bluuebunny/crossref_metadata_2025 huggingface dataset:
Design of a Digital Intervention to Improve Connectivity and Reduce Loneliness in Older Adults (Preprint)
Authors: Stuart Avelie , Yan Ronnie Jieru , Harkin Lydia , Katz Dmitri , Stevenson Clifford , Mehta Vikram , Giles Emilie , Talbot Catherine , Gooch Daniel , Bennasar Mohamed , Self Tara , Nuseibeh Bashar , Price Blaine
Published: September 2022

BACKGROUND

The COVID-19 pandemic impacted older adults' social connections and increased loneliness, but also led to increased technology adoption, providing new opportunities to develop technology interventions to meet their social needs. Existing off the shelf social connection platforms do not contain facilities designed to break the cognitive cycle of loneliness, and loneliness interventions implemented without due process could cause detriments to wellbeing. There is also lack of digital technology designed with older adults.

OBJECTIVE

We set out to iteratively design a user-centred smartphone app that could address older adult needs for social connection. The research questions were: how could our prototype smartphone app be used in mitigating loneliness and increasing a sense of social connectedness? What were emergent concerns resulting from use? In what ways could it be improved to better meet user needs?

METHODS

We used technology probes to elicit older adults' reflection on the concept of using the app in two studies: Concept focus groups (N=33) and Concept interviews (N=10), and then conducted a prototype trial with one week of use and follow up interviews (N=12).

RESULTS

A thematic analysis was conducted to explore the experience and emergent challenges of our app through the design process. This led to the development of four themes occurring in all three qualitative datasets: 1) Reflection on a digital social map is reassuring, 2) App features encourage socialising, 3) Risk of compounding loneliness, and 4) Feeling more control with mutual, socially beneficial activities.

CONCLUSIONS

Smartphone apps have the potential to increase older people’s awareness of the richness of their social connections, which may support loneliness reduction. Our qualitative approach to app design enabled the inclusion of older adults' experiences in the technology design. With that, we conclude that our older adults most desired functionalities that can support mutual activities and maintaining or finding new connections, rather than sharing of emotional state. They were wary of the app being used to replace preferred in-person social interactions, and they raised concerns about making the user aware of a lack of connections or support in their social network, unless they are offered specific means of addressing their needs. Further user-centred design work is needed to enhance the app to support mutual activities and socialising. Our study illustrates the continued importance of user-centred design work to ensure that digital interventions are designed for populations like older adults.
Mediaciones de violencia. Discursos legitimadores sobre violencia social y criminal
Authors: Guerra Edgar
Published: September 2022

A partir de las premisas teóricas “pedagogías y mediaciones de la violencia”, el artículo describe y sistematiza los discursos que legitiman ciertas formas de violencia social y criminal en la región de Tierra Caliente, Michoacán; analiza el caso de Los Caballeros Templarios para preguntarse qué tipo de mediaciones discursivas permitían legitimar ciertas formas de violencia criminal. Su carácter es exploratorio y descriptivo y se basa en evidencia empírica construida a partir de un extenso trabajo de campo, cuyos resultados aportan algunas líneas de trabajo para proseguir con la búsqueda de los mecanismos reproductores de la violencia en el orden criminal.
Global Companies and Their Territorialization Strategies: The Royal Agrifirm Group Case in Brazil
Authors: Krampe Márcia Estela Daltoé , Etges Virgínia Elisabeta
Published: September 2022

This article studies transnational companies and their territorialization strategies. The case study addressed refers to the Royal Agrifirm Group cooperative. We sought to analyze how the territorialization strategies of global companies, aiming at greater competitiveness and opportunities for expansion in new markets, have repercussions on the territory in which they are installed. To understand such contexts, semi-structured interviews were carried out with qualified informants; data collected from secondary sources; bibliographic and documentary. The systematization and interpretation of qualitative data took place through content analysis, with the MAXQDA software (2022). The results obtained showed that the company has a strong culture, with well-defined norms and that it applies its strategies by developing its processes in a space of continuous and vertical flows. Its territorialization strategies include specific and orderly planning, based on the planning and control of goals and results to be achieved, as a way of making investments made in the territory viable.
Evaluation of the interference of paracetamol on blood glucose measurement: A randomized laboratory trial
Authors: Marcelino Bianca Louise Inácia , Santos Thalita Grazielly , Bernardes Nicole Blanco , Júnior Nilton Nascimento dos Santos , Carvalho Marco Túlio Menezes , Faria Camila Belfort Piantino , Silva Isabella dos Santos , Santos Thatiane Danielly , Vasconcelos Esdras Haine Soares , Reis Tainá Martins Arruda
Published: September 2022

