The above is from a series of algorithms I developed . . . .

a GIS-like representation . . .  without the use of GIS!

STATUS:  DISSERTATION On Hold during Covid 19 

Full CV for download:   brianaltonen_cv_msmphphdabd_projlist.

Extracts from :

BRIAN L. ALTONEN, MS MPH

Beacon NY 12508
303-503-0845

altonenb@yahoo.com

http://www.researchgate.net/profile/Brian_Altonen/   [Academic biography]
http://www.linkedin.com/in/brianaltonen      
[Employment outside academia]



BUSINESS/POPULATION HEALTH ANALYST

2002 – Present.   Businesses/Research/Surveillance specialist and spatial epidemiology consultant.  Seasonal, repeated and/or institutional grant-defined contracts only.   Federal, State, regional, county, town, agencies/groups, education institutions, npos, etc. preferred. 
  SPATIAL ANALYST.

–Responsible for DB development and analytics applied to small and large area disease mapping programs (EPA, DEC, SHP, HIT).
–Developed comprehensive risk assessment & survey tools for profiling and predicting health behaviors and physical and social disease risks based on mixed datasets, multiple resources (EPA, SHP)
–Invented algorithm for hexagonally mapping state data, producing more accurate contours of areal health & economics (SHP, CHP).
–Developed a combined linear-cuboid 3D algorithm for flood plain risk analysis using DEM modeling and point-ras conversion techniques; redefines stream and floodplain as a flat surface, not slanted towards the ocean edge (SHP, CHP).
–Field epidemiologist responsible for surveillance and detection of local disease sources, ecological requirements (SHP, CHP, NEDS).
–Redesigned formulas to more accurately report on local ID, demographic and SES health concerns for small areas, including health/rx crimes, abuse, age-gender specific terrorist acts, psych non-compliance, in-migrating disease patterns (HS/ABU, CDC, NEDS).

August 2015 to Present.  Population Health Analyst, NYCHHC.

0.98 – 1.7M patients per year, 5 boroughs, 8 networks, 11 acute care hospitals, Bellevue emergency, 2 special care hospitals, 2 long term care facilities, prisons, schools.  20+ years of EMR/EHR.  Evaluated 10-12M patient rows for 20+ year period, 8.8-9.5 for 10 year period.  Estimate rate of growth (3k/mo); 40,000 analyses per year.  As of 12/17/2021:  412 projects/6.7 years

  • Evaluate the rarest of conditions, inherited diseases
  • Assign Geocodes and map according to mailing code, SES data developed for zip code areas.
  • Developed Lifetime Care Modeling methodology and data gathering, analysis methods.
  • Developed Elixhauser and combined Charlson-Elixhauser Risk index modeling algorithms
  • Developed reclassification algorithms for Culture-Race-Religion health studies
  • Focus on specific culturally-bound, culturally-linked, and culturally-linked behavioral ICDs.
  • Designed surveillance tools for foreign infectious disease migration patterns within the city
  • Developed database for and evaluated Child/Spouse Abuse indicators (EHR ICD algorithm)
  • Developed database for and evaluated lifetime care modeling aspects of FGC population (1098)
  • Specialize in spatial analysis of most important E and V codes such as child abuse, sexual abuse, spouse/elder violence, suicide, sexual behaviors, childhood violence and related misbehaviors.
  • Ongoing evaluation of birth defects, malformations, suspected intrafamilial communities, and Rare Genetic disease patterns, for specific culture and neighborhoods
  • Continuous and ongoing evaluation of ca 23k Covid inpatient cases from complete datapull.
  • Periodically review violence and terrorism related ICD coded ED events in the city
  • Use SES algorithms to evaluate neighborhood related poverty-related medical events
  • Review of Injury, Fracture, Dislocation, by Age and Gender, with a focus on geriatrics

Ongoing or Recurring Projects (as of 2016):

  • Oversee of get involved with about 52-55 residency research projects per year, ten department research projects, and ten grant related projects or grant proposal projects.
  • Largest project is focused on historic WTC 911 Population health data, for 2007 to 2017, with analysis, focused on Long Term epidemiology and Advanced Secondary disease patterns
  • NYC Population analyzed for genomic disease patterns and new “Precision Care” based programs
  • Initiated focus on religion and place, for evaluation of special needs sociocultural groups.
  • Engage in some Infectious Disease Surveillance work for NYC setting (i.e. Legionnaires disease; the natural history of all Clostridium difficile cases since 2007)
  • City wide H+H patient database developed for domestic abuse cases
  • Complex Chronic Disease Indices algorithms development, NYC
  • Developed traditional population pyramid based evaluation technique for analyzing age, gender, ethnicity, race, region differences
  • Redefining the single Race/Ethnicity column into two columns: Race, Ethnicity (ca. 65%-70% could be reclassed; with only one of 8 networks producing most of the unclassed, mostly for the race column.)
  • Developed 135, 303 groups, 750+ and 1250 ICD groups classification
  • Developed a natural language processing algorithm for pulling lengthy non-structured text entries from the data warehouse, using SQL (SQL limits each cell pull to 500 char).
  • Developed algorithm for charting the Top 20 ICD groups by Race, Ethnicity Groups, merged into a single table, for each of 8 regions, with n and percentage columns for each and totals combined (1000 lines, 53 subprograms, in SAS).
  • Developed algorithm for merging regional data, reclassifying ethnicity and race, analyzing race/ethnicity changes, and differences between regions
  • Developed algorithms for evaluating health risk for patients with multiple comorbidities: Charlson Comorbidity Index (CCI), Federal Chronic Disease Score (CDS) and Elixhauser (Elix) Score; merged these with demography data risk assessment (age groups, gender) to define a new “Comprehensive Health Risk Index”. (This formula successfully reproduced the OptumHealth Risk Score “black box” results).
  • Developed algorithms for mapping the NYCHHC data at the small area level (zip code and small area grid).
  • Develops algorithm and tools for analyzing LTC and senior population living facility populations, for use in defining the least health patients in need of the most monitoring, and for predictive modeling purposes (producing regular lists of flagged patient records related to EMR defined increased mortality potential).
  • Developed algorithms for mapping culture and health, based upon 7 world regions (ICDs or medical events linked to those regions)
  • Developed algorithms for mapping genetic and development diseases at any area level, for 10 organ system groups.
  • developed ICD9 ###.** 15750 rows dataset, added CCI, CDS and Elix column, added foreign country columns indicating sources for rare to infrequent diseases.
  • developed ICD9 data set for genetic, birth, development, functional/morphological ICD codes, for use in genomic monitoring.
  • mapped a number of the most controversial, culturally sensitive or linked diseases, for a ten year period; identified peak areas (centroids) at the small area level.
  • mapped a number of the most controversial in-migrating disease patterns
  • mapped and evaluated antibiotic resistance strain histories for a several year period
  • mapped wife abuse histories, total, and by ethnicity, religion and race.

