Jersey Region Research Articles

The Boomerang Protocol: Tying Data to Geographic Locations in Mobile Disconnected Networks

We present the boomerang protocol to efficiently retain information at a particular geographic location in a sparse network of highly mobile nodes without using infrastructure networks. To retain information around certain physical location, each mobile device passing that location will carry the information for a short while. This approach can become challenging for remote locations around which only few nodes pass by. To address this challenge, the boomerang protocol, similar to delay-tolerant communication, first allows a mobile node to carry packets away from their location of origin and periodically returns them to the anchor location. A unique feature of this protocol is that it records the geographical trajectory while moving away from the origin and exploits the recorded trajectory to optimize the return path. Simulations using automotive traffic traces for a southern New Jersey region show that the boomerang protocol improves packet return rate by 70 percent compared to a baseline shortest path routing protocol. This performance gain can become even more significant when the road map is less connected. Finally, we look at adaptive protocols that can return information within specified time limits.

Use of Regional Transportation Planning Tool for Modeling Emergency Evacuation: Case Study of Northern New Jersey

Evacuation modeling and analysis are concerned primarily with identifying the types of traffic movements associated with a disaster evacuation, as well as the estimation of evacuation and clearance times. Thus, an efficient evacuation planning model is important in determining evacuation times, identifying critical locations in the transportation network, and assessing traffic operations strategies and evacuation policies. In this paper various scenarios, including a hurricane, a toxic chemical leak, dirty bombs, and a nuclear event, are studied to understand the evacuation and highway network effects of the evacuating population. Unlike corridor studies or bottleneck studies found in the literature, a network model with equilibrium assignment is used. The scenarios are tested with a case study of Northern New Jersey, modeled with the North Jersey Regional Transportation Model–Enhanced, a large-scale travel demand model of the region. The results presented in this paper focus on the effect of several assumptions and input data on the evacuation estimates, giving planners an idea of the necessary considerations for evacuation planning with a modeling context. The experience with this study shows that regional planning models are suitable tools to model evacuation; however, the modeler must be careful in their use. Multiple methodologies can be used, and assumptions, such as time of day, notice or no-notice, passengers per car, and background traffic in the network, have wide-ranging effects.

Training Nurses for Interdisciplinary Communication with Families in the Intensive Care Unit: An Intervention

Critical care nurse communication training has largely been limited to didactic materials, interactive training for nurse supervisors, or brief participatory learning programs within the context of comprehensive end-of-life care educational seminars. Preliminary evidence suggests that an interactive approach can also be effective in communication skills training for intensive care unit (ICU) nurses. We implemented a 1-day educational intervention in five acute care hospitals within Veterans Integrated Service Network (VISN) 3 (New York-New Jersey region) of the Department of Veterans Affairs and focused solely on communication skills and targeted specifically to nurses providing bedside care for critically ill patients. A "learner centered" approach to skills training that has several integral components was employed. AMONG THESE ARE: a cognitive, evidence-based foundation upon which to build new skills; a method such as role-play that allows participants to practice newly learned skills; and an affective component, during which trainees can freely discuss their impressions of the exercise or explore difficulties that may have been encountered. Before and after the program we conducted a detailed assessment of participants' self-rated communication skills and of the techniques and materials we used. Post-program responses documented significant improvement in self-evaluated skills for each of the core tasks we assessed. Evidence suggests that communication with patients and families in the ICU can be most effectively approached in an interdisciplinary way. For nurses to fully realize their potential for optimal communication as members of the multidisciplinary team, they must be equipped with the necessary skills. We believe this new program helps to expand the range of approaches for training nurses in essential communication skills.

Port Authority of New York and New Jersey Criterion Pollutant and Greenhouse Gas Emission Inventory

The Port Authority of New York and New Jersey (PANYNJ) has adopted a policy to reduce its greenhouse gas (GHG) emissions by 80% by the year 2050. For this project, E. H. Pechan & Associates, Inc., and Southern Research Institute developed 2006, 2007, and 2008 calendar year GHG and criteria pollutant emission inventories for PANYNJ facilities and operations, including the emissions of its tenants (e.g., airlines and shippers) and patrons [e.g., airport passengers and Port Authority TransHudson (PATH) riders]. In addition, the consulting team developed and implemented systems that allow for annual tracking and reporting of GHG emissions. PANYNJ manages and maintains the bridges, tunnels, bus terminals, airports, PATH commuter rail system, and marine terminals that are critical to the metropolitan New York and New Jersey region's trade and transportation capabilities. Major facilities owned, managed, operated, or maintained by PANYNJ include John F. Kennedy International, Newark Liberty International, and LaGuardia Airports; the George Washington Bridge; the Lincoln and Holland Tunnels; Port Newark and the Howland Hook Marine Terminal; the Port Authority Bus Terminal; and the 16-acre World Trade Center site in lower Manhattan. This paper describes the methods used to develop consistent GHG and criterion pollutant emission estimates for a diverse set of source types and how these methods have been updated as new information and new protocols have emerged.

