeography to make nidal development (nesting) of Ebolavirus possible.  Cuba has a population and just enough wilderness to make it possible for ebolavirus to arrive undetected and difficult to closely monitor, watch for, or just trace in order to see if there is another ebolavirus in its newest carriers.  We may need to set up some sentries in this region.

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Culturally-linked diagnoses -- geophagia or earth/clay pica dirt eating 0605 5
Brian Altonen's insight:

There is a cultural part of the pica behavior we occasionally learn about.  During the 1970s and 1960s, we learned about pica behavior in children due to the problems of lead based paint, a requirement of home-builders in the early 1900s that was established by sanitarian officers and health professionals in order to reduce mold growth in domestic settings.  Most lead paint used in the early 1900s was a consequence of the conditions experienced in the Chicago environment, when fire resistant paint, curtains, and other building materials were promoted due to the tragedy of the Chicago Fire.


Lead was added to paint for sanitation purposes.  This in turn led to new problems linked to the mold infestation problems of much older homes, par for the course during the sanitation movement.    


The new pica problem that is erupting more slowly in the U.S. involves Caribbean and African American cultural settings.  Numerous speculations have appeared in the medical literature about why this unique form of pica behavior continues; the theories are often linked to diet and nutrition related desires (the need for more iron for example).    But geography and studies of food chemistry and nutrition have yet to show this is truly the case.


Whatever the reason, some culturally-rich regions can be identified by reviewing the spatial distribution of this very unique cultural behavior, as is the case for this mapping.  


On my Scoopit! page, you can see two maps conveniently side by side--the videomap of general African American/Caribbean linked diagnoses, culturally bound syndromes, genetic-related ICDs, Africa-/Caribbean-linked ecological diseases and other codes, for comparison with this Pica related behavior videomap.  




NOTE: I extensively review (in a five part series) the distinctions between culturally-bound, culturally-linked and other culturally-related diagnoses, taking a medical anthropological approach, at ;

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Brian Altonen's insight:

I did these studies years ago about African health history, disease patterns, linked human behaviors, genetic, and culturally-bound disease patterns into the US.     


I broke down the African cultures in-migrating into the slavery era defined, post slavery and predominantly Muslim related in-migration periods.  These ICDs related to African heritage were then  reclassed into those groups,  and about 180 definitive ICDs for African influence defined.     


This 3D rotating map is one of the first I produced depicting my study results.  It was used to demonstrate the value of the Remote Sensing equations when applied to grid modeling techniques, the mathematical method I designed for implementing this detailed US epidemiological surveillance technique.   


Other examples of my cultural ICD 3D mapping studies are at [Topic: Inmigrating Disease Patterns];   


The primary, secondary and tertiary mapping developed begins with the basic in-migration patterns, followed by cultural-behavioral and then genetic diseases, all identified based upon ICDs.   


This Youtube site is also rich in sociological, zoonotic, genetic, V-code and numerous other foreign born and/or re-emerging disease patterns that I developed NPHGs for.   




My REGIONS & HEALTH pages provide specific applications for these techniques.  The Pacific Northwest issue for example was detailed and discussed extensively a few years ago, beginning with    


Regional Health Planning and the Pacific Northwest Medical GIS and Regions series;   


I posted hundreds of examples of the 3D mapping in this series, 

with GIS applied specific to Pacific NW issues on the page at;   

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A New Report Examines First Reported Spread of Vaccinia Virus Through Shaving After Contact Transmission

A New Report Examines First Reported Spread of Vaccinia Virus Through Shaving After Contact Transmission | National Population Health Grid |
A 30-year-old unvaccinated male security forces student is the first reported case of spreading the smallpox vaccine virus (vaccinia) across his face by shaving after he had inadvertently acquired the virus during combative training at the largest U.S. Air Force training installation, according to a recently released health surveillance report.
Brian Altonen's insight:

Say 'Hi!' to the new small pox strain!!!   


I should mention -- there is precedent for what these types of events reveal to us, events that have recurred in US epidemic history.  The military is the most successful transporters of international disease, but they have come to realize this and have ample amounts of public health procedures in place.  For example, Sandwich Island News paper tells us the Cholera spread across to Sandwich Island in 1849 due to military crafts, and the indigenous tribes 5th chieftain died due to the measles brought in by these ships.  The great 1862 erysipelas epidemic in Chicago, due to Streptococcus pyogenes  or beta-hemolytic group A streptococci, had its predecessors at a military fort to the north a year or two before.


I'll give you the first three paragraphs to review:   


[Begin Quote]


Newswise — SILVER SPRING, MD, August 27, 2014 – A 30-year-old unvaccinated male security forces student is the first reported case of spreading the smallpox vaccine virus (vaccinia) across his face by shaving after he had inadvertently acquired the virus during combative training at the largest U.S. Air Force training installation, according to a recently released health surveillance report.

On June 9, the patient sought medical care at the trainee clinic at the Joint Base San Antonio–Lackland, Texas, and complained of “bumps on his face” after noticing a single small lesion on the underside of his chin three days earlier, according to the report published in the August issue of Medical Surveillance Monthly Report (MSMR) from the Armed Forces Health Surveillance Center (AFHSC) released on August 27. He described the site of the initial lesion as itchy and burning until it “popped” later that day. Within two days, he noticed more lesions on the chin, lower jaw and throat. He had shaved his face and neck on the day of and the day following the rupture of the initial lesion.

Over the past decade, most cases of contact vaccinia (i.e., spread of the virus from a vaccinated person to an unvaccinated person) have been traced to U.S. service members, who comprise the largest segment of the population vaccinated against smallpox. Most involve women or children who live in the same household and/or share a bed with a vaccinee or with a vaccinee’s contact. Of adult female cases, most are described as spouses or intimate partners of vaccinees or secondary contacts. Of adult male cases, most involve some type of recreational activity with physical contact, such as wrestling, grappling, sparring, football, or basketball. Household interactions (e.g., sharing towels or clothing) and “unspecified contact” are also implicated.


[End Quote]


For more . . .;


Want to see how small pox is noted in the medical records for 80M plus people, see my video, . . . 


Immunizations of Diseases.  A video on immunizable disease cases found in EMRs.;


My Wordpress page "The Childhood Immunization Problem", going on many years of views now, at;


My full collection of videos on IMMUNIZATION REFUSAL nationwide are at:


The recent outbreaks are due to a failing preventive care system, and too much reliance upon the "herd effect" hypothesis.  


HERDING is no long an effective means for preventing immunizable disease spread.  The recent outbreak of Measles in NY is clear evidence for our need to eliminate this paradigm from our professional word games.

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Map Shows Every Country's Likely Casualty Rate In The Event Of A Global Pandemic

Map Shows Every Country's Likely Casualty Rate In The Event Of A Global Pandemic | National Population Health Grid |
If you want to know what a global pandemic for something like ebola would look like, we already sort of know.   



To learn the basics of GIS, as taught by its primary inventor and initiator ESRI, begin with ;  and set up a free account.


Brian Altonen's insight:

"Google maps are interesting, but I'm an analyst."    


Also worth a try (just for the experience) are:


Mango Map --

MindMup -- ;

MapSphere -- ;

Click2Map -- ;


and one of the few that require cost and engagement, that is advantageous since it makes use of Excel:  


eSpatial --


Why take on mapping as a healthcare analyst?  


My reply to that is "why isn't your company saving the money it could save, through the use of GIS to improve your business intelligence?"  


Let's face it.  Mapping at the country level isn't as interesting as mapping at the regional level within each country.  It is better at the regional level, but mapping at the state/province or governing level is where many places strive to go.  The county mapping results are even better, and the census block groups some of the best we've been taught to use over the years.  The Metropolitan District, Urban Region and similar spatial definitions, on down to the town and village level are useful.   But for me, in terms of predictive modeling and predictive or explaining disease outbreaks, small area is the only way to go, assuming all medical GIS pros are HIPAA compliant of course (whew! covered that part!).   


NPHG mapping is designed to evaluate a prediction down to the smallest area that a researcher wishes to define.  It shortcuts the mapping procedure by not requiring a GIS.  It shortcuts other pseudo-GIS methods for mapping by focusing on details, saving time by reducing the base map requirements.  


We routinely engage in regional or state and even county level in many health care business industries.  To be able to focus on the mile, or ten mile area, and map out events by hundreds to thousands per day, depending upon your programming and automation processes, is really a major accomplishment for most businesses.  



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The Immigration Problem We’re Not Talking About

The Immigration Problem We’re Not Talking About | National Population Health Grid |

These are the distribution of immunizable diseases (ID) in the U.S., based on a review of EHR/EMRs for ICD defined infectious diseases.  These numbers do not always indicate true cases, for ICDs are entered into medical records for "rule out" cases.  The other stragglers in such rare IDs as small pox are presumable mistakes.  Some cases of unusual claims may be noted in the EHR/EMR as "a history of . . . "   The point of these maps is to demonstrate several patterns.  


First, the popular density pattern typical of mumps, measles, rubella (diphtheria as well, although recent outbreaks were noted in the diphtheria data for the midwest that had to be corrected for).  


Second, the in-migration population density routes, in the NY-NJ-CT-PA ports area, but especially the route heading from south to northnorthnortheast from San Antonio.  


Third, the cluster formed around the great lakes region for poliomyelitis.  Culturally-based over-documentation has been considered a cause, as well as behaviors linked to the proximity of this region to Canada.


