Technology & Policy

Co-Monitoring for Transit Management

Co-Monitoring for Transit Management
NYU Rudin Center for Transportation, February 2014.

Kaufman, Sarah
02/26/2014

Emerging technologies offer transit agencies an opportunity to transform fundamental aspects of their operations and the way they communicate with their riders.  With nearly ubiquitous smartphones and social media tools among growing ridership patterns, transit providers can use aggregate mobile phone data and social media posts to improve system management.

Data-based reports can reach the operations center faster than field personnel, with mobile phone networks indicating station crowding or a passenger posting a photo of another pulling the emergency brake. Exceeding traditional reporting mechanisms (exclusive information from personnel) would save time and lower the costs of field monitoring while raising the trust between transit agencies and their customers.

By employing “co-monitoring” - the monitoring of field conditions through a combination of staff reports, data analysis and public observations – transit agencies will save time and costs for information gathering, improve their responsiveness, and establish working partnerships between the agencies and their customers. This report proposes a framework for a co-monitoring system, and discusses the expected benefits and challenges, as well as policy recommendations for agencies pursuing co-monitoring systems. Keys to successful co-monitoring systems are agency openness to new streams of data and respectful dialogue from both management and riders. Well-designed co-monitoring tools will put transit on track to manage smarter, more versatile transit systems for the twenty-first century.

Smart Cities: Big Data, Civic Hackers, and the Quest for a New Utopia

Smart Cities: Big Data, Civic Hackers, and the Quest for a New Utopia
W. W. Norton & Company

Anthony M. Townsend
10/07/2013

An unflinching look at the aspiring city-builders of our smart, mobile, connected future.

We live in a world defined by urbanization and digital ubiquity, where mobile broadband connections outnumber fixed ones, machines dominate a new "internet of things," and more people live in cities than in the countryside. In Smart Cities, urbanist and technology expert Anthony Townsend takes a broad historical look at the forces that have shaped the planning and design of cities and information technologies from the rise of the great industrial cities of the nineteenth century to the present. A century ago, the telegraph and the mechanical tabulator were used to tame cities of millions. Today, cellular networks and cloud computing tie together the complex choreography of mega-regions of tens of millions of people.

In response, cities worldwide are deploying technology to address both the timeless challenges of government and the mounting problems posed by human settlements of previously unimaginable size and complexity. In Chicago, GPS sensors on snow plows feed a real-time "plow tracker" map that everyone can access. In Zaragoza, Spain, a "citizen card" can get you on the free city-wide Wi-Fi network, unlock a bike share, check a book out of the library, and pay for your bus ride home. In New York, a guerrilla group of citizen-scientists installed sensors in local sewers to alert you when stormwater runoff overwhelms the system, dumping waste into local waterways.

As technology barons, entrepreneurs, mayors, and an emerging vanguard of civic hackers are trying to shape this new frontier, Smart Cities considers the motivations, aspirations, and shortcomings of them all while offering a new civics to guide our efforts as we build the future together, one click at a time.

What’s the Worst That Can Happen? Social Media Protocols and Policies

What’s the Worst That Can Happen? Social Media Protocols and Policies
In Best Practices for Transportation Agency Use of Social Media, CRC Press, October 2, 2013.

Sarah M. Kaufman and Susan Bregman
10/02/2013

Timely updates, increased citizen engagement, and more effective marketing are just a few of the reasons transportation agencies have already started to adopt social media networking tools. Best Practices for Transportation Agency Use of Social Media offers real-world advice for planning and implementing social media from leading government practitioners, academic researchers, and industry experts.

The book provides an overview of the various social media platforms and tools, with examples of how transportation organizations use each platform. It contains a series of interviews that illustrate what creative agencies are doing to improve service, provide real-time updates, garner valuable information from their customers, and better serve their communities. It reveals powerful lessons learned from various transportation agencies, including a regional airport, city and state departments of transportation, and municipal transit agencies. 