Black-White Appreciation of Owner-Occupied Homes in Upper Income Suburban Integrated Communities: The Cases of Maplewood and Montclair, New Jersey

This paper examines black-white differences in housing appreciation in northern NewJersey, with particular emphasis on the communities of Montclair and Maplewood in the1970 to 2000 period. The findings reveal that home appreciation at the block group levelin these communities was inversely related to changes in the black population. The effectof changes in the proportion of the population that was black on home appreciation wassimilar to the effects of changes in black population at the census tract level in thenorthern New Jersey region as a whole. These high-income communities with award-winningschool districts and well maintained housing stocks were not immune from theeffects of race on home appreciation.

Measuring Toll Burdens

This paper uses a unique survey data set of toll revenue collection on New York City bridges administered by the Metropolitan Transportation Authority's Bridges and Tunnels (MTA Bridges and Tunnels). This data set, which contains detailed information on road user income and location, is analyzed to assess distributional equity of burden across road users of various toll facilities (both value-priced and fixed-rate tolls) in the New York-New Jersey region. The distributional impact is summarized with the use of Lorenz curves and Gini coefficients, a standard economic measure with these and other measures, the authors develop empirical estimates of the social equity conditions on the existing priced facilities. The authors find that burdens are least equitable on facilities where there are few alternative routes and more equitable on those with more alternatives but that, in general, users of MTA Bridges and Tunnels facilities have higher income than the general population surrounding those facilities.

Structure and Evolution of Precipitation along a Cold Front in the Northeastern United States

Abstract Heavy precipitation in the northeastern United States is examined through observational and numerical modeling analyses for a weather system that produced extreme rainfall rates and urban flash flooding over the New York–New Jersey region on 4–5 October 2006. Hydrometeorological analyses combine observations from Weather Surveillance Radar-1988 Doppler (WSR-88D) weather radars, the National Lightning Detection Network, surface observing stations in the northeastern United States, a vertically pointing lidar system, and a Joss–Waldvogel disdrometer with simulations from the Weather Research and Forecasting Model (WRF). Rainfall analyses from the Hydro-Next Generation Weather Radar (NEXRAD) system, based on observations from WSR-88D radars in State College, Pennsylvania, and Fort Dix, New Jersey, and WRF model simulations show that heavy rainfall was organized into long-lived lines of convective precipitation, with associated regions of stratiform precipitation, that develop along a frontal zone. Structure and evolution of convective storm elements that produced extreme rainfall rates over the New York–New Jersey urban corridor were influenced by the complex terrain of the central Appalachians, the diurnal cycle of convection, and the history of convective evolution in the frontal zone. Extreme rainfall rates and flash flooding were produced by a “leading line–trailing stratiform” system that was rapidly dissipating as it passed over the New York–New Jersey region. Radar, disdrometer, and lidar observations are used in combination with model analyses to examine the dynamical and cloud microphysical processes that control the spatial and temporal structure of heavy rainfall. The study illustrates key elements of the spatial and temporal distribution of rainfall that can be used to characterize flash flood hazards in the urban corridor of the northeastern United States.

Is the Worst Over? Economic Indexes and the Course of the Recession in New York and New Jersey

The New York–New Jersey region entered a pronounced downturn in 2008, but the pace of decline eased considerably in spring 2009 and then leveled off in July, according to three key Federal Reserve Bank of New York economic indexes. These developments, in conjunction with a growing consensus that the national economy is headed for recovery, suggest that the worst may be over for the region’s economy. However, a downsizing of the area’s critical finance sector could pose a major risk to the economic outlook going forward—particularly for New York City.