June 2013 – May 2015.   Business Analyst.

–Contracted EMR/EHR analyst for therapeutics and pharma HealthHelp, Inc., McKesson/US Oncology, Humana, Bayer, Celgene.
–Cost Prediction analyst, Survival analyst for highest risk Cardiac Surgery patients requiring transplants and defibs/pacemakers.
–Survival Analyst focused on prediction modeling and lifespan analyses of previously diagnosed cancer cases with secondary metastasis diagnosis.
–Logcost tree modeling of most expensive diagnoses and therapeutic regimens.
–Quasi-Experimental Cohort analysis of end of life/quality of life treatment programs for cancer patients.

June 2010 – November 2012. Business Analyst, Express Scripts, Inc., formerly Medco, Inc. 
POPULATION STATISTICIAN/DATA MINER & ANALYST

–Responsible for analyzing and reporting on 90+ million people with electronic records, for $10B/yr industry.
–Designed standardized SAS, SQL, and other macro queries for standard consumer behavior metrics.
–Invented new population statistical modeling techniques for populations of n>1M+ people, at 1 yr age-gender level.
–Performed federal, regional and gatekeeper required review of census records, income, SIC and local history.
–Performed client-driven adhoc queries in SQL and SAS on Terabyte stored data.

June 2007 – May 2009. Postgraduate Institute for Medicine, Jobson, Inc. Denver CO.
STATISTICIAN, Education Outcomes Manager

–Invented grounded theory text analysis technique and semi-automated tool quantifying survey generated open end text responses.
–Responsible for analyzing and reporting on teacher and student performance for continuing education programs.
–Analyzed satisfaction surveys for more than 250 programs, with 60 end-of-year summary surveys, 80,000 students/contacts per year, 3500 end-of-year participants with a 2-3% response rate.
–Developed, implemented and maintained automated/semi-automated reporting tools for all standard queries and reports.

July 2004 to May 2007 Denver Health Managed Care Denver CO
MEDICARE/MEDICAID PROGRAM ANALYST/COMPLIANCE SPECIALIST

–Biostatistician responsible for analyzing and reporting on the performance of approximately 60,000 members, and 400+ care givers for four Medicaid and Medicare health plan programs.
–Regularly reviewed more than 25 standard health measures, performed 7 special studies and 3 service industry studies per year, producing related databases and reports.
–Created a variety of statistical tools and SQLs used to calculate and graph descriptive data, and evaluate statistical significance in a timely fashion.
–Periodically produced summaries and reports for internal departments and committees, periodic reports for state and regional offices, and focus study reports targeting special interests in order to meet outside agency needs.
–Responsible for storage, upkeep and maintenance of databases and datasets developed for unique member/demographic studies.

EDUCATION

–PhD (diss. only), Business, Healthcare Administration, Northcentral University, Phoenix, AZ
–MPH, School of Community Health, 2003. Portland State University, Portland, OR
–MS, Geography Department, 2000. Portland State University, Portland, OR
–Post-Baccalaureate, Chemistry (12 years).
–MD, D/R (3 years), SUNY at Stony Brook, Stony Brook, NY
–BS, Biology, 1982. SUNY at Stony Brook, Stony Brook, NY
–BS, Earth and Space Sciences, SUNY at Stony Brook, Stony Brook, NY

RESEARCH/WRITING SKILLS

–Medical Geographer, Spatial Analyst and Population Specialist.
–IT-data quality analyst; SQL, SAS, Terabyte writer; Medicaid, Medicare, Institutional QAs for NCQA and HEDIS
–Quantitative Researcher: advanced skills in Excel, Access, SPSS, S-Plus, Stat-Plus, VB, SAS, vector and raster GIS.
–Qualitative Researcher: completed 15 month training program offered by School of Education, Portland State University
–Survey Analyst and tool developer; SurveyMonkey, SurveyWriter.
–Community/Focus Group leadership experience.
–Grantwriter (local agency letters, federal/national agency submissions)
–Institutional Review Board/Human Subjects Review compliance.


TECHNICAL SKILLS

–“Big Data” demographics analyst, with expertise in Teradata, Perot Systems, Caremark, National and Census datasets.
–SAS, SPSS v9, StatPlus, VB, Visio, SATSCAN, ClusterSeer
–Quattro Pro, Paradox, dBase 5-7. Oracle 7-8; Teradata certified.
–ATLAS/TI, NUDIST, ETHNOGRAPH
–ArcGIS, IDRISI. MapInfo, EpiMap. ESRI Avenue extension writer; MrSID, GeoTIFF, dlgv32, MultiSpecW32, ERDAS, GeoMedia, MapInfo.
–Crystal Reports, Adobe Illustrator, Photoshop, Acrobat Writer, Corel Draw
–Dreamweaver, Frontpage Web Design
–Publisher, Power Point, Access, Excel, Word, Office; WordPerfect
–Trained in TierMed.com; ManagedCare.com; Perot Systems

.
ADJUNCT PROFESSORSHIPS/INSTRUCTORSHIPS 


–2005–2006 Arapahoe Community College Denver, CO. Introductory, Intermediate GIS.
–1988–2003 Chemistry Department, PSU Portland, OR. OTC/Nutritional Supplements analysis; Pre-Med, Pre-Allied Health, Pre-Pharm student advisor/mentor. Handicapped Student Services mentor/tutor; ADA Rights and epilepsy.
–1997–2001 Geography Department, PSU Portland, OR. Population health monitoring, disease ecology, epidemiologic surveillance, remote sensing, spatial analysis.
–1982–1985 SUNY at Stony Brook Stony Brook, NY.  MOLINS.