Filled with examples from transportation organizations, the text provides ideas that can apply to all modes of transportation including mass transit, highways, aviation, ferries, bicycling, and walking. It describes how to measure the impact of your social media presence and also examines advanced uses of social media for obtaining information by involving customers and analyzing their social media use. 

The book outlines all the resources you will need to maintain a social media presence and describes how to use social media analytical tools to assess service strengths and weaknesses and customer sentiment. Explaining how to overcome the digital divide, language barriers, and accessibility challenges for patrons with disabilities, it provides you with the understanding of the various social media technologies along with the knowhow to determine which one is best for a specific situation and purpose.

 
 

Social Media in Disaster Preparation, Response, and Recovery

Social Media in Disaster Preparation, Response, and Recovery
TR News July-August 2013: Logistics of Disaster Response

Sarah M. Kaufman
09/27/2013

Social media have become an essential source of information before, during, and after disasters. Social networks like Twitter, Facebook, and Tumblr—instantaneous, far-reaching, and interactive— have become the convergence point for a range of information sources, dialogues, and dynamic content. A survey conducted by the New York University (NYU) Rudin Center for Transportation Policy and Management found that during Superstorm Sandy, social media were the second-highest-rated source of information, ranking higher than other popular sources such as television and radio news, news websites, and community groups.

Monitoring the pulse of hospital activity: Electronic health record utilization as a measure of care intensity

Monitoring the pulse of hospital activity: Electronic health record utilization as a measure of care intensity
Journal of Hospital Medicine, Vol. 8, no. 9, pp. 513-518. DOI: 10.1002/jhm.2068

Blecker, S., J.S. Austrian, D. Shine, R. Scott Braithwaite, M.J. Radford, and M.N. Gourevitch
09/01/2013

Background: Hospital care on weekends has been associated with reduced quality and poor clinical outcomes, suggesting that decreases in overall intensity of care may have important clinical effects. We describe a new measure of hospital intensity of care based on utilization of the electronic health record (EHR).

Methods: We measured global intensity of care at our academic medical center by monitoring the use of the EHR in 2011. Our primary measure, termed EHR interactions, was the number of accessions of a patient's electronic record by a clinician, adjusted for hospital census, per unit of time. Our secondary measure was percent of total available central processing unit (CPU) power used to access EHR servers at a given time.

Results: EHR interactions were lower on weekend days as compared to weekdays at every hour (P < 0.0001), and the daytime peak in intensity noted each weekday was blunted on weekends. The relative rate and 95% confidence interval (CI) of census-adjusted record accessions per patient on weekdays compared with weekends were: 1.76 (95% CI: 1.74-1.77), 1.52 (95% CI: 1.50-1.55), and 1.14 (95% CI: 1.12-1.17) for day, morning/evening, and night hours, respectively. Percent CPU usage correlated closely with EHR interactions (r = 0.90).

Conclusions: EHR usage is a valid and easily reproducible measure of intensity of care in the hospital. Using this measure we identified large, hour-specific differences between weekend and weekday intensity. EHR interactions may serve as a useful measure for tracking and improving temporal variations in care that are common, and potentially deleterious, in hospital systems.

Prostate Cancer Imaging Trends After a Nationwide Effort to Discourage Inappropriate Prostate Cancer Imaging

Prostate Cancer Imaging Trends After a Nationwide Effort to Discourage Inappropriate Prostate Cancer Imaging
Journal of the National Cancer Institute, Vol. 105, no. 17, pp. 1306-1313. DOI: 10.1093/jnci/djt175

Makarov, D.V., S. Loeb, D. Ulmert, L. Drevin, M. Lambe, and P. Stattin
07/13/2013

Background: Reducing inappropriate use of imaging to stage incident prostate cancer is a challenging problem highlighted recently as a Physician Quality Reporting System quality measure and by the American Society of Clinical Oncology and the American Urological Association in the Choosing Wisely campaign. Since 2000, the National Prostate Cancer Register (NPCR) of Sweden has led an effort to decrease national rates of inappropriate prostate cancer imaging by disseminating utilization data along with the latest imaging guidelines to urologists in Sweden. We sought to determine the temporal and regional effects of this effort on prostate cancer imaging rates.

Methods: We performed a retrospective cohort study among men diagnosed with prostate cancer from the NPCR from 1998 to 2009 (n = 99 879). We analyzed imaging use over time stratified by clinical risk category (low, intermediate, high) and geographic region. Generalized linear models with a logit link were used to test for time trend.

Results: Thirty-six percent of men underwent imaging within 6 months of prostate cancer diagnosis. Overall, imaging use decreased over time, particularly in the low-risk category, among whom the imaging rate decreased from 45% to 3% (P < .001), but also in the high-risk category, among whom the rate decreased from 63% to 47% (P < .001). Despite substantial regional variation, all regions experienced clinically and statistically (P < .001) significant decreases in prostate cancer imaging.

Conclusions: A Swedish effort to provide data on prostate cancer imaging use and imaging guidelines to clinicians was associated with a reduction in inappropriate imaging over a 10-year period, as well as slightly decreased appropriate imaging in high-risk patients. These results may inform current efforts to promote guideline-concordant imaging in the United States and internationally.

Reimagining Governance in Practice: Benchmarking British Columbia’s Citizen Engagement Efforts

Reimagining Governance in Practice: Benchmarking British Columbia’s Citizen Engagement Efforts
The GovLab, May 2013

Andrew Young, Christina Rogawski, Sabeel Rahman, and Stefaan Verhulst
05/01/2013

Over the last few years, the Government of British Columbia (BC), Canada has initiated a variety of practices and policies aimed at providing more legitimate and effective governance. Leveraging advances in technology, the BC Government has focused on changing how it engages with its citizens with the goal of optimizing the way it seeks input and develops and implements policy. The efforts are part of a broader trend among a wide variety of democratic governments to re-imagine public service and governance.

At the beginning of 2013, BC’s Ministry of Citizens’ Services and Open Government, now the Ministry of Technology, Innovation and Citizens’ Services, partnered with the GovLab to produce “Reimagining Governance in Practice: Benchmarking British Columbia’s Citizen Engagement Efforts.”  The GovLab’s May 2013 report, made public today, makes clear that BC’s current practices to create a more open government, leverage citizen engagement to inform policy decisions, create new innovations, and provide improved public monitoring­—though in many cases relatively new—are consistently among the strongest examples at either the provincial or national level.

According to Stefaan Verhulst, Chief of Research at the GovLab : “Our benchmarking study found that British Columbia’s various initiatives and experiments to create a more open and participatory governance culture has made it a leader in how to re-imagine governance. Leadership, along with the elimination of imperatives that may limit further experimentation, will be critical moving forward. And perhaps even more important, as with all initiatives to re-imaging governance worldwide, much more evaluation of what works, and why, will be needed to keep strengthening the value proposition behind the new practices and polices and provide proof-of-concept.”

Surgical Decompression is Associated with Decreased Mortality in Patients with Sepsis and Ureteral Calculi

Surgical Decompression is Associated with Decreased Mortality in Patients with Sepsis and Ureteral Calculi
Journal of Urology, Vol. 189, no. 3, pp. 946-951. DOI: 10.1016/j.juro.2012.09.088

Borofsky, M.S., D. Walter,O. Shah, D.S. Goldfarb, A.C. Mues, and D.V. Makarov
03/01/2013

Purpose: The combination of sepsis and ureteral calculus is a urological emergency. Traditional teaching advocates urgent decompression with nephrostomy tube or ureteral stent placement, although published outcomes validating this treatment are lacking. National practice patterns for such scenarios are currently undefined. Using a retrospective study design, we defined the surgical decompression rate in patients admitted to the hospital with severe infection and ureteral calculi. We determined whether a mortality benefit is associated with this intervention.

