Open-Source Geriatric Beers Criteria–Part D Crosswalk, for Analyses of Drugs Adverse to Elders (DAE)

[Under development]

A crucial resource for describing the quality of prescribing practices for elder patients (those age 65+) is essentially unusable for research and data analysis. This blog post documents the challenges and decision-making for creating a crosswalk for these drugs that can be used in Part D data.

The Beers Criteria published in 2019 by the American Geriatric Society are an important resource for all who interact with geriatric patients’ medications. For clinicians trusted to manage or add to the prescriptions issued to these patients, the Beers Criteria provide a list of drugs adverse to the elderly, succinct recommendation (e.g., “avoid” or “avoid as first-line therapy…”, a rationale for each recommendation, and the strength and evidence-quality of each.

Major challenges arise from the structure of Part D data, which contain the generic name (GNN) and National Drug Code (NDC) to identify the drug sensitively (GNN) and specifically (NDC).


The generic name seems promising: it’s an abstraction of the drug itself — agnostic of its dose, its form, and the brand. For example, Xanax, Niravam, and generic alprazolam would all have the GNN of “alprazolam.” If we had all generic names for drugs falling under the Beers Criteria recommendation, we could simplify our search to just a couple hundred terms, matched against the entire GNN field in Part D Event data. This approach may prove most efficacious and efficient.

My fear for the GNN is that we under-represent “all generic names falling under the recommendation.” When working in an FDA metathesaurus software, I find complex relationships among drugs that indicate complex relationships persist in the world of GNNs: drugs may be used in combination

The goal of this project is to create an algorithm for

My initial list of 15 benzodiazepine names (suggested by peers) is exceeded by the 2015 Beers Criteria, which includes “amitriptyline” and “clidinium.” On the other hand, my list exceeds the 2019 Beers Criteria, which omits Halazepam, Midazolam, and Prazepam. Relying theon the
At least in the 2019 Beers Criteria, “Chlordiazepoxide (alone or in combination with amitriptyline or clidinium)”

Launching CouchDB

Created a new EC2 instance on Linux 2018.

Log in with SSH, with key in the directory

Install dependencies

yum install gcc gcc-c++ libtool curl-devel ruby-rdoc zlib-devel openssl-devel make automake rubygems perl git-core

Enable EPEL repository

sudo yum-config-manager --enable epel

Build SpiderMonkey JS Engine

tar xvfz js185-1.0.0.tar.gz
cd js-1.8.5/js/src
sudo make install

downloaded dependencies, got spidermonkey, and all that. I’ve been using

The challenge is

Once you have installed all of the dependencies, you should download a copy of the CouchDB source. This should give you an archive that you’ll need to unpack. Open up a terminal and change directory to your newly unpacked archive.

Configure the source by running:


But I don’t have a good way yet to download the CouchDB source. I believe I will need to use curl url-to-couchdb-source.bin –output usr/local/couchdb-bins.bin

RedHat 8: Place the following text into /etc/yum.repos.d/bintray-apache-couchdb-rpm.repo:

 ^ I used vi ....filename above and found that it wouldn't let me write - try again as root?

Update: sort of fixed by using nano and the CentOS option. Now the next step sudo yum -y install couchdb gives:

Error: Package: couchdb-3.1.1-1.el8.x86_64 (bintray–apache-couchdb-rpm)
Error: Package: couchdb-3.1.1-1.el8.x86_64 (bintray–apache-couchdb-rpm)
Error: Package: couchdb-3.1.1-1.el8.x86_64 (bintray–apache-couchdb-rpm)
Requires: systemd
Error: Package: couchdb-3.1.1-1.el8.x86_64 (bintray–apache-couchdb-rpm)
Error: Package: couchdb-3.1.1-1.el8.x86_64 (bintray–apache-couchdb-rpm)
Error: Package: couchdb-3.1.1-1.el8.x86_64 (bintray–apache-couchdb-rpm)
Error: Package: couchdb-3.1.1-1.el8.x86_64 (bintray–apache-couchdb-rpm)
Error: Package: couchdb-3.1.1-1.el8.x86_64 (bintray–apache-couchdb-rpm)
Error: Package: couchdb-3.1.1-1.el8.x86_64 (bintray–apache-couchdb-rpm)
Error: Package: couchdb-3.1.1-1.el8.x86_64 (bintray–apache-couchdb-rpm)
Error: Package: couchdb-3.1.1-1.el8.x86_64 (bintray–apache-couchdb-rpm)
Requires: mozjs60

Now, did

sudo yum --enablerepo=epel update

sudo yum groupinstall "Development Tools"

sudo curl -O

tar -xvf js185-1.0.0.tar.gz

cd js-1.8.5/js/src/

sudo make install

sudo yum install libicu-devel ncurses-devel openssl-devel
mkdir couch-compile && cd couch-compile

This is from , but sudo curl -O had to be prepended by sudo.