Data from the International Diabetes Federation (IDF) indicate that 8.8% of the world's population suffers from diabetes. Glycemic dosage is one of the most important laboratory parameters for the diagnosis and monitoring of the disease. That is why it is of paramount importance to guarantee doctors and the patient a reliable, safe and error-free report. It is known that the majority of the population uses medications randomly and without a prescription. Many drugs can interfere with the analytical methods of various laboratory tests. The objective of this study was to evaluate the in vitro interference of the drug paracetamol in glycemic dosage by the glucose oxidase method, which the literature reports is the most used method in glycemic dosages and which is susceptible to interference by paracetamol. Glycemic measurement of a control sample was performed with commercial serum of known value, at a concentration of 100 mg/dl, and commercial serum samples submitted to different concentrations of paracetamol, ranging from 10 μg/ml to 5 mg/ml. A significant decrease (p<0.0001) in blood glucose was observed in the samples with the presence of paracetamol at concentrations of 200 μg/ml and 5mg/ml. The present study demonstrated a negative correlation between increasing concentrations of acetaminophen and glycemic dosage.
Innovative cocktails: Physical-chemical profile during storage
Authors: Souza Fábio Pereira de , Machado Mariana Teixeira da Costa , Souza Alexandre Santos de , Gregório Sandra Regina , Chavez Davy William Hidalgo , Souza Lara Bruna Brito Castro de , Costa Karina , Maia Luiz Fernando Oliveira , Rodrigues Jairo Lisboa
Published: September 2022

For the improvement and inclusion of new food technologies in the market, several evaluations must be carried out carefully in a new product, from its formulation, physical-chemical and microbiological tests to acceptance by the final consumer. This study aimed to evaluate the formulation of bottled alcoholic beverages in relation to physical-chemical aspects and stability during storage at two temperatures, for a period of up to 150 days, analyzing the physical-chemical parameters. Mixed alcoholic beverages, caipirinha, margherita and dulce de leche flavors, were evaluated regarding mandatory parameters of identity and quality standards of the legislation, quantification of chemical elements (Mg, k, Mn, Fe, Cu, Pb, As, Cd and Sn). For the stability study, the Accelerated Shelf-Life Test (TAVP) was performed, the samples were stored at temperatures of 30 and 40 °C in a BOD-type oven, in the absence of light and evaluated at regular intervals of time in relation to the parameters physical-chemical properties and color, in order to verify if there was a significant difference between the standard sample (beginning of storage) in relation to each elapsed temperature and time. With the exception of the caipirinha, which did not reach the minimum limit of 1g/100 mL of lemon juice, but this parameter can be easily corrected. The drinks remained stable throughout the storage time, the physico-chemical parameters analyzed of the three samples did not show changes in behavior at temperatures of 30 and 40 °C, when compared to each other, despite having presented a significant difference by the Tukey test and the non-parametric Kruskal Wallis test at a significance level of 5%. It was noticeable in the visual analysis of color and the comparisons of color parameters (L, Chroma and HUE) that there was a color variation over the storage time, however, this did not influence the shelf life, which was estimated to be greater than 150 days. Thus, it can be concluded that the drinks were stable and commercially acceptable.
Synthesis, Spectral Studies and Anti-Microbial Activity of Novel Chalcones of 2-Acetyl Pyridine
Authors: Kumbhare S. L. , Meshram Y. K.
Published: September 2022