CORPORATE PROJECTS

Managed Care. Developed and analyzed population datasets; regularly produced in-depth reports (var. 50-300 pp each) for:

–State-required Performance Improvement Projects (PIPs) (3)
–National Committee for Quality Assurance (NCQA)-required Quality Improvement Activity (QIA) reports (4-6)
–Annual Reports on Quality Assurance for Medicaid, Medicare and Employee health programs reviewed by administrative teams (2-3)
–Annual Review of the Denver Health Managed Care Program for approval by internal administrative committees, annual corporate report, and public presentations (2-3)
–Annual Health Care Access/Availability Reports for the three programs
–Monthly-Quarterly utilization statistics for all services and members
–Quarterly Demographic Reviews, with 1- and 5-year population pyramids and graphs depicting populations served

Regularly produce numerous databases and reports for:
–Customer satisfaction and complaints lines
–Monitoring population office activities and products utilization for various State and Regional offices.
–Performing ad hoc Focus Studies on special needs populations for Medicaid and Medicare programs
–Evaluating successes, benchmarks and statewide goals pertaining to special medical community projects.
–Monitoring and evaluating Management team customer/member contact and follow-up activities
–Regularly reported to national npos regarding program successes and goals.

STATISTICAL ACCOMPLISHMENTS

National Population Grid Map.

‘The next generation of consumer reporting.’

Invented methodology for evaluating any and all population-based metrics in the U.S., using a grid map with variable cell size and area. Developed a 3D algorithm for mapping results on the US, with the continent portrayed at various angles and/or as a rotating image; applied to more than 1000 metric-specific studies. Processing speed is fast due to use of non-GIS software for map production, producing up to 30,000 maps per day, merged to form 50-100 videos per day. Applicable to all metrics pulled from a standard hierarchical database system, including median income data, age-gender-ethnicity, log-cost analyses, standard family income-product purchasing power relationships, prediction modeling, as well as the generation of standard sums, averages and frequency analyses, compliance/non-compliance metrics, and individual/group activities scoring.

Hexagonal Grid Analysis. Invented and published unique ArcInfo/ArcView/ArcGIS algorithms and SQLs used to produce hexagonal grid overlays for maps. These are applied to standard high level GIS methods for implementing new areal and temporal population health analytic programs.

Population Pyramid Comparison Algorithm. Invented formulas for incremental 1-year age-gender testing technique for comparing two populations with possible statistically significant differences at the 1-year age level using a new algorithm.

SUMMARY OF NYC HHC YEARS, TO DATE

DATA VISUALIZATION WORK

2D and 3D video mapping using SAS, SPSS, and GIS.

3D+ Mapping

Adopting new Preventive Health Measures, based upon Medical GIS findings.  July 9, 2017.  Overview of the history of developing these algorithms.  https://brianaltonenmph.com/2017/07/09/adopting-new-preventive-health-measures-based-upon-medical-gis-findings/

2D+ Mapping

Demonstrating how to define case clusters using aerial-case spatial data for NYC.  https://www.facebook.com/brian.l.altonen/videos/625481735134885

1D/2D mapping

Standard GIS point, arc, polygon, time, z-axis mapping and surveillance, 2002 to present.  Created “hierarchical disease spread” models for SES-based outbreaks studies and analyses (See Thesis, 2000; see extensive work on NY West Nile outbreaks ecology work and related ESRI award, at National Conference, Denver CO, 2006).

Hexagonal Grid Mapping.

Hexagonal Grid Analysis.  (Invention of algorithm ca. January 2006.)  Algorithm published October 19, 2009; made publicly accessible and put into public domain starting 2010.  See https://brianaltonenmph.com/6-gis-ecology-and-natural-history/hexagonal-grid-analysis/

Grid mapping health and disease in the United States.  April 1, 2012. Blog site brianaltonenmph.com. https://brianaltonenmph.com/gis/population-health-surveillance/grid-mapping-disease-in-the-united-states/

Grid Economics & Demographics.  November 9, 2012.  https://brianaltonenmph.com/about/grid-economics-and-population-health-work-experience/

Hex grids – essential to developing a more effective Medical GIS workstation.  April 15, 2015.  Blog site brianaltonenmph.com.  https://brianaltonenmph.com/2015/04/15/hex-grids-are-essential-to-developing-a-more-effective-medical-gis-workstation/

INTELLECTUAL PROPERTY / ALGORITHM INVENTION – Hexagonal Grid Modeling Algorithm. 

First published applications of this algorithm are by colleagues in Canada and India.  Referenced as “Altonen B (2011) Hexagonal grid analysis « Brian Altonen, MPH, MS. Available at: brianaltonenmph.com/6-gis-ecology-and…/hexagonal-grid-analysis/ (accessed 20 July 2012)”

Implemented by:

Debnath, Ripan & Amin, ATM. (2015). A geographic information system-based logical urban growth model for predicting spatial growth of an urban area. Environment and Planning B: Planning and Design. 43. 10.1177/0265813515618565.  Accessed at: https://www.researchgate.net/publication/286637594_A_geographic_information_system-based_logical_urban_growth_model_for_predicting_spatial_growth_of_an_urban_area [accessed Nov 30 2021].

Accessed at https://www.researchgate.net/publication/286637594_A_geographic_information_system-based_logical_urban_growth_model_for_predicting_spatial_growth_of_an_urban_area

Ripan Debnath (2013) An assessment of spatio-temporal pattern of urban earthquake vulnerability using GIS: a study on Dhaka City, Annals of GIS, 19:2, 63-78, DOI: 10.1080/19475683.2013.782468  https://www.tandfonline.com/doi/full/10.1080/19475683.2013.782468?fbclid=IwAR2UvSELLOwDnZkCDrli6Xs7r5WmYFMpnMRyQo8_GeTVB5igruPfO92HUIs

Lifetime Care Analysis Methodology

[Dissertation Proposal. PhD.]  Designed a model for analyzing lifetime care using ‘Deep Data’ analysis. A study of patients, demographics, medical and diagnostics history, visits, lines of care, procedures, actions, outcomes, and cost data contained in EMR. (15M patients, 2005 to 2016 services, PHI data 1993-2016). [Placed on hold due to staff/committee changes, IRB, Covid.]

As of 12/2021, applied to: Female Genital Cutting/Mutilation (1096 patients): Childhood Lead Poisoning Patients with a value >5 (borderline learning disability, up to toxic, at 20+) (10,000 patients); Epilepsy (53k); Sickle Cell and related hematocytogenetic diagnoses (approx. 8k); Domestic Abuse cases, by Race, Ethnicity, Religion and Culture (8k); C Diff Pos testing, 2007 on (7k).