Personal Statement Prep

Academic Statement: How will a ### Masters degree help you meet your career and educational objectives? (max ~250 words) *

I anticipate using a ## Masters primarily to prepare to lead organizations that use novel data and methods about complex systems to improve the effectiveness of public- and private-sector interventions aimed at U.S. social and health problems. This may include future work in academia. To me, creative financial instruments, long-standard technologies, and existing streams of data are underused in planning such interventions. The organizations that lead them often are incapable of leveraging such resources — and often view them as distractions or nice-to-haves. Finally, such resources are underused in financial decisionmaking, systematically excluding financially viable interventions from investment by private investors.

Personal Statement: How have your personal background and life experiences, including social, cultural, familial, educational, or other opportunities or challenges, motivated your decision to pursue a graduate degree? (max ~250 words)

I have a complex background and identity, but one that consistently reminds me of the urgency of resourceful action by public institution and the civil sector. I was raised mostly by my brother, 3 years older than me, while my mother worked tirelessly to establish a new California State University and my father conducted environmental research in Mexico. With my brother, I grew up in a military-base-turned-university-campus where education loomed large; relatedly, in both our boredom and our interactions with our parents we fostered bold curiosity and a methodic and cheery approach to conducting meaningful projects.

Time spent in Mexico showed me how institutional failures could harm everyone, by way of drawing stark contrasts to California. Simultaneously, I returned to America to reckon with the inequities in my community: how my school had no art program while the school three towns over funded new stone arches for its large theatre.

Planning a Hectic Quarter

Priority Activities

  • Project Report
  • Seeking funding
  • Creating pool of prospective TA sites
  • Developing automated TA products
  • Creating reproducible research
  • Publication


I will feel great momentum if I get a draft of the project report together, using a clear structure and leaving placeholders where I am not best suited for the writing task.

I should keep the data dictionary open while integrating the code segments from across the Shiny app, Rmd, and R scripts.

I should continue with my approach, creating an R script that outputs pngs and csvs (add), and then pulling these and outputing them in the Rmd. The Rmd could present a lot more info by using tables in lieu of some vizzes.

Week of 10/5 Activities

  • Project Report Draft
  • Data dictionary
  • Combining the maps, histograms, and other graphs into a single document
  • List of leads for (1) government interest (2) academics who could use this (3) prospective funders (4) prospective TA sites
  • Identify waitlist data options – note that waitlists may be capped or diverted
  • % Elders on SNAP % Elders receiving meals on site (day centers, MOW)

Projects Beyond Eldercare Data

  • Water – ECHO and SDWIS; Census ACS to most granular level – all in R.
  • SDOH – Write up common forms of bias seen in social-intervention literature that monetizes and evaluates health effects of social interventions. – before Thursday and after RWJ?

Mindful and Reflexive Compassion

Today, I’m thinking about how many people need/expect their friends to reflexively express emotional support when they experience hardships. How often and cheaply our friends will lob insults at the perceived wrongdoers (never present) in a story we recount. How ready and fake the ego-reinforcing mantras are, when reflexively served up after we concede our shortcomings or failures to win external validation.

I could never do that: I was the silent one off to the side, wishing we could talk about action steps, about structuring a response for our despondent friend to effect, or about talking about what our emotions really are telling us – surely we feel something more nuanced when we break it down to it’s nuts and bolts.

Kassie and I talked about the lost opportunity in my approach, which is also so common among my friends. I viewed it as cheap, as fake, and as degrading of the person we are trying to cheer up. We are treating them like a one dimensional object, a leaf being blown around in a wind of emotion. We offer them nothing substantive to reflect on or learn from. We neuter their drive to improve themselves and exert agency over the situation.

But that is not the only story, and many people do require that reflexive compassion to reestablish their emotional footing.

It’s a matter of communication style, and I would frankly be doing my friends wrong to impose my style – seeking to dig in during the rawest feeling of emotion – onto other people. Understanding their style and meeting them with what they need to heal -/ that is compassion, and it is attainable.

Creating a habit of supporting certain friends in this way – with my own flavor of reflexive compassion that is meant to be genuine — can coexist with a mindset that looks for improvement opportunities, for agency, and for exploring the emotions granulay and honestly.

Two solutions:

  • Ask my friend, “hey, I see things are not going to plan, and you’re having a hard time but also preparing yourself to deal with it.” This leads us to meet the style that’s right in the moment, and to have an open conversation about emotions (centering on them).
  • Consider “wise compassion,” the sort of helpful scrutiny most people expect from a therapist, in appropriate dose and at appropriate times. Offer “reflexive compassion” as a rule, and “wise compassion” as an act of lovingkindness for my friends.

The Business Candidates

Notoriously, the race for at-large city council member in DC is 24 candidates deep. The seat is open because of the retirement of David Grosso, an incumbent I’ve respected since 2015 for his work on juvenile justice reform. Two business-friendly candidates running for the seat are worth analyzing.

An established former at-large member, Vincent Orange, is in the mix after losing his seat in 2016 and then stepping away from the Council before his term ended, to lead the DC Chamber of Commerce. That resignation process was telling: he resisted calls to leave the seat, which would have prevented any conflicts of interest. The Chamber is, after all, the primary advocacy and lobbying heavyweight representing the big tent of the business community, and thus a major lobbying force jockeying for influence in the Council. In resisting the calls to resign and avoid overlapping job obligations, he tried to justify his situation by comparing it with (or more generously, “comparing it against”) the tragically low standard set by Jack Evans’ conduct at that time. Evan’s, then Ward 2’s councilmember, is since ousted. He is both a snollygoster and a two-time Wikipedia vandal.

What could be more of a conflict-of-interest red flag than Orange’s past intention to simultaneously steer the council and lobby it on behalf of the broad business community? What Marcus Goodwin might do as a developer-turned-Councilmenber: actively engaging in business activity that has a narrower, more concentrated policy interest than the Chamber’s — a special interest premised on excluding large swaths of DC’s residents and homeowners from the Council’s priorities. Goodwin, who is a real-estate developer and second-time candidate for at-large Councilmember, could be a new guard in the Democratic establishment of DC: his Neighborhood Development Company can immediately point to its Benning Market development, at 3451 Benning Road NE for progressive credibility. That “food hall” concept would supposedly provide a venue in Ward 7 for a community market and black-owned businesses, at least for now. This dream has yet to come to fruition; its key tenant has an out-of-date website (from December 2019, as of October 2020), suggesting little forward momentum several years from its founding, and a year since NDC’s crowdsourced quarter-million dollar funding round. Other NDC projects are more run-of-the-mill: a lot of gentrifying projects and a sideshow of affordable housing, which can be targeted toward people with fairly high incomes because of DC’s high median income, which is used for defining affordable housing eligibility.

Do we overlook our concerns about Goodwin’s development-industry policy interests because his company sponsored one as-yet-unfulfilled project that it asserts will elevate community interests in Ward 7? Can we even trust that his company, the landlords, will keep black-owned businesses at center-stage in the property’s future, if Ward 7 continues to gentrify? Or will its joint food hall–grocery store design be home to the next Whole Foods by decade’s end?

Development ties imply several priorities that are out of step with many DC residents’ own. Developers want the opportunity to raise rents for businesses and homes. This is fastest aided by deprioritizing low-income residents’ needs and pushing out low-income residents from their current neighborhoods. Developers take this approach to create large swaths of the city that are highly appealing to high-income residents. (High-income residents in turn can sign high-end, high-profit leases and can purchase bottomless volumes of high-profit items from nearby businesses, increasing the businesses’ rent potential.)

Many pressing policy areas — like criminal justice, tenants’ rights, education, and behavioral health — are instrumental to push out or keep out lower income residents (including those trying to make an honest living) just as the city reshapes itself to appeal to prospective tenants in the upper classes. Appealing to higher-income residents can involve policies that improve services and rights for all — but this is slower. If Goodwin takes the at-large seat, what broad approach he will take to reshape DC via policy makes all the difference. At best, he would expand the pie and shepherd corporate interests to generate opportunities for the lower-income DC residents. Or he could shepherd lower-income DC residents out of town to generate opportunities for corporate interests. DC’s progress in offering economic opportunity and household stability to all residents is threatened if we replace the inclusivity-oriented ethic of David Grosso with someone who will not be a fierce negotiator on behalf of the district when facing business interests who want a place in our city’s economic activity.

Those concerns about how his development background would shape his political priorities should be weighted heavily because he is so young, and his career so promising: voters mistaking his intentions in this election could accidentally invite development-friendly policy angles — and perhaps related graft — for the next decades. He is 30, and last year was elected president of DC’s club for young Democrats.

Goodwin’s statement in the Post focused on his experience: that “the work that I’ve done in commercial development gives me the knowledge and savvy to know how public-private partnerships should be structured and how to preserve housing for residents that is truly affordable.” This is a fair point, for those looking for a community-oriented business voice. Goodwin is a DC high school graduate, with a pedigree from St. Albans, UPenn, and Harvard. He is deep into the financial and government-facing part of NDC’s work. He previously worked at Four Points and JBG Smith, according to his NDC profile.

On one hand, his election would reshape which groups of DC residents he will champion, with concerning likelihood that the poor would lose. On the other hand, his election would welcome new frontiers for graft and cronyism. His Neighborhood Development Company would be intensely embedded in DC or whatever firm he goes in later decades with his coupled political power and development skills. If Goodwin takes political office, development companies offering a better vision for DC land use might get cut out of a fair process — or might avoid competing with his firms altogether in key areas, to avoid his disfavor.

For that reason, keeping Goodwin on the bench seems a good idea, at least until he reveals more about his priorities and shows real commitment to equity, or until he commits to disentangling from his own industry to take on the $130,000/year salaried work of DC Councilmember. If he’s committed to equitable development for the right reasons, he will have much to do in the next decade anyway in our city. If he’s committed to bringing his business experience to negotiate and legislate on behalf of DC’s citizenry, I hope he would return to take a third shot at a Council seat in future elections.

I’m moving with way too little structure around learning about post-acute care. I have data that I want to analyze about patients’ post-acute care spending, and about conditions of the post-acute care users in Medicaid in each year.

Post-acute care has seen some efforts to make the payments setting-neutral. There are also alternative payment models that are bundling pay for post-acute care.

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