Employment in the New York - New Jersey Region: 2008 Review and Outlook

The 2007 slowing in job growth in the New York-New Jersey region continued through August 2008. A projected weakening in the national economy through the end of 2008 combined with the market turmoil affecting New York City's finance sector suggests that the region will post substantially smaller job gains this year than it did in 2007. Beyond 2008, continued financial stress could lead to an even sharper and more protracted contraction in the city's finance sector, potentially spreading to other sectors of the region's economy.

Organochlorine Pesticides, PCBs, Dioxins, and Metals in Postterm Peregrine Falcon (Falco peregrinus) Eggs from the Mid-Atlantic States, 1993–1999

Peregrine falcons were extirpated from the eastern United States by 1964 due to the effects of dichloro-diphenyl-trichlorethane (DDT) (Peakall and Kiff 1988). As a result of restoration efforts, peregrines have largely recovered in the region but remain a barometer of environmental contamination. In the course of monitoring nests, biologists in the mid-Atlantic states collected peregrine falcon eggs that failed to hatch. In the period 1993-1999, 93 eggs were collected from 66 nests in 31 locations in New Jersey, Pennsylvania, Delaware, Maryland, and Virginia. We analyzed eggs for organochlorine pesticides, PCBs, and metals, and calculated toxic equivalencies (TEQs) for dioxins and furans. Organochlorine contaminants were detected in eggs from all parts of the region. Although nest success in all parts of the region was good, the PCB TEQ in the Atlantic-New Jersey region was significantly related to nest success, and the regionwide PCB TEQ was nearly significant for nest success across the five-state area. dichloro-diphenyl-dichloroethylene (DDE), DDT, and total PCBs were negatively correlated with eggshell thickness, although eggshell thinning (10.4%) was not at a level associated with deleterious population effects. The five states represented in this study are productive for peregrine falcons and have contributed to the recovery of this species. However, the results suggest that Atlantic coastal peregrines might be subject to contaminant burdens that have the potential to decrease nest success and productivity.

Late Cretaceous to Miocene sea‐level estimates from the New Jersey and Delaware coastal plain coreholes: an error analysis

ABSTRACTSea level has been estimated for the last 108 million years through backstripping of corehole data from the New Jersey and Delaware Coastal Plains. Inherent errors due to this method of calculating sea level are discussed, including uncertainties in ages, depth of deposition and the model used for tectonic subsidence. Problems arising from the two‐dimensional aspects of subsidence and response to sediment loads are also addressed. The rates and magnitudes of sea‐level change are consistent with at least ephemeral ice sheets throughout the studied interval. Million‐year sea‐level cycles are, for the most part, consistent within the study area suggesting that they may be eustatic in origin. This conclusion is corroborated by correlation between sequence boundaries and unconformities in New Zealand. The resulting long‐term curve suggests that sea level ranged from about 75–110 m in the Late Cretaceous, reached a maximum of about 150 m in the Early Eocene and fell to zero in the Miocene. The Late Cretaceous long‐term (107 years) magnitude is about 100–150 m less than sea level predicted from ocean volume. This discrepancy can be reconciled by assuming that dynamic topography in New Jersey was driven by North America overriding the subducted Farallon plate. However, geodynamic models of this effect do not resolve the problem in that they require Eocene sea level to be significantly higher in the New Jersey region than the global average.

The Use of Data to Assist in the Design of a New Service System for Homeless Veterans in New York City

Operation Home is an agreement between the City of New York and the US Department of Veterans Affairs to design a new service system to help end veteran homelessness in New York City. The authors' task was to obtain data to inform the design of this new system. A variety of methods were used. The group reviewed relevant literature and data from street homeless survey samples, analyzed shelter data, and consulted with VA homeless program staff on the findings. We then surveyed case managers at a veterans' shelter regarding their clients and determined their housing eligibility using a standardized logic model, and led two focus groups of veterans at this shelter regarding their views of the current shelter system and services for homeless veterans and how these might be improved. Among those resident in shelters during 2006, 37.2% of self-identified veterans compared to 0.9% of others reported their prior residence as supported housing, suggesting the need for more intensive case management at veterans' supported housing sites to help them sustain their tenure. The lack of interconnectedness among the various information systems made it more difficult to collect and analyze pertinent data. To begin to address this, a data match was undertaken to estimate the proportion of veterans resident in the veterans' shelter who were not in receipt of VA benefits to which they may be entitled. The data obtained through collaboration between staff from NYC's Department of Homelessness Services, US Department of Veterans Affairs facilities in the New York/New Jersey region and Common Ground Community led to information that informed the evaluation design of the new system. The identification of gaps in available data on homeless veterans will lead to projects both to improve and share data.