Abstract: Some new chalcones have been synthesized by the condensation of 2-acetyl pyridine with different aromatic aldehydes in 40% alkali. The synthesized compounds were identified by Physical data and Spectral data (IR, 1HNMR). These Synthesized derivatives of Chalcones Screened for Antimicrobial Activities. Some of these compounds showed moderate to considerable antimicrobial activity
Muralismo, grafite e pichação:
Authors: Almeida Pedro Paulo de , Franzi Juliana , Rocha Marcelo Augusto
Published: September 2022

o presente artigo deriva do Trabalho de Conclusão de Curso do primeiro autor e se desenvolve a partir da apresentação da história do muralismo, do grafite e da pichação, reconhecendo-os como um grito de resistência perante as opressões sociais, culturais e economicamente impostas. Posteriormente, realiza um debate que os indica como ferramentas pedagógicas, dado que permitem transcender a educação tradicional e incorporar o ensino de Geografia, sobretudo em escolas públicas, comprometido com a transformação da realidade social. Nesta direção, as orientações pedagógicas – teóricas e práticas – respaldam-se em caminhos já trilhados pelo primeiro autor, cujos trabalhos poderão ser conhecidos neste artigo. As reflexões aqui aventadas visam a oportunizar às escolas, por meio do ensino de Geografia, o desenvolvimento dos(das) estudantes ao favorecer suas próprias análises espaciais e o entendimento das paisagens em seus múltiplos sentidos e dos territórios em seus múltiplos agentes.
Slam
Authors: Cristi Miguel Ahumada , Lopes Aislene da Silva
Published: September 2022

O slam é um movimento cultural e artístico de origem norte-americano. No Brasil, ele é especialmente cultivado pela população negra das periferias. Este artigo teve como objetivo abordar o slam desde uma perspectiva interdisciplinar: histórica, social e pedagógica. Nesse sentido, o texto aborda três esferas deste movimento: a trajetória histórica dos sentidos e significados do slam; a cultura do slam e a produção de conhecimento; a natureza pedagógica do slam, isto é, a conscientização pela linguagem.
Política de Cultura e Participação Social
Authors: Teixeira Simonne , Caetano Rodrigo da Costa , Azevedo Nilo Lima de , Souza Joseane de , Lima Hamilton Gracia de
Published: September 2022

Os Conselhos Municipais de Políticas Públicas são importantes instrumentos de participação social e espaços estratégicos de interação entre a gestão governamental e a sociedade. O presente artigoanalisa com especial atenção os Conselhos de Cultura dos municípios produtores de petróleo da Bacia de Campos/RJ. Para tanto, são utilizadosos dados da pesquisa MUNIC do Instituto Brasileiro de Geografia e Estatística (IBGE), pesquisasnos sites das prefeituras e as experiências de reuniões de Conselhos e Fóruns de Cultura. Além de mapear as Instituições Participativas de Cultura na região, buscou-se compreender como essas se articularam para implementar políticas públicas na área, em um momento de retração democrática, visando assegurar o direito à cidadania cultural.
Analisis Tingkat Kebisingan Akibat Lalu Lintas Pada Kawasan Perkantoran dan Pendidikan di Kecamatan Kota Utara Kota Gorontalo
Authors: Fortuna D. , Mahmud M. , Kadir Y.
Published: September 2022

Increased traffic volume can result in environmental issues such as noise or noise pollution. The purpose of this study is to analyze the noise levels in the office and educational areas in Kota Utara District, Gorontalo City, using a traffic noise prediction calculation model and to analyze the comparative value of noise levels based on the prediction calculation model and quality standards according to KEP-48/MENLH/11/1996. The location of this study is spread over several points, namely in Kampus STIKES Bina Mandiri Gorontalo, in front of Kantor Kejaksaan Tinggi Gorontalo, and in front of Kantor Imigrasi TPI Kelas I Gorontalo. The method used in this study is an empirical method with a prediction model for traffic noise prediction.The results showed that the highest noise levels on Monday and Thursday occurred in the Kampus STIKES Bina Mandiri Gorontalo area with a noise intensity of 65.71 dB (A) and 64.71 dB (A). The highest noise level on Saturday occurred in front of Kantor Kejaksaan Tinggi Gorontalo with a noise intensity of 65.12 dB (A). According to a comparison of the results of the analysis and the quality standard according to KEP-48/MENLH/11/1996, the average noise level in the Kampus STIKES area has exceeded the quality standard value for the educational area, which is 55 dB (A). The noise level in front of Kantor Kejaksaan Tinggi Gorontalo on Saturday at 07.00–08.00 WITA shows that the noise intensity has exceeded the quality standard for office areas, which is 65 dB (A). Meanwhile, the noise level in front of Kantor Imigrasi on average still meets the quality standards required for office areas.
Higher risk for influenza-associated pulmonary aspergillosis (IAPA) in asthmatic patients. A Swiss multicenter cohort study on IAPA in critically ill influenza patients.
Authors: Waldeck Frederike , Boroli Filippo , Zingg Sandra , Walti Laura , Garcia Pedro Wendel , Conen Anna , Pagani Jean-Luc , Boggian Katia , Schnorf Madeleine , Siegemund Martin , Abed-Maillard Samia , Michot Marc , Que Yok-Ai , Baettig Veronika , Suh Noemie , Kleger Gian-Reto , Albrich Werner
Published: September 2022

Background: Influenza-associated pulmonary aspergillosis (IAPA) is an
important complication of severe influenza with high morbidity and
mortality. Methods: We conducted a retrospective multicenter study in
tertiary hospitals in Switzerland during 2017/18 and 2019/20 influenza
seasons. All adults with PCR-confirmed influenza infection and treatment
on intensive-care unit (ICU) for >24h were included. IAPA
was diagnosed according to previously published clinical, radiological
and microbiological criteria. We assessed risk factors for IAPA and
predictors for poor outcome which was a composite of in-hospital
mortality, ICU length of stay ≥7d, mechanical ventilation ≥7d or
extracorporeal membrane oxygenation. Results: 158 patients (median age
64 years, 45% females) with influenza were included, of which 17
(10.8%) had IAPA. Asthma was more common in IAPA patients (17% vs. 4%
in non-IAPA, p=0.05). Asthma (OR 12.0 (95% CI 2.1-67.2)) and days of
mechanical ventilation (OR 1.1 (1.1 – 1.2)) were associated with IAPA.
IAPA patients frequently required organ supportive therapies including
mechanical ventilation (88% in IAPA vs. 53% in non-IAPA, p=0.001) and
vasoactive support (75% vs. 45%, p=0.03) and had more complications
including ARDS (53% vs. 26%, p=0.04), respiratory bacterial infections
(65% vs. 37%, p=0.04) and higher ICU-mortality (35% vs. 16.4%,
p=0.05). IAPA (OR 28.8 (3.3–253.4)), influenza A (OR 3.3 (1.4-7.8)) and
higher SAPS II score (OR 1.07 (1.05—1.10)) were independent predictors
of poor outcome. Interpretation: High clinical suspicion, early
diagnostics and therapy are indicated in IAPA because of high morbidity
and mortality. Asthma is likely an underappreciated risk factor for
IAPA.
Pre-isolation measures and clinical features for 50 pediatric patients with Suspicious COVID-19: Case Series Report
Authors: Li Xiaoyu , Jiang F.Q. , Qiu Y. , J. Yu , Zhu Y. , Tang X.L. , Chen H.Y. , Hu T.T. , Zhao Y.H.
Published: September 2022

Aim: To investigate prevention measures of hospital-acquired infection
and clinical features of suspicious COVID-19 patients in the pediatric
respiratory ward. Methods: Patients with fever and cough or fever
accompanied by vomiting and diarrhea were given pre-isolation measures.
The medical records of the patients were collected and analyzed to
summarize the pre-isolation measures and patients’ clinical features.
Results: A total of 50 pre-isolated children with suspicious COVID-19
hospitalized between January 28 and March 5, 2020 were included in.
Pre-isolation measures combined with epidemiological history and
pathogen screenings were used to rule out COVID-19 patients. No definite
COVID-19 cases were detected, while 2(4%) patients were suspected of
having COVID-19. The pathogenic results mainly included Mycoplasma
pneumonia (35, 70%).Thirty-five (70%) patients had bronchopneumonia.
The pre-isolation patients had the common clinical epidemiological
characteristics as patients with fever and cough, vomiting, and
diarrhea. Discussion: Pre-isolation measures could prevent suspicious
COVID-19 patients from coming in contact with other patients before
definite exclusion. Clinical analysis of the patients was helpful for
clinical nursing management. Conclusions: Pre-isolation measures
combined with epidemiological history and pathogen screening (novel
coronavirus nucleic acid and general pathogen) can help to minimize the
risk of COVID-19 as a hospital-acquired infection.
Adult colo_colic Intussusception an unusual presentation of right colonic cancer: Case Report
Authors: Ali Mohamed , Mohamed Noon , Ahmed Ahmed , Basher Mohamed , Mohamed Samya , Elgemaabi Osama
Published: September 2022

Adult intussusception is uncommon diagnosis, with1-3cases in
1000000/year, primarily due to pathological lead point of which 70%is
malignant.61-year-old female presented with intermittent colicky
abdominal pain for one month and Right iliac fossa mass.CT scan
confirmed the presence of colo-colic intussusception. It requires high
clinical suspicion and has fatal complications
Does Corruption Discourage Entrepreneurship?
Authors: Park Donghyun , Shin Kwanho
Published: September 2022

In this paper, the authors examine the relationship between corruption and entrepreneurship employing two widely used proxies from the Global Entrepreneurship Monitor and the World Bank Group Entrepreneurship Survey. Corruption discourages entrepreneurship because it undermines fair competition. This is the premise under which the study was undertaken considering (i) nascent entrepreneurship collected from Global Entrepreneurship Monitor and (ii) entry rate defined as the number of new firms divided by the total number of the previous year’s registered businesses from the World Bank Group Entrepreneurship Survey. Evidence presented in the paper show that entrepreneurial activity tends to be more vibrant in less corrupt countries.
Biology, morphology, and phylogeny of some strains of the Pleurotus eryngii species complex
Authors: Bisko Nina , Lomberg Margarita , Mykchaylova Oksana , Mytropolska Nadiya , Kutovenko Vira , Gryganskyi Andrii
Published: September 2022

Effective methods of preserving the gene pool of valuable edible and medicinal mushrooms are to maintain them in in vitro culture collections and to correctly identify and verify the preserved strains. It is necessary to consider not only the results of molecular genetic studies but also cultural, morphological and physiological characteristics as additional criteria. This article presents data on the colony and mycelial morphology, growth characteristics and temperature tolerance, and phylogenetical placement of four strains of edible and medicinal mushroom from the P. eryngii species complex received into the IBK Mushroom Collection as P. nebrodensis strains. All the studied strains are mesophiles with the fastest growth rate of 11.0 mm/day at 26?? and a lethal temperature of 40??. In addition to common anastomoses, mycelial strands and clamp connections, the vegetative mycelium of the studied strains formed single colorless round excretory cells on the lateral hyphal ramifications. All cultures were able to form primordia and fruit bodies on agar media. Phylogenetic analysis suggests that all four strains do not belong to P. nebrodensis, but two of them, IBK 1947, 2035 are P. eryngii var. ferulae, and two strains, IBK 1855 and 1927, belong to P. tuoliensis (P. eryngii var. tuoliensis).
Using Backward Design to Incorporate Technology into a Non-AIS Course
Authors: Lamberton Barbara A. , Raschke Robyn L.
Published: September 2022

The purpose of this paper is to present a prototype using the Backward Design methodology to enhance a non-Accounting Information Systems (AIS) course with accounting and technology learning objectives. The backward design framework also provides an effective means of documenting that technology-learning strategies are being deployed in the curriculum, an important benefit for accreditation purposes. By illustrating backward design in cost accounting, this paper provides a blueprint that can be adapted and applied to other non-AIS courses, a helpful tool for curriculum redesign—especially for those who hesitate to add technology topics to their accounting courses.
Targeting Technology in Underserved Adults With Type 1 Diabetes: Effect of Diabetes Practice Transformations on Improving Equity in CGM Prescribing Behaviors
Authors: Mathias Priyanka , Mahali Lakshmi Priyanka , Agarwal Shivani
Published: September 2022

OBJECTIVE

Continuous glucose monitoring (CGM) is associated with improved outcomes in type 1 diabetes, but racial-ethnic disparities exist in use. We were interested in examining whether addressing structural health care barriers would change provider prescribing behaviors to make CGM access more equitable.

RESEARCH DESIGN AND METHODS

From January 2019 to December 2021, we used multilevel stakeholder input to develop and implement several non-grant-funded practice transformations targeted toward equity, which included 1) developing a type 1 diabetes clinic, 2) conducting social needs assessments and management, 3) training support staff to place trial CGMs at the point of care, 4) optimizing prescription workflows, and 5) educating providers on CGM. Transformations were prioritized based on feