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nursingwriter · 2 months ago

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¶ … Elderly in Monrovia, CA The population of people aged 65 years or greater is steadily escalating, as baby boomers come of age. It is estimated that this age bracket accounts for 10% of the total world population, and is statistically increasing. As this sector of the population steadily increases, there are of course, accompanying health care issues: osteoarthritis, cardiac and kidney issues, Alzheimer's or dementia, and an ever-growing problem with depression. For this essay, we will concentrate on several health issues that plague seniors nationally, but will specifically focus on the aging population over 65 in Monrovia, California. Monrovia is a smallish city located at the foothills of the San Gabriel Mountains in the San Gabriel Valley, Los Angeles County. Monrovia was settled in the late 1800s as a central hub for the growing orange grove industry, but has now become more of a bedroom community that supports the urban sprawl of the valley area. Monrovia's population has held steady since the 2000 census, growing only .6%. The city's median age is 38, and families represent 67% of the population. There are more people of Hispanic origin (37%) in Monrovia, with other at 25%, white at 20%, Asian at 9%, and Black at 8%. Income for Monrovia, though, is a bit higher than the U.S. national average, and higher than Los Angeles County: Monrovia $63,383, U.S. Average $60,374, and Los Angeles County $58, 647. 46% of the population are married couples, 33% non-families, and almost 9% are families or singles who are 65 years of age or older (MuniNet, City of Monrovia Guide, U.S. Census Bureau). Because of Monrovia's proximity to Los Angeles, it does have a propensity for a higher than average air pollution risk, and its location on near the San Andreas fault gives it an earthquake likelihood over 7 times the national average. Average yearly rainfall is 24," the national average 39" -- and temperatures range from the mid-upper 30s in January to the low 80s in July, making the city a bit more evenly temperate than many in the Los Angeles basin. Cost of living is 63% higher than the national average, with the bulk of that increase coming in general consumer expenditures. Crime in general is 4% below the national average, but 52% higher for vehicle theft and 46% higher for robbery (PropertyMaps, 2007). Monrovia is a somewhat typical smaller Southern California city that still has the flavor of a smaller town with organic and farmer's markets, local arts and festivals, and a more localized education system. As noted in the crime statistics, however, it has not escaped the rise in vehicular crime, but is far safer than most of Los Angeles County for violent crime. Monrovia is served by a community hospital and several health care clinics, albeit relatively small with 50 active beds. The hospital does support Medicare and Medicaid, and has 30 full time Registered Nurses on staff, updated accreditation, but is considered a short-term care facility by licensing boards (HospitalData.Com, 2007). There is only one Senior Center in Monrovia, with several other organizations close by in El Monte and Baldwin Park. There are, however, 4-6 organizations that, through volunteer or federal funding, do provide outreach programs for the elderly, with Catholic Social Services providing the bulk of non-governmental care (Monrovia's population is almost 70% Catholic) (Monrovia Community Organizations, 2007). As of 2006, there were 85 seniors in nursing homes, 76 people in group homes, and 73 people in noninstitutional group quarters (CityData.com, 2006). Key findings for the area (Los Angeles County which also correlates to Monrovia) show the following based on populations over 65, ranked male and female, and ranged for the 4 major groups studied in the research: Figure 1 -- Overall Mortality in Los Angeles County Cause of Death Overall & Average Age of Death Male Female White Hispanic Black Asian Heart Disease 1-33% Age: 74 1 1 1 1 1 1 Cancer 2-23% Age: 70 2 2 2 2 2 2 Stroke 3-7% Age: 78 3 3 3 3 3 3 Respiratory Disease 4-5% Age: 77 4 4 4 5 5 Pneumonia and Influenza 5-4% Age: 72 6 5 5 4 Alzheimer's 10-1.5% Age: 85 8 Note: If blank, does not fit into the top 10 causes of death for that population, Source: "Mortality in Los Angeles County," Centers for Public Health, 2001. Figure 2 -- Overall Mortality Ranking of National Causes of Death in Senior Populations and Comparisons With Los Angeles County -- Top Six Causes (2002) Cause of Death National/% LA Cty/% National Male National Female Heart Disease 1 -- 32% 1-33% 1 1 Cancer 2 -- 22% 2-23% 2 2 Stroke 3-8% 3-7% 4 3 Respiratory Disease 4-6% 4-5% 3 4 Pneumonia and Influenza 5-3% 5-4% 5 6 Alzheimer's 