PUBLICATIONS

DIRECT (Includes Authorship)

Engdahl R, Altonen B.  Factors Associated with Hand Patients Leaving Against Medical Advice at an Urban Public Hospital.  Annals of Plastic Surgery.  [Submitted, November 30, 2021]

Laniado, Nadia (P.I.), Altonen B, et al.  Interprofessional oral health collaboration: a survey of knowledge and practice behaviors of hospital-based primary care medical providers in New York City.  Advances in Medical Education and Practice 2021, 12:1211-1218. 14 October 2021.

Altonen BL, Arreglado TM, Leroux O, Murray-Ramcharan M, Engdahl R. Characteristics, comorbidities and survival analysis of young adults hospitalized with COVID-19 in New York City. PLoS One. 2020 Dec 14;15(12):e0243343. doi: 10.1371/journal.pone.0243343.

Dinesh A, Mallick T, Arreglado TM, Altonen BL, Engdahl R. Outcomes of COVID-19 Admissions in the New York City Public Health System and Variations by Hospitals and Boroughs During the Initial Pandemic Response. Front Public Health. 2021 May 11;9:570147. doi: 10.3389/fpubh.2021.570147. PMID: 34046379; PMCID: PMC8144284.  Access at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8144284/pdf/fpubh-09-570147.pdf

Obayemi A, Roure R, Banuchi, VE Altonen B, Taylor B, Fisher A,. 2021. An Examination of COVID-19 among Healthcare Workers in a Highly Affected Region of the Bronx, New York City.  Journal of Hospital Infection. I. Infect. Dis. Epidemiol 6(5): 167. DOI: 10.23937/2474-3658/1510167 https://www.clinmedjournals.org/articles/jide/journal-of-infectious-diseases-and-epidemiology-eng

Clare CA, Amoebeng O, White MP, Altonen BL. (2020).  (A review of a 918 Female Genital Cutting patients within a City Health Care system: their health care needs and utilization related to FGC over the past 5 to 20 years). [In mid-draft writing process, as of August 9, 2021.]

Greenfield J, Ukatu M, Tounkel I, Kaur S, Altonen BL, Clare CA. (2020).  Women Speak Out: Female Genital Cutting. [In middle of submission processes.]

Clare, C., Greenfield, J., Augustus, P., Ukatu, N., Manu, E., & Altonen, B. (2017). Women Speak Out: Female Genital Cutting, Qualitative Research. Reproductive Health, 14 (Suppl. 2), 3.  Conference : Article: Female Genital Mutilation/Cutting: sharing data and experiences to accelerate eradication and improve care: part 2: Geneva, Switzerland. March 13-14, 2017.

Mohammed AlOwain, Ola Ali Khalifa, Zahra Al Sahlawi, et al.  (2019) Optic neuropathy in classical methylmalonic acidemia, Ophthalmic Genetics, 40:4, 313-322, DOI: 10.1080/13816810.2019.1634740

Loy B, Shkedy CE, Tankersley MA, Altonen BL.  Do Case Rates Affect Physician’s Clinical Practice in Radiation Oncology?  (June 2014. https://docushare-web.apps.cf.humana.com/Marketing/docushare-app?file=2520206).

Tankersley MA, DeFrance A, Altonen BL.  Efficiency of non-invasive imaging modalities in the evaluation of outpatient chest pain: a 24-month retrospective study.  HealthHelp and Humana; 2014: 40.   https://www.ahajournals.org/doi/abs/10.1161/circoutcomes.8.suppl_2.262

Tankersley MA, DeFrance A, Altonen BL.  An evaluation of patients after use of a Wearable Cardioverter Defibrillator through 240 days.  HealthHelp and Humana; 2014: 19.  (May 2014. See https://docushare-web.apps.cf.humana.com/Marketing/docushare-app?file=2477124).

Altonen, B. (2013). Commentary: John Lea’s Cholera with Reference to Geological Theory, April 1850.  Int. J. Epidemiol. (2013) 42 (1): 58-61. doi: 10.1093/ije/dys242. http://ije.oxfordjournals.org/content/42/1/58.extract  [invited by publisher]

 

INDIRECT (As Biostatistician: Extractor/Analyst, published, without inclusion in authorship)

Bashir MH, Iqbal S, Miller R, Singh J, Mubarak G, Likhtshteyn M, Bigajer E, Gallagher B, Hurairah A, Stefanov D, McFarlane SI, Ferstenberg R. Management and outcomes of hepatorenal syndrome at an urban academic medical center: a retrospective study. Eur J Gastroenterol Hepatol. 2019 Dec;31(12):1545-1549. doi: 10.1097/MEG.0000000000001462. PMID: 31169567.  Accessed at https://pubmed.ncbi.nlm.nih.gov/31169567/

Beri K, Menon V, Guzman E, Chapa C, Patel R, Shariff MA, Kasubhai M. The effect of living a ‘yogic lifestyle’ on stress response and self-image in healthcare professionals: a pilot study. Future Sci OA. 2020 May 27;6(6):FSO473. doi: 10.2144/fsoa-2019-0154. PMID: 32670602; PMCID: PMC7351084.

Bryan A, Tatem K, Diuguid-Gerber J, et al. Cross-sectional study evaluating the seroprevalence of SARS-CoV-2 antibodies among healthcare workers and factors associated with exposure during the first wave of the COVID-19 pandemic in New York.  BMJ Open 2021;11:e053158. doi: 10.1136/bmjopen-2021-053158.  IRB proposal: “18-001 The Effect of Living a “Yogic Lifestyle” on a Stress Response & Self Image in Health Care Professionals. ” (incl Follow-up study).

Deane K, Singh A, Sarfraz A, Sarfraz Z, Ciccone L, Zheng B, Afzal A, Khan G, Rodriguez G, Bahtiyar G. Correlation of Severity of COVID-19 Disease With Gastrointestinal Manifestations and Liver Injury – A North Brooklyn Community Hospital Experience: A Retrospective Cohort Study. Cureus. 2021 Apr 18;13(4):e14543. doi: 10.7759/cureus.14543. PMID: 34017658; PMCID: PMC8130634.