Materials and Methods: Patient demographics and hospital characteristics were extracted from the 2007 to 2009 Nationwide Inpatient Sample. We identified 1,712 patients with ureteral calculi and sepsis. Multivariate logistic regression was performed to determine the association between mortality and surgical decompression.

Results: Of the patients 78% underwent surgical decompression. Mortality was higher in those not treated with surgical decompression (19.2% vs 8.82%, p <0.001). Lack of surgical decompression was independently associated with an increased OR of mortality even when adjusting for patient demographics, comorbidities and geographic region of treatment (OR 2.6, 95% CI 1.9–3.7).

Conclusions: Absent surgical decompression is associated with higher odds of mortality in patients with sepsis and ureteral calculi. Further research to determine predictors of surgical decompression is necessary to ensure that all patients have access to this life saving therapy.

Centralization of Radical Prostatectomy in the United States

Centralization of Radical Prostatectomy in the United States
Journal of Urology, Vol. 189, no. 2, pp. 500-506. DOI: 10.1016/j.juro.2012.10.012

Anderson, C.B., D.F. Penson, S. Ni, D.V. Makarov, and D.A. Barocas
02/01/2013

Purpose: Radical prostatectomy is a common treatment for organ confined prostate cancer and its use is increasing. We examined how the increased volume is being distributed and what hospital characteristics are associated with increasing volume.

Materials and Methods: We identified all men age 40 to less than 80 years who underwent radical prostatectomy for prostate cancer from 2000 to 2008 in the NIS (Nationwide Inpatient Sample) (586,429). Ownership of a surgical robot was determined using the 2007 AHA (American Hospital Association) Annual Survey. The association between hospital radical prostatectomy volume and hospital characteristics, including ownership of a robot, was explored using multivariate linear regression.

Results: From 2000 to 2008 there was a 74% increase in the number of radical prostatectomies performed (p = 0.05) along with a 19% decrease in the number of hospitals performing radical prostatectomy (p <0.001), resulting in an increase in annual hospital radical prostatectomy volume (p = 0.009). Several hospital variables were associated with greater radical prostatectomy volume including teaching status, urban location, large bed size and ownership of a robot in 2007. On multivariate analysis the year, teaching status, large bed size, urban location and presence of a robot were associated with higher hospital radical prostatectomy volume.

Conclusions: Use of radical prostatectomy increased significantly between 2000 and 2008, most notably after 2005. The increase in radical prostatectomy resulted in centralization to select hospitals, particularly those in the top radical prostatectomy volume quartile and those investing in robotic technology. Our findings support the hypothesis that hospitals with the greatest volume increases are specialty centers already performing a high volume of radical prostatectomy procedures.

How Social Media Moves New York, Part 2: Recommended Social Media Policy for Transportation Providers

How Social Media Moves New York, Part 2: Recommended Social Media Policy for Transportation Providers
NYU Rudin Center for Transportation, December 2012

Kaufman, Sarah.
12/01/2012

Social media networks allow transportation providers to reach large numbers of people simultaneously and without a fee, essential factors for the millions of commuters and leisure travelers moving through the New York region every day. This report, based on earlier findings (from Part 1), which analyzed local transportation providers’ use of social media, and a seminar on the subject in the wake of Hurricane Sandy, recommends social media policies for transportation providers seeking to inform, engage and motivate their customers.

The goals of social media in transportation are to inform (alert riders of a situation), motivate (to opt for an alternate route), and engage (amplify the message to their friends and neighbors). To accomplish these goals, transportation providers should be:

- Accessible: Easily discovered through multiple channels and targeted information campaigns

- Informative: Disseminating service information at rush hour and with longer-form discussions on blogs as needed

- Engaging: Responding directly to customers, marketing new services, and building community

- Responsive: Soliciting and internalizing feedback and self-evaluating in a continuous cycle

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