6-3% 6-1.5% 7 5 Source: "Chronic Diseases Are Leading Causes of Death Among Senior Citizens," SeniorJournal.Com, 2002. The data sets show that Monrovia is well within the national average for leading mortality indicators, with the exception of being half that of Alzheimer's. Interestingly enough, though, one might expect the percentage of respiratory diseases to be higher in Los Angeles County than the national average due to air pollution, this is not the case. Like the national averages, heart disease and cancer remain the two leading causes of death for senior citizens -- 33% for heart disease and 20% for cancer. Strokes follow a lower third, with respiratory and immune diseases lagging. However, depending on the ethnic makeup of the population, Alzheimer's disease increased since the 1970s, both nationally and for Los Angeles County, so that it is now within the leading mortality indicators for persons 65 or older; even though the average age of death from Alzheimer's is in the mid 80s. However, although infectious diseases are no longer ranked as one of the top causes of death within seniors, older adults are far more vulnerable to common infections, and drug-resistant bacteria show that in seniors over 80, pneumonia is one of the most serious diseases (Trends in Health Data, CDC, 2009). Statistical data does not show any particular factor for those seniors living in Los Angeles County to be more or less affected or susceptible to disease than any other part of the nation. Within areas of other ethnic majority (e.g. Eastern Cities with higher African-American populations), other diseases present themselves in higher ratios -- kidney disease for instance; but overall national averages remain consistent for the Monrovia area. The difference in percentages for Alzheimer's patients in California vs. The national average are, according to recent statewide studies, due to the difference in the aging of the population nationally vs. California (Ross, 2009). Programs in the Monrovia/Los Angeles County area dealing with either the top causes of mortality or the causes that are increasing the most include: Alzheimer's -- A specific Alzheimer's Council has been funded that shows as of 2011, Alzheimer's will have an even more dramatic effect upon California as the baby boomer generation ages. Advances in medicine are allowing seniors to live longer, and the disease is expected to double in severity in California by 2030. Recommendations are expensive, but shown to be necessary to keep the cost of care reasonable: Build an integrated and comprehensive long-term care service network for dementia and Alzheimer's; develop robust family caregiver policies that utilize public and private funding, and support the increase of geriatrically trained workers (Ibid, 9). Cancer -- Even with the health care cuts that have hit California, researchers at the University of Southern California and the Norris Comprehensive Cancer Center are on the national cusp of providing breakthrough treatments for a number of cancers. These treatments are cutting edge, and are expected to be available with FDA approval within the next five years (University of California Health Sciences, 2009). Heart Disease -- As both age and obesity increases in the Los Angeles County area, heart disease continues to rise. Often on a fixed budget, seniors are particularly vulnerable to a poor diet; typically high in carbohydrates or fast-food items, low in fresh fruit and vegetables. Coupled with a decrease in activity, heart disease is often the result. Legislation has been signed into law requiring chain restaurants to disclose calorie and fat content, increasing spending on educating seniors about exercise and nutrition is in effect, but needs more public health focus (Lin, 2009). Respiratory Disease -- California has made major strides in decreasing respiratory problems due to air pollution -- a vast improvement from the 1960s when it had several days per year with "mask alerts." Strict regulations on automobiles, industry, and trash burning account for a number of improvements. However, it now appears that non-smog related respiratory diseases are hitting the elderly. Medical professionals agree, though, that this is less an environmental factor than a reduction of the body's own immune system to fight of influenza complications, pneumonia, etc. (See: Breathe California). According to B. Sapp-Pradia, Los Angeles County liaison for Senior Citizens, various programs are in place in both Monrovia city and Los Angeles County specifically designed for seniors, often administered by the Area Agency on Aging. This service organization contracts with over fifty other community agencies to deliver services that promote the well-being and independence of seniors (Sapp-Pradia, 2009). Home delivered meals and nutrition programs Home-based care and illness management Alzheimer's Day Care Health and Wellbeing classes and information Integrated Care Management Elder Care The community is well poised to assist seniors in Monrovia with these and other services such as legal advice, health insurance, activities, and even ombudsman programs. Program help sheets, documents, and forms for enrollment are easily accessed at the Los Angeles County web page (www.lacounty.gov), or simply by calling the Senior Services Office. While there are gaps in service due to reliability of funding, the number of secondary agencies that assist in these programs are wide-range enough to continue care within the needs of a smaller population center like Monrovia. Additionally, programs available through the regional hospital center provide several outreach programs to assist seniors, including translation services, community nursing, and regular senior workshops (Ibid). In comparison to other cities of similar size to Monrovia, the services per capita appear greater than in many other locations. Certainly, the involvement of both the AAA and Catholic Social Services program contribute to the success of Monrovia's senior care, as well as the higher per capita income and bedroom community reputation (See Appendix A for sample services). Los Angeles County, too, is committed to integrating many of the policies and recommendations from the national "Healthy People 2010" campaign, particularly in regard to workplace safety, increased education on preventative disease, and a focus on the use of public health to form a liaison with local health care professionals to rapidly improve care through the focus on education and preventative medicine. In fact, California has achieved 16 of the 26 Focus Areas in the National "Healthy People 2010" directive, and indicates they are well on track for fulfilling the rest by the Federal deadline (California Department of Public Health, 2009). This assignment was extremely interesting from both a cultural and academic viewpoint. Assessing a particular area's statistics and commitment to health uncovered a wealth of new sources, and also provided a means of comparing overall data from a real-world population with that of the same population nationally. Looking in depth at the community of Monrovia, one finds that, as a senior, it would be a very reasonable choice for retirement or senior care. Facilities are available, weather is mild, many of the issues of the Los Angeles basin are absent, and the population is stable. Appendix A 1) Alzheimer's Day Care Resource Center -- primary purpose to provide quality daycare for persons with dementia; education, training and resources for caregivers or interested parties and support services. Services are free, and constitute primary, secondary and tertiary advocacy and care. Preventative care is not available under the current medical rubric. (See: http://css.lacounty.gov/Aaa/docs/Adcrcfact.pdf). 2) Dietary Administrative Support Services -- primary purpose is to provide centralized dietary services and oversight at food production locations for seniors. The service ensures proper menu development, food production, safety, and sanitation, and assures that the nutritional needs of seniors are being met in the most efficient and individually sensitive manner. Home delivered meals are specifically for seniors who are home-bound, providing not only meals, but a mechanism to check on the client. Donations are accepted, but the program is free to those in need. Services are primary and secondary. (See: http://css.lacounty.gov/Aaa/Nutr/docs/HomeDeliveredProviders.pdf). 3) Integrated Care Management -- primarily purpose is to promote and maintain independent living for seniors and to decrease the need for institutionalized care. The program links clients to appropriate services and funding sources, and attempts to do everything possible to help the senior retain their independence while still providing appropriate care and a safety net. (See: http://css.lacounty.gov/Aaa/docs/IcmProviders.pdf). WORKS CITED Breathe California of Los Angeles County. (2009). Cited in: http://www.breathela.org/ California Department of Public Health. (June 2009). "Healthy California -- 2010 Midcourse Review." Executive Summary. Cited in: http://www.cdph.ca.gov/data/indicators/goals/Documents/summary.pdf Centers for Disease Control. (2009). "Trends in Healthcare Among the Elderly." Cited in: http://www.cdc.gov/nchs/agingact.htm County of Los Angeles Department of Health Services. (2001). "Mortality in Los Angeles County." Health Services and Public Health. Cited in: http://publichealth.lacounty.gov/wwwfiles/ph/hae/dca/mortalityrpt_01.pdf HospitalData.Com. (2007). "Monrovia Community Hospital." Cited in: http://www.hospital-data.com/hospitals/MONROVIA-COMMUNITY-HOSPITAL-MONROVIA.html