1996 Job Outlook: The New York-New Jersey Region

The New York-New Jersey region's hard-earned recovery in employment is being overshadowed by ongoing job losses in certain sectors and the prospect of moderating growth in the United States as a whole. Fortunately, several positive trends are bolstering the region's employment picture. Strength in the services sector, a falloff in restructuring, and gains in income point to continuing—though modest—regional job growth in 1996.

New York-New Jersey Region's Job Growth to Continue on 1999, But Risks Have Risen

Employment growth in the New York-New Jersey region in 1998 is likely to match the previous year's pace of 1.7 percent, or 200,000 new jobs. Growth will continue in 1999, but it will slow modestly, to about 1.2 percent, or 145,000 new jobs.

Two New Indexes Offer a Broad View of Economic Activity in the New York-New Jersey Region

The authors develop two coincident indexes that provide a comprehensive measure of economic activity in New Jersey, New York State, and New York City.

Impact of Splitting Risperidone Tablets on Medication Adherence and on Clinical Outcomes for Patients With Schizophrenia

Impact of Splitting Risperidone Tablets on Medication Adherence and on Clinical Outcomes for Patients With Schizophrenia

Impact of Splitting Risperidone Tablets on Medication Adherence and on Clinical Outcomes for Patients With Schizophrenia

Tablet splitting is a strategy aimed at reducing the cost of prescriptions. Some clinicians question whether patients with psychosis can understand and follow tablet-splitting instructions. The clinical impact of tablet splitting for individuals with severe mental illness is unknown. The research objectives were to determine whether risperidone tablet splitting is associated with changes in medication adherence, service utilization, or clinical outcomes. The study was a retrospective analysis of administrative data from the New York-New Jersey region of the Veterans Health Administration for 2,436 individuals with schizophrenia or schizoaffective disorder who were prescribed risperidone from January 2001 through March 2003. Antipsychotic medication adherence was measured by medication possession ratio (MPR). Clinical outcomes included attendance at scheduled and unscheduled outpatient appointments and psychiatric and medical admission rates. The MPR increased from .83 to .90 (p<.001) after initiating tablet splitting. The rate of unscheduled mental health appointments increased significantly, particularly in the first 60 days after initiating splitting; attendance at scheduled outpatient mental health appointments was unchanged. Psychiatric admission and general medical admission rates were unchanged. The results provide some assurance that prescribing tablet splitting for patients with schizophrenia does not result in poor outcomes as measured by psychiatric and medical inpatient admissions. Increased MPRs and unscheduled appointments suggest that some patients may have experienced minor difficulty, especially early on (crumbled tablets or misunderstood splitting instructions). Patients should be instructed carefully when tablet splitting is prescribed. Future studies should address longer-term clinical outcomes and systemwide costs.

Theatres, Metaphors, and E-Collaboration

A metaphor methodology was used to understand and interpret the Web presences of 15 nonprofit theatres that comprise the regional theatre of Southern New Jersey that is present on the Web. In addition, findings from our earlier studies of off-Broadway and regional theatre festivals were extended to analyze the Web presence of the theatres in Southern New Jersey. The contribution of the work resides in its systematic and intense consideration of the strategic importance of the Web for nonprofit theatre arts groups in the Southern New Jersey region and in its use of the metaphor methodology in order to facilitate a fully developed picture of the Web and nonprofit organizations. This is intended to help administrators become aware of the need for strategic use of e-collaboration via creation of a regional theatre Web presence for South Jersey that enacts a more evolutionary metaphor, perhaps that of the organism. Theatres are encouraged to practice collaborating on the Web by creating reciprocal links and thus cooperating as a region.

The Variable Success of Managing Bleeding Disorder Related Menorrhagia: A Multicenter Study within the Hemophilia Treatment Center Network.

The growing awareness to screen women with menorrhagia for an underlying bleeding disorder has led to an increase in enrollment of identified cases in Hemophilia Treatment Centers (HTCs). However, the outcome of menorrhagia management in these women has not been well-described.Objective: To determine the efficacy/outcome of the management of bleeding disorder-related menorrhagia in patients enrolled within the HTC network.Patients and Methods: Registry study of initial data collection of retrospective obstetrical and gynecological events with prospective yearly follow-up for 5 years for new obstetrical and gynecological events.Results: 99 women from five HTCs in New York-New Jersey Region II have been registered to date, mean age 38±16.3, median age 40. Diagnoses are: von Willebrand disease (VWD) in 71%; thrombocytopathy in 6%; factor deficiency in 23%. Menstrual status and outcomes presently:⇒32/99 (32%) are not menstruating due to hysterectomy or post/peri-menopausal status; 13/99 have undergone a hysterectomy (n=10) or endometrial ablation (n=3) for menorrhagia control; in 7/10 of the women undergoing a hysterectomy for menorrhagia control, the diagnosis of VWD was previously established; 6/7of these women attempted medical treatment prior to hysterectomy⇒68/99 (68%) are presently menstruating. Of those menstruating, menstrual status is as follows:•Normal menses: 23.5% (16/68)•Menorrhagia under control: 23.5% (16/68); of these patients; 11/16 have achieved control with oral contraceptive(OC), the remaining 5 patients have achieved control with intranasal DDAVP or Amicar•Menorrhagia presently: 53% (36/68); 22/36 (61%) have undergone a course of ineffective menorrhagia treatment including intranasal DDAVP in 17/22Conclusions: The majority of women with menorrhagia enrolled in HTCs have persistent menorrhagia despite evaluation and management within the HTC network. Only a small proportion have menorrhagia control due to intranasal DDAVP use and a proportion still necessitate hysterectomy for menorrhagia control. The value in United States HTCs of hemostatic measures alone such as intranasal DDAVP in the management of bleeding disorder related menorrhagia is uncertain at this time. Further study of combined therapy (intranasal DDAVP and Amicar ± OC) and novel approaches (levonorgestrel-intrauterine device) is warranted as are efforts to procure tranexamic acid for use in the U.S.

The measurement of productivity in an emergency medicine group practice

Study objectives: Productivity in a medical service organization is difficult to define, and its measurement is a controversial issue. Relative value units (RVU) have been used by some organizations, but this index takes into account only work product. A new emergency medicine financial productivity index (EMPI) has been developed for testing and validation. We calculate the EMPI defined as revenue per patient service hour per work hour and determine the correlation of the EMPI with RVU. Methods: This was a retrospective data review of fee-for-service emergency medicine group practice comprising 16 sites in the northern New Jersey region. A total of 210 physicians working at 16 emergency departments were studied for each month from January 2003 through March 2004, accounting for 825,549 consecutive patient encounters. Input variables included hours worked, charges per patient, collections per patient, length of stay (LOS) per patient, RVUs per patient encounter, and volume of patients. RVU work units were compiled using federal 2003 guidelines. The EMPI was defined as the revenue per patient-hour per work-hour and is derived as follows: EMPI = {{Average revenue per patient encounter ÷ Average LOS per patient encounter} ÷ Hours worked} × Patient volume The EMPI calculation was performed 3 ways where the average revenue per patient encounter was charge based, collection based, or the RVU work product index. The financial EMPI (both charge and collection based) by physician and hospital site was derived and plotted against the corresponding RVU function to determine correlation. The EMPI was also derived by sample disease states, including ankle sprain, asthma, upper respiratory infection (URI), and chest pain. The EMPI by sample disease state was plotted against the RVU function to determine correlation. Results: The charge-based financial EMPI by physician and hospital site correlated with the RVU function for all patient encounters by month at all ED sites and yielded a remarkably linear relation (R=0.991 charge based by physician). The collection-based financial EMPI also correlated with the RVU function, but not as well as the charge-based calculation (R=0.877). The correlation of the charge-based financial EMPI by disease states with the RVU function was also very linear (R=0.993 for asthma, R=0.996 for ankle sprain, R=0.978 for URI, and R=0.991 for chest pain). The collection-based financial EMPI was also linear but had less of a correlation with the RVU function (R=0.882 for asthma, R=0.886 for ankle sprain, R=0.967 for URI, and R=0.908 for chest pain). Conclusion: A productivity index for emergency medicine practice has been developed that incorporates revenue (charges versus collections), hours worked, LOS, and patient volume. This model is financially based and does not incorporate other physician-centric attributes such as patient satisfaction, hospital committee participation, or research publications. This index is shown to correlate well with RVU calculations. The correlation appears to occur by physician, ED site, and disease state for all patient encounters. Further studies are warranted for validation of this model.