Dunlop, J.C., Meltzer, J.A., Silver, E.J., & Crain, E.F. (2012). Is nonperforated pediatric appendicitis still considered a surgical emergency? A survey of pediatric surgeons. Academic pediatrics, 12 6, 567-71 . DOI:10.1016/j.acap.2012.08.004. Accessed at https://www.semanticscholar.org/paper/Is-nonperforated-pediatric-appendicitis-still-a-A-Dunlop-Meltzer/321f453c37c4ec8b201f9f5e00400d12ab26633b

Fraij O, Castro N, de Leon Castro LA, Brandt LJ. Stool cultures show a lack of impact in the management of acute gastroenteritis for hospitalized patients in the Bronx, New York. Gut Pathog. 2020 Jun 22;12:30. doi: 10.1186/s13099-020-00369-2. PMID: 32582380; PMCID: PMC7310251.  Accessed at https://pubmed.ncbi.nlm.nih.gov/32582380/

Freedman, Rachel & Dockter, Travis & Lafky, Jacqueline & Hurria, Arti & Muss, Hyman & Cohen, Harvey & Jatoi, Aminah & Kemeny, M. & Ruddy, Kathryn. (2018). Promoting Accrual of Older Patients with Cancer to Clinical Trials: An Alliance for Clinical Trials in Oncology Member Survey (A171602). The Oncologist. 23. theoncologist.2018-0033. 10.1634/theoncologist.2018-0033.  Accessed at https://www.researchgate.net/publication/324619725_Promoting_Accrual_of_Older_Patients_with_Cancer_to_Clinical_Trials_An_Alliance_for_Clinical_Trials_in_Oncology_Member_Survey_A171602

Jeganathan, S., Shilkrut, A.G., Fuks, A., & Kaminsky, S. (2018). Fetal Fibronectin Test Performance in Patients at Low Risk for Preterm Delivery. International Journal of Women’s Health and Reproduction Sciences.  Accessed at https://www.semanticscholar.org/paper/Fetal-Fibronectin-Test-Performance-in-Patients-at-Jeganathan-Shilkrut/38bfab003732b7d39120bad5108dc6b661068bb3 [Requested by Shilkrut]

Mbekeani JN, Fattah MA, Poulsen DM, Hazzaa SA, Dababo MA, Eldali A, Ahmed M. Etiology of optic atrophy: a prospective observational study from Saudi Arabia. Ann Saudi Med. 2017 May-Jun;37(3):232-239. doi: 10.5144/0256-4947.2017.232. PMID: 28578363; PMCID: PMC6150579.    Accessed at https://pubmed.ncbi.nlm.nih.gov/28578363/

Reliford A, Adebanjo B. Use of Telepsychiatry in Pediatric Emergency Room to Decrease Length of Stay for Psychiatric Patients, Improve Resident On-Call Burden, and Reduce Factors Related to Physician Burnout. Telemed J E Health. 2019 Sep;25(9):828-832. doi: 10.1089/tmj.2018.0124. Epub 2018 Oct 31. PMID: 30379635.  Accessed at https://pubmed.ncbi.nlm.nih.gov/30379635/

Waseem M, Chen J, Leber M, Giambrone AE, Gerber LM. A Reexamination of the Accuracy of the Broselow Tape as an Instrument for Weight Estimation. Pediatr Emerg Care. 2019 Feb;35(2):112-116. doi: 10.1097/PEC.0000000000000982. PMID: 28099296. Accessed at https://pubmed.ncbi.nlm.nih.gov/28099296/ [LIN-2015-05]

OTHER LESS FORMAL “PUBLICATIONS” and PRESENTATIONS

“Comparative Efficacy and Complications of Novel Oral Anticoagulants in Management of Non-Valvular Atrial Fibrillation”. Researchers: Sudhaka Prabhu; Moustafa Elsheshtawy  [Coney Island]

Arumairaj A, Habtes I, Boktor H, Newman T.  (2020). 1683: Determining the Prognostic Value of APACHE IV in Critically Ill Patients with Sepsis. Critical Care Medicine: January 2020 – Volume 48 – Issue 1 – p 816. doi: 10.1097/01.ccm.0000648632.44799.07    Accessed at https://journals.lww.com/ccmjournal/Citation/2020/01001/1683__DETERMINING_THE_PROGNOSTIC_VALUE_OF_APACHE.1635.aspx

Moreira H, Sinert R. How Effective Is the Early Management Bundle for Severe Sepsis/Septic Shock? JAMA Intern Med. 2020 May 1;180(5):716-717. doi: 10.1001/jamainternmed.2020.0180. PMID: 32250386.  Accessed at https://pubmed.ncbi.nlm.nih.gov/32250386/

ABSTRACTS, POSTERS, at CONFERENCES

Arumairaj A, Park H, Valencia J, Newman T, Habtes I.  (2021). Predicting the need for Invasive Ventilation with APACHE IV Score in Patients with Sepsis from Community Acquired Pneumonia. Chest 2021 Annual Meeting, October 17-20.  Critical Care section. DOI:https://doi.org/10.1016/j.chest.2021.07.980. Accessed at https://journal.chestnet.org/article/S0012-3692(21)02431-4/pdf

Arumairaj A, Park H, Quesada F, Habtes I. (2020).  [Conference Presentation, ARTICLE.] Determining the need for additional testing with Quantiferon TB Gold in patients with positive Tuberculin Skin Test and History of BCG Vaccinations. Chest 2021 Annual Meeting, October 18-21. DOI:https://doi.org/10.1016/j.chest.2020.08.324  Accessed at https://journal.chestnet.org/article/S0012-3692(20)32510-1/pdf

Arumairaj A, Boktor H.  (2021). [POSTER]  The Use of CORB Score versus CURB 65, for predicting the severity of community acquired pneumonia. TP093 NEW DEVELOPMENTS IN DIAGNOSTICS AND TREATMENTS OF PNEUMONIA / Thematic Poster Session.