Lin, R. (April 10, 2009). "L.A. County Has Among State's Worst Heart Disease And Diabetes Death Rates." Los Angeles Times. Cited in: http://articles.latimes.com/2009/apr/10/local/me-health-reportcard10 MuniNetGuide. (2008). "Monrovia, California." Cited in: http://www.muninetguide.com/states/california/municipality/Monrovia.php. "Monrovia, California." Cited in: http://www.ci.monrovia.ca.us/ Monrovia Community Organizations. (2007). "Senior Citizens' Organizations." Cited in: http://www.dexknows.com/local/government_and_community/community_organizations/geo/c-monrovia-ca/att/senior-citizens-organizations/ Property Maps, (2007). "Monrovia, CA 91016." PropertyMaps.Com. Cited in: http://www.propertymaps.com/location/mls/usa/california/monrovia/91016#community_demos Ross, L., et.al. (2009). "Alzheimer's Disease -- Facts and Figures in Califronia." Alzheimer's Association, California Council, February 2009. Cited in: http://www.cdph.ca.gov/programs/alzheimers/Documents/CADataReport-full-corrected3-2.pdf Sapp-Pradia, B. (June 17, 2009). Los Angeles County Government Office. Personal Communication. SeniorJournal.Com. (2002). "Chronic Diseases Are Leading Causes of Death Among Senior Citizens." Cited in: http://seniorjournal.com/NEWS/SeniorStats/6-08-07-ChronicDiseases.htm University of Southern California Health Sciences. (May 30, 2009). "University Of Southern California Faculty Present Cancer Research At ASCO Annual Meeting." Cited in: http://www.medicalnewstoday.com/articles/151969.php U.S. Census. (2007). "Monrovia City, California Quick Links." Cited in: http://quickfacts.census.gov/qfd/states/06/0648648lk.html ADDITIONAL REFERENCES AND FURTHER READING Baggett, S.A. (1989). Residential Care for the Elderly: Critical Issues of Public Policy. Greenwood Press. Earl, Jack, ed. (2009). Senior Care Handbook. Rinky Dink Press. Green, Helen. (2007). Running in the Fourth Quarter: A Personal Account of Some of The Experiences, Issues, and Problems Faced by Some American Senior Citizens, The Fastest Growing Population in the United States. PublishAmerica. Howard, R. (1996). Depression in Elderly People. Informa HealthCare. Sapp-Pradia, B. (June 17, 2009). Los Angeles County Government Office. Personal Communication. Thau, Richard, ed. (1997). Generations Apart: Xers Vs. Booomers Vs. The Elderly. Prometheus Books. Read the full article

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globalmediacampaign · 5 years ago

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Exploring Apache TinkerPop 3.4.8’s new features in Amazon Neptune

Amazon Neptune engine version 1.0.4.0 supports Apache TinkerPop 3.4.8, which introduces some new features and bug fixes. This post outlines these features, like the new elementMap() step and the improved behavior for working with map instances, and provides some examples to demonstrate their capabilities with Neptune. Upgrading your drivers to 3.4.8 should be straightforward and typically require no changes to your Gremlin code. This article demonstrates commands using the Gremlin console and relies on the sample data provided by the air routes dataset, which prior posts have utilized for such purposes. For instructions on loading it through Neptune Workbench, see Visualize query results using the Amazon Neptune workbench. elementMap() Users have long utilized valueMap() to transform graph elements (vertices, edges, and vertex properties) to a map representation. For example, see the following code: gremlin> g.V().has('airport','code','BOS').valueMap('code','city','runways') ==>[code:[BOS],city:[Boston],runways:[6]] gremlin> g.V().has('airport','code','BOS'). ......1> valueMap('code','city','runways').with(WithOptions.tokens) ==>[id:5,label:airport,code:[BOS],city:[Boston],runways:[6]] gremlin> g.V().has('airport','code','BOS').outE().limit(1). ......1> valueMap('code','city','runways').with(WithOptions.tokens) ==>[id:190,label:route] gremlin> g.V().has('airport','code','BOS').outE().limit(1).valueMap() ==>[dist:612] gremlin> g.V().has('airport','code','BOS').outE().limit(1). ......1> valueMap('dist').with(WithOptions.tokens) ==>[id:190,label:route,dist:612] This approach has the desired effect, but you typically encounter two issues. The first issue is that valueMap() assumes multi-properties for values even if the cardinality was single, and therefore each map entry value is wrapped in a List. This List makes the results a bit unwieldly and forces you to unpack the List to get your single value. Although you can accomplish this unpacking directly in Gremlin with valueMap().by(unfold()), it’s inconvenient because including that extra by() modulator is more the rule than the exception. The second issue is related to edges that produce similar output to that of a vertex or vertex property. The