Finally, the occasional scattering of claims for rare diseases, in particular small pox (n = 1 or 2, max), which may be even due to data entry errors.

Brian Altonen's insight:

This importation of immunizable disease has been an ongoing dilemma with illegal immigration patterns.  


The recent changes in policy that enables immigration could leave the U.S. in one of its most potentially deadly states ever, in terms of loss or reductions in US population health.  


This is a deliberate exposure, with increases in prevention practices engaged in within the local encampments used as the primary reason we are allowing this to happen.    


So the key questions are . . .  


Will the possible influx of more international diseases like Chikungunya  compromise this security even more?    


Will its impact on local communities outside the national border compromise the security of the borderlands even more?  


Could there be an influx on individuals that we cannot control?  


And do we really know where all of the carriers or potential carriers are?  


The following video on the once geographically bound and fortunately mostly non-contagious Chiclero's ulcer (place of origin - Yucatan peninsula) indicates a very effective in-migration of its carriers to the northern latitudes of the U.S.;


My video on these immunizable diseases and where they were noted in US EMR/EHR documents is at ;

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Why Americans Should Worry About the Ebola Outbreak, by Samantha Cowen, TakePart Live

Why Americans Should Worry About the Ebola Outbreak, by Samantha Cowen, TakePart Live | National Population Health Grid |

The influx of African born epidemiologic culture, traditions, influence, and genetics.  There are two culturally distinct in-migration African routes.  The traditional commercial routes evident since slavery, and the more recent increasingly used Islamic in-migration routes.  

Brian Altonen's insight:

A simple comparison of sickle cell versus infibulation practices over the past decade reveals how these medical diagnoses make their way into this country.  This is reviewed extensively on these ScoopIt! pages and in numerous others posted in other web locations.  


This topic is reviewed extensively as part of the NPHG mapping program.


It remains a topic poorly reviewed by the majority of healthcare programs being developed.  


In the video linked to on the news page --

Why Americans Should Worry About the Ebola Outbreak --

(if you can ignore the overly "flowery" pop culture interpretation it provides)

virus hunter Anne Rimoin talks about the Ebola outbreak in West Africa and how it could affect the U.S.

Romoin talks about outbreaks like Ebola, such as the 2003 Monkey Pox outbreak due to pet animals importation


See  CDC review and recommendations: and ;


and article

CMAJ. Jul 8, 2003; 169(1): 44–45.  "Monkeypox outbreak among pet owners" by James Maskalyk

-- ;).  

For my partial listing of the numerous diseases this issue brings up, see ;


Youtube search on  MonkeyPox videos:


My NPHG videos on


Monkey Pox -- ;


Ebola --;


Yakatopox --


Korean Hemorrhagic Fever --


Crimean or Congo Fever --



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Suicide, z versus z-squared - YouTube

National Population Health Grid-mapping Project. New GIS Technology for Medicine, Conference educational materials. Demonstration of the value of using Z-squared instead of Z or true data values when implementing a new preventive care program.

Brian Altonen's insight:

It sounds really simple.  Your company wishes the  develop a program that targets underserved populations by setting up a new clinic and contacting the neighborhoods where the least amount of health care activities are engaged in by all of the family members.


The way we traditionally do this is we look at something like zip code and street addresses, towns and even hamlets if we have that information, and then we look at whatever services we already have in place for the most needed neighborhoods and where a new office may have to be rented in order to set up a new clinic.


Ideally, this is what we might do, until we see the tables and graphs in front of us and haven't an idea of where to start.  All you need to do is map out that data, adjust it according to the whims and wishes of your managers or quality assurance teams, and then produce a 3D map of your results.  If those results are not easy to interpret, meaning the hot spots don't stand out the way you'd like, all you need to do with your visual is square those z values, and the most needed places in communities are easy to spot.


So why don't we do this?  In a way it appears to be too much common sense at play here, and historically it has been the traditional of spatial health projects to focus on the large area evaluations for reasons of simplicity and, as some might argue, HIPAA compliance.  However, for internal work, there is no reason not to produce maps that explain exactly where the boost in services is needed.  In periurban and rural settings, a zip code tract could mean a 5 or 10 mile difference in locating your new clinic, meaning that you could miss the most needed houses and families.


I used suicide z versus z-squared to point out where the most aggressive suicide prevention programs need to be wet up in the United States.  These are the regions where the most people take their lives, no matter what their normalized incidence rates are.  In most of the V- and E-codes and many ICDs with high social significance or meaning, prevalence/incidence rates suppress the information we have about where the best services need to be provided.  


For managed care programs, this same method can also be used to evaluate costs and savings.  Any statistic can be analyzed using 3D NPHG techniques.  best of all, no GIS is required, if that's the reason a managed care program is simply not implementing GIS as a part of its healthcare management program.

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