Arumairaj A, Habtes I.  (2021). A Comparison of Pneumonia Severity Assessment Scores in Predicting Outcomes of Hospitalized Patients with Community- Acquired Pneumonia. Accessed at  https://www.atsjournals.org/doi/pdf/10.1164/ajrccm-conference.2021.203.1_MeetingAbstracts.A3872

Arumairaj AJ, Boktor H, Cosico J, Newman T,. (2020).  [POSTER, Abstr.] Comparison of CORB and CURB 65 Scores for Predicting the Severity of Community Acquired Pneumonia.  A59 Clinical Diagnosis, Prediction and Outcomes of Lung Infections/Thematic Poster Session.   Accessed at https://www.atsjournals.org/doi/book/10.1164/ajrccm-conference.2020.A59

Sanaa Bdiiwi ; Moustafa Elsheshtawy ; Apurav Panwala ; Rahul Valluru. “Initiative CAUTI Preventive Model in Coney Island Hospital Translating Research into Clinical Practice” [CAUTI] [n=2196]  [POSTER] PAGNY:  https://www.pagny.org/resources/nyc-health-hospitalsconey-island-team-chosen-to-be-poster-presenter-for-campaign-to-reduce-catheter-related-urinary-tract-infections/   See also the related https://medicalxpress.com/news/2019-06-female-external-catheter-technology-cauti.html

Altonen BL, Arreglado TM, Leroux O, Murray-Ramcharan M, Engdahl R. Characteristics, comorbidities and survival analysis of young adults hospitalized with COVID-19 in New York City. PLoS One. 2020 Dec 14;15(12):e0243343. doi: 10.1371/journal.pone.0243343. PMID: 33315929; PMCID: PMC7735602.

ANALYSES PERFORMED FOR RESEARCHER’S EVENTS, ACTIVITIES

‘Jacobi STAND-UP To Violence Program’. PROJ ID: JAC-2018-30. PI: Dr. Noè Romo, pediatrician;  Erika Mendelsohn, LSMW, Program Director.  See https://www.bronxnet.org/watch/videos/8634/  AND   https://www.pagny.org/resources/stand-up-to-violence/

Clare C.  (2018). The Historical, Psychosocial, and Cultural Context of Breastfeeding in the African American Community.  (Interview, Presentation, Discussion.)  Accessed at https://www.liebertpub.com/doi/full/10.1089/bfm.2019.29135.abstracts#

Clare C, Green V.  (2019)  National Medical Association Breastfeeding Alliance Approach to Addressing Health Disparities in Breastfeeding in African Women.    Accessed at https://www.bfmed.org/2021-poster-presentations.

Clare C.  (2018).  Breastfeeding Survey Analysis.  https://blackhealthmatters.com/our-health/camille-clare-m-d-climbing-breastfeeding-stumbling-blocks/    and   https://www.liebertpub.com/doi/full/10.1089/bfm.2019.29135.abstracts#   and https://allhealthtv.com/townhall/breast-cancer-in-women-of-color/

Administrative Research Assistance

“Demographic of Ankylosing Spondylitis in Black, Asian, Asian Indian and Hispanic population in portions of New York and The Bronx.”

Geriatrics Assessment 3: The impact of initial comprehensive Geriatric Assessment of elderly new patients in an inner city hospital population: a retrospective study [n=100]

“A Re-examination of the Accuracy of the Broselow Tape (BT) as an Instrument for Weight Estimation ” [multiple presentations, updates]

SURVEILLANCE REQUESTS OR QUERIES (Ongoing)

E Coli – testing results for urinalysis, ED vs IP patients comparison.  Richard Sinert.  [KIN-2016-05] (Siren Study?)  See related: i) Comparison of UTI antibiograms stratified by ED patient predisposition.  Lee Grodin et al.  5(9): Amer Jl Emerg Med, 3 Sept 2017. ii) Lee Grodin, Alyssa Conigliaro, Song-Yi Lee, Michael Rose, Richard Sinert, Comparison of UTI antibiograms stratified by ED patient  disposition, The American Journal of Emergency Medicine, Volume 35, Issue 9, September 2017, Pages 1269-1275, ISSN 0735-6757, https://doi.org/10.1016/j.ajem.2017.03.061. Accessed at https://www.sciencedirect.com/science/article/pii/S0735675717302486  [See also KIN-2015-18, KIN-2015-25]

Sickle Cell [HIT-2015-02-SUR] and Thalassemia [HIT-2015-DAT]

Adolescent Health [HIT-2015-09-DAT]  [GOU]

Tuberculosis Carriers.  A Complete assessment of all TB Lab data.  PI Kevin Roy.  [HIT-2015-35-SUR]

Bellevue ED utilization (for NIH/CDCC). [HIT-2016-21-SUR]  EITS, DIR/CO.

Anaphylaxis [Queens County]

Epilepsy HIT [HIT-2016-06-SUR]

Septicemia [Kings County, Woodhull]

SIRS Prediction Models.  Christopher Chum.  [HAR-2016-18]

Legionnaire’s Disease.  Sampathkumar, Haresh. [213 pts, 3 datasets pulled] [MET-2016-63]

Angioplasty/CABG Patients.  [BEL-2016-35]  Sripal Bangalore, Cardiologist, Cardio Lab; Dr. Sohah, Associate Director of Cardiac Catheterization at Bellevue.  See also https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.120.048194    Extensive database provided; possibly for citation at  https://pubmed.ncbi.nlm.nih.gov/29731024/     Possibly linked to: Guandalini GS, Bangalore S. The Potential Effects of New Stent Platforms for Coronary Revascularization in Patients With Diabetes. Can J Cardiol. 2018 May;34(5):653-664. doi: 10.1016/j.cjca.2018.02.020. Epub 2018 Mar 1. PMID: 29731024.

“Likelihood of culture positive patients in the setting of moderate to severe Clostridium difficile infection” [Gastroenterology 2017]

Mandible fractures.  For study and article: Demesh D, Leonard JA, Schechter CB, Dhillon P, Hsueh W, Stupak H. Evaluation of a Vertical Box Plating Technique for Mandibular Body Fractures and Retrospective Analysis of Patient Outcomes. JAMA Facial Plast Surg. 2019 Jul 1;21(4):271-276. doi: 10.1001/jamafacial.2019.0057. PMID: 31120473; PMCID: PMC6547119.  See https://pubmed.ncbi.nlm.nih.gov/31120473/    See also https://medicalxpress.com/news/2019-05-vertical-plating-benefit-mandibular-body.html, and https://www.doximity.com/pub/daniel-demesh-md

INTERVENTIONS RELATED ANALYSES, QUERIES

Hassen GW, Roy A, Fernandez D, Dunn N, Bulbena-Cabre A, Chirurgi R, Li L, Dittmar M, Aldous KM, Su M. Analysis of K2 products sold as incense. Am J Emerg Med. 2018 Jul;36(7):1307-1309. doi: 10.1016/j.ajem.2017.11.030. Epub 2017 Nov 13. PMID: 29157793.  At https://pubmed.ncbi.nlm.nih.gov/29157793/

Anitha Srinivasan. Caution Ahead: Research Challenges of a Randomized Controlled Trial Implemented to Improve Breast Cancer Treatment at Safety-Net Hospitals. January 2018.  Journal of Oncology Practice 14(3):JOP.2017.026534.  See https://www.researchgate.net/publication/322237554_Caution_Ahead_Research_Challenges_of_a_Randomized_Controlled_Trial_Implemented_to_Improve_Breast_Cancer_Treatment_at_Safety-Net_Hospitals

SIMPLE QUERIES, SURVEILLANCE (PROJECT DESIGN AND PLANNING)

Sickle Cell [HIT-2015-02-SUR]

Dipper Study (Cyclic, recurring Nocturnal Hypotension). [CON-2015-15]

Use of KID (“Kids Inpatient Database”) Outside query. [HIT-2015-12-QUE]

30-day and 60-day Readmission rates [HIT-2015-13-QUE]

Compartment Syndrome.  All networks. Diana Fleisher, Stephen Blumberg. [JAC] [HIT-2016-24-QUE]

Well Visits and Vaccine refusals [HIT-2015-08-SUR]

Immunization refusals at H+H [HIT-2016-13-SUR]

Mortalities, by Network [HIT-2016-14-QUE]

Monthly Enrollment Rates.  New Members and Well Visits Immunizations Completions in 2017.  [HIT-2018-XX-SUR]

COMPLETED, NOT YET SUBMITTED

Mbekeani J. (2018).  Assessment of Neurocognitive Consequences of Call Duty in Hospital Medical Staff Using Saccadic Eye Movements.

Alemeny L.   (2018).   The Impact of Anxiety Level and Sleep Patterns on Perceived pain during Intravitreal Injections.  Submitted?

DISSERTATIONS, THESES

George V.  “Comparing the Effectiveness of Different Treatments in Managing Knee Osteoarthritis Pain. A Retrospective Chart Review Quality Improvement Project”, [May 2017- ]

GRANT RELATED

HIV and Mental Health (for Jacobi Grant) [HIT-2015-01-RSC]

Pfizer Sickle Cell Disease Pharmacotheraputics (Pre and Post grant work, Kings County Hospital, for all of H+H) [HIT-2015-10-QUE]

PHARMA

Novartis-Entresto Research Feasibility. [data requirements, time]  PI/Requester: Richard Sinert [KIN-2015-19].  See April 16, 2018, press release:  https://www.novartis.com/news/media-releases/novartis-announces-new-analysis-demonstrating-entresto-helped-preserve-kidney-function-patients-chronic-heart-failure-especially-those-diabetes

Acute Heart Failure patients, research project eligibility (for Pharma product). Sinert. [KIN-2015-21]

STATUS UNCERTAIN

“The Impact of Anxiety Level and Sleep Patterns on Perceived pain during Intravitreal Injections”

“Determination of Burnout in Residents Training at an Urban, Public, Community Medical Center – An application of the Maslach Burnout Inventory (MBI) – Human Services Survey (HSS) at Lincoln Medical and Mental Health Center, in Bronx, NY . . . aka “The Lincoln Resident Wellness Survey”  PI: Joseph Yuen,MD; Co-PI: Eduardo J. Rodriguez-Perez,MD

Kemeny M.   “The Effect of Centralizing Cancer Care in an Urban Public Hospital” {Queens Hospital]

Mustafa Al-Lami, Kareem Moasis; Juang.  “The significance of the use of Transesophageal Echocardiography in Patients with 1/4 positive blood cultures for gram positive cocci in clusters and at low risk for infective endocarditis”  [CONEY ISLAND]

“Assessment of the Diagnostic Value of P Wave Morphology in Initial Electrocardiogram in Patients with Acute ST Elevation Myocardial Infarction”  PI: George Juang; RES: Ashok Khanna; ASSTS: Falgun Patel, Vasudev Virparia, Christopher Chum, Roshanak Najibi, Youstina Michael [CON-2015-04]

REGISTRY PRODUCTION AND/OR WORK

Surgical Disparity: A Rerun of all data pulls for final submission and DB development, including new GIS data component and figures to submit with the Grant  [GRANT. New Grant; forwarded data to new Data manager]; Surgical FU registry (see later information on this.)  [GRANT]   [GIS]

REGISTRY. Aortic Dissection Aneurysms Case Files/Registry/Study Dataset.  Dr. Deane E Smith. [BEL-2016-25]

DATABASE DEVT/POPULATION HEALTH MODELING

Epilepsy [HIT-2015-16-DB] Descr. 2 MB, 126files

Antibiograms [KIN-2015-18] PI: Richard Sinert, RA: Alyssa Conigliaro. Descr. 341.5 MB, 77 files.

A Study of Female Genital Cutting – documentation amongst H+H Patients residing within the five boroughs.  Phase 1: Planning, 6 days. 24 files, 10.5 MB. [HIT-2015-27-SUR].  Phase 2: subsequent ‘big pull across all 8 networks’, identified as “Pulls of Infibulation Patients data” (Surveillance); consists of SQL and SAS merge and deidentification, reclassification work, 983 days to complete runs and activities, producing 152 files, 57 MB. [HIT-2015-28-SUR].  <These were later merged further, cleaned, with numbers condensed, for conversion into standard 4 datasets process developed for assessing “Total patient care”; then applied to second and third FGC research activities, and fourth FGC DBing project; data used for interventions planning, research, and review for second article planned.>

WTC911 [EXPLORATORY] – DEVELOPMENT OF A TOOL FOR ASSESSING DIAGNOSTIC CHANGES OVER TIME. 2900 Patients still alive after 2005 and in the H+H EMR. 210 MB DB developed, Visits, Procs, ICDs.

“LIFETIME CARE” MODELING

Sickle Cell – A total population health review.  Development of the “Lifetime Care model” for assessing Chronic Disease patients with 5 or more years of EMR documentation.

Female Genital Cutting.

Epilepsy

Citywide Domestic Violence Cases and Victimization, related to SES and Health

OTHER PRESENTATIONS: PAGNY, LECTURES, etc. (in chronological order)

Dr. M. Waseem, Dr. N.Cemalovic . “Retrospective review of a Trauma Database: Utility of the FAST examination to identify intra-abdominal injury.” Fully analyzed, etc.. [LIN-2015-11]

Hussein Assallum.  “Obstructive Sleep Apnea and Atherosclerosis: A Case-Control Study (OSA occludes study)”  [IRB 9/13, appr. 3/14, PAGNY 2018]  See 3chup2auj4q45vvmk16av4j4-wpengine.netdna-ssl.com/wp-content/uploads/2018/11/Abstract-List-for-people-2018-PAGNY-Research-Day.pdf  Fully analyzed, etc.. [LIN-2015-14]

The Impacts of Alcohol on Head Injury Patients; the value of vital signs.  Rsch Team: Yudil Velez; Muhammed Waseem; Rose Yosheved; Mark Leber; Toussaint Reynolds; Fernando Jara. Fully analyzed, etc.. [LIN-2015-22]

Akker E.  “Correlation between Serum Parathyroid Hormone Levels and HbA1C in Secondary Hyperparathyroidism caused by CKD.” (Paper prstd)  Up to datapulls. [CON-2016-11]

Akker E et al.  “Utility of CT imaging in the evaluation of patients with non-traumatic abdominal pain” Elig. List; up to datapulls. [CON-2016-11]

“Low Specific gravity of Urine and its Effects on Detecting Urinary tract Infections in the Young Pediatric Population “. Muhammed Waseem; Eurypides Roques; Wendy Henriquez, Lenier Perez, Erin Ciummo.  (MedStud). (Resident) Basic analysis. [LIN-2016-17]

NEW GIS-GUIDED INTERNAL EXPLORATIONS

An Exploration of Regions and Regionalism in New York City [for later sue in GIS/SES research projects]. [HIT-2015-20-GIS]

An Exploration of Abuse and Violence Mapping in the NYC area (and exploration of ICDs, and V and E codes most related to these cases).  Status: Evolved into other later studies. [HIT-2015-26-GIS]

Sickle Cell Carriers, and Sickle Cell Patients Geography, for the H+H Population. [HIT-2015-24-DAT]

Developing Zipcode datasets with Longitude-Latitude depicting zip code area centroids, for linking EMR data to spatial demographics and SES data using a GIS. [HIT-2015-26-GIS]

Complete research portfolio—1975 to 2020, updated yearly, is posted at ResearchGate.com and bibliographed at https://brianaltonenmph.com/about/research-gate/

PORTLAND STATE UNIVERSITY ACTIVITIES

SPECIAL STUDIES


Smoking behavior and QUITLINE use. Reviewed Denver Health Managed Care Medicaid and Employee 2001 to 2004 QUITLINE activities.

OIHM. Studied an adult summer camp generating $3.5M annually from 22,000 participants; interviews, surveys, analysis of demographics, income ranges, profits per program in relation to course type and lecturer; interviewed local community. Summer 2001. (INTERNSHIP. 140 pages, 7 chapters).

Diagnosis, Treatment, and Prevention of Prostate Cancer. A Combined Short-term Watchful Waiting Program, and Long Term Nutrition Based Prevention Program. [MPH FINAL PROJECT]

Pregnancy Counseling and Testing activities by the Student Population. Six-year summary of monthly and quarterly utilization reports for counseling center and clinics, SUNY Stony Brook, EROS group.

PRESENTATIONS

Are Older People (>65) using herbal supplements at High Risk for Complications? Consumer marketplace survey and analysis of National OTC Nutritional Stores and Chains. OASIS, Portland, OR, 2001.

Use of GIS in Predicting West Nile Disease Patterns. Study of High. Middle and Low-income community Settings with likelihood for disease penetration. Presented at Colorado State University, School of Bioagricultural Sciences, Fort Collins, CO. April 27, 2004.

Asiatic Cholera and Dysentery along the Oregon Trail. 2000. [MS THESIS]. The geography of diarrhea, dysentery and cholera, 1849-1856, from Platte River, Nebraska to the Columbia River. An historical epidemiology study.

Defining Exposure Risk in the State of Oregon. Developed innovative algorithm and program used to produce grid maps depicting high risk areas for chemical exposure, based on income, census and case data, with contour maps produced depicting exposure risk in relation to median income status, ethnicity, age and gender at the block and block group level.

West Nile Host-Vector Ecology, Dutchess County, NY. Use of demographic and field data in relation to aerial photography, kernel density mapping, and modified grid and cluster techniques for identifying and predicting risk areas. October 2006 ESRI Health GIS Conference “GIS Solutions Today for a Healthier Tomorrow”, Denver, CO.

AWARDS & ACCOMPLISHMENTS

My SBasic DBASE program TOXIDROM is probably one of the first personal PC databases produced that is still out there and in use on the internet.  Developed in Fall of 1982 on a Sanyo MBC, it has been continuously used for 33 years, the last 23 years as a diagnostic/clinical recommendation tool.  (The word “toxidrome” is the signature for it and for finding it on the web; see also http://ouribis.com/)

First individual to ever obtained a perfect score for my federal report required for a required QA program.

Received communications award for 2000-2003/4 GIS work at 2006 ESRI Healthy GIS Conference.

http://brianaltonemph.com, approximately 1000pp receives more than 6000 hits/3000 individuals per month, mostly by students, teachers and Medical GIS professionals.

.

This algorithm takes 20 to 30 minutes to run on the national data.  Semi-automated/semi-manually, this process produces 20 videos per day, 15sec to 4 mins/video (avg 45-60sec),  at 400-2000 images per video, averaging 20,000 images per day, with a 1:3 ratio of run:production/view time.   Automating the last process triples productivity, to 60 videos/day, 60,000 images/day.  I demonstrated to several potential vendors that when fully automated (running in the background in a good Teradata system), it is capable of doubling to quadrupling productivity, more if you apply it into the evening.  Production rates calculated per person over the past several years have been:  100,000 images per week (100 videos), more than 5 million images (5000 1minute videos) per year, for the semi-automated processing technique. Reporting for each single metric, without the video, requires one tenth the time or less!  A daily surveillance report of hundreds of potential in-migrating foreign born diseases can be accomplished using this technique, within a standard public IT work setting. 

More importantly  . . .

Any company with the right basic software package can do this ! !

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.