problem is that it doesn’t provide reference to the incident vertices bound to it. Without that data present, you have to do some form of custom project() of your edge, like the following code: gremlin> g.V().has('airport','code','BOS').outE().limit(1). ......1> project('properties','in','out'). ......2> by(valueMap('dist').with(WithOptions.tokens)). ......3> by(inV().id()). ......4> by(outV().id()) ==>[properties:[id:190,label:route,dist:612],in:21,out:5] To address these two shortcomings, TinkerPop introduced elementMap(), which assumes single cardinality for properties and returns the in and out reference vertices of an edge: gremlin> g.V().has('airport','code','BOS').outE().limit(1).elementMap('dist') ==>[id:190,label:route,IN:[id:21,label:airport],OUT:[id:5,label:airport],dist:612] When upgrading, replace calls to valueMap() with elementMap(). This replacement is an especially nice improvement if using the valueMap().by(unfold()) pattern, because the readability of the traversal should improve without the by() modulator and there is no secondary transformation of the map to its final result. While performing this refactoring exercise, it’s also a good opportunity to look for valueMap() usage that doesn’t specify property keys and, when replacing those with elementMap(), to be explicit in their specification, as shown in the examples. It’s a good practice to specify these keys explicitly for the same reasons that you specify the column names in a SQL statement as opposed to using a wildcard, thus avoiding SELECT * FROM table. Working with map instances Graph elements, which are vertices, edges, and vertex properties, have similar behavior as map objects in the sense that their contents are accessed by way of keys. In Gremlin, the access patterns for elements and maps have drawn closer together with this release because the by(String) modulator now works on both objects equally well. Prior to this change, using by(String) on an element or map yielded two different results. For example, see the following code: gremlin> g.V().has('airport','code','BOS').project('c').by('code') ==>{c=BOS} gremlin> g.V().has('airport','code','BOS').valueMap().project('c').by('code') {"detailedMessage":"PropertyMap cannot have properties","requestId":"36a9279d-b515-4b43-84b6-63621251f94d","code":"UnsupportedOperationException"} Type ':help' or ':h' for help. Display stack trace? [yN]n The error wasn’t terribly informative, but rest assured that the issue is related to the use of by(String) where it isn’t welcome. In making by(String) behave more consistently, you can now use it in a variety of contexts related to map objects. See the following code: gremlin> g.V().has('airport','code','BOS').elementMap().project('c').by('code') ==>[c:BOS] gremlin> g.V().hasLabel('airport').limit(10). ......1> elementMap('code','country'). ......2> order().by('code',desc) ==>[id:25,label:airport,country:US,code:TPA] ==>[id:28,label:airport,country:US,code:SNA] ==>[id:24,label:airport,country:US,code:SJC] ==>[id:23,label:airport,country:US,code:SFO] ==>[id:22,label:airport,country:US,code:SEA] ==>[id:26,label:airport,country:US,code:SAN] ==>[id:44,label:airport,country:US,code:SAF] ==>[id:45,label:airport,country:US,code:PHL] ==>[id:27,label:airport,country:US,code:LGB] ==>[id:46,label:airport,country:US,code:DTW] In evaluating your existing code to determine if this change is helpful to you, you should typically look for situations where there was use of select(String) in a by() modulator, which was the usual approach for grabbing a value from a map in this context. For example, see the following query: gremlin> g.V().has('airport','code','BOS').elementMap().project('c').by(select('code')) ==>[c:BOS] You can replace it with: gremlin> g.V().has('airport','code','BOS').elementMap().project('c').by('code') ==>[c:BOS] Edge property equality TinkerPop established a more predictable behavior for edge property equality. Equality for edge properties, which unlike vertex properties don’t have a unique identifier, no longer concern themselves with their parent element (the edge object itself). In other words, if the key and the value are the same, then the property is considered equal irrespective of whether that property is associated with the same edge or not. See the following code: gremlin> g.E().has('dist',2300).properties() ==>p[dist->2300] ==>p[dist->2300] ==>p[dist->2300] ==>p[dist->2300] gremlin> g.E().has('dist',2300).properties().dedup().count() ==>1 Prior to this upgrade, the count would have been 4 because the properties were each coming from a different edge object. Unfortunately, the preceding example demonstrates how this alteration might represent a breaking change because the behavior of the traversal has been modified. If you relied on the old approach, you might find your results different after upgrade. TinkerPop considered the old behavior bad enough to classify the issue as a bug and chose to introduce the fix despite the fact that it changed behavior. If you need the old behavior, you need to take some approach that includes the edge identifier with each property. The following code presents one way of doing that: gremlin> g.E().has('dist',2300).as('e'). ......1> properties(). ......2> map(union(select('e'), ......3> identity())). ......4> dedup().count() ==>4 Setting timeouts There are times when you might wish to configure a particular request to have a timeout that is different than the default setting provided by the server. There are two specific contexts where this upgrade affects how those per-request timeouts are set: A Gremlin bytecode-based request using with() syntax. A request using the Java driver, where the RequestMessage is manually constructed and the timeout is provided to that message using the Builder object’s add() or addArg() options. This form is considerably less common and is usually reserved for either advanced cases or is inherited from older code that was never upgraded to take advantage of newer APIs (such as RequestOptions introduced at TinkerPop 3.4.2). TinkerPop has long used the scriptEvaluationTimeout to control the length of time in milliseconds a request is allowed to run before timing out. That form is the String representation of the configuration option, but it’s sometimes also referred to by way of the constant Tokens.ARGS_SCRIPT_EVAL_TIMEOUT in the Java driver. This option is now deprecated, though still supported. The preferred naming is simply evaluationTimeout when using the String form or, if using the constant in the Java driver, Tokens.ARGS_EVAL_TIMEOUT. The naming was changed to better reflect the general nature of the timeout in that it was used for both scripts and bytecode. Consider converting your code to use this preferred naming when you upgrade, because support for both deprecated options may be removed in future versions. Typically, look for Java code lines like the following: // “g” is a TraversalSource constructed by traversal(),withRemote(…) List vertices = g.with(“scriptEvaluationTimeout”, 500L).V().out("knows").toList() List vertices = g.with(Tokens.ARGS_SCRIPT_EVAL_TIMEOUT, 500L).V().out("knows").toList() You then code like the following: // “g” is a TraversalSource constructed by traversal(),withRemote(…) List vertices = g.with(“evaluationTimeout”, 500L).V().out("knows").toList() List vertices = g.with(Tokens.ARGS_EVAL_TIMEOUT, 500L).V().out("knows").toList() Improved error handling for JavaScript The Gremlin JavaScript driver now produces a ResponseError rather than attempting to pack the server statusMessage and statusCode into a string of a more general Error.message. The ResponseError also includes the statusAttributes, which incorporate more information on server-side exceptions. Although the Error.message property contents have not been changed at this time, it’s worth identifying any code that is performing a string parsing of that field and replacing it with usage of the new fields provided. Session support in GLVs Some use cases simply require session support and, if you needed to use that functionality, you needed to use Java because that was the only language driver to support that mode of operation. The latest version of the drivers (Python, Javascript, and .NET), however, all support session functionality. As with Java, this new session support in these languages is meant for script submission only (not bytecode). The following examples demonstrate how sessions are established: // javascript const sessionId = utils.getUuid().toString() const client = new Client('wss://:8182/gremlin', { traversalSource: 'g', 'session': sessionId }); # python client = Client('wss://:8182/gremlin', 'g', session=str(uuid.uuid4())) // C# var gremlinServer = new GremlinServer("", 8182); var client = new GremlinClient(gremlinServer, sessionId: Guid.NewGuid().ToString())) Conclusion This post was designed to call attention to some of the key changes from TinkerPop that are now officially compatible with Neptune. There were many other changes that offered bug fixes and minor enhancements. If you’re interested in learning more about any of those improvements, see the official TinkerPop GitHub repo and view the CHANGELOG. About the Author Stephen Mallette is a member of the Amazon Neptune team at AWS. He has developed graph database and graph processing technology for many years. He is a decade long contributor to the Apache TinkerPop project, the home of the Gremlin graph query language, and is currently serving as its PMC Chair. https://aws.amazon.com/blogs/database/amazon-neptune-now-supports-apache-tinkerpop-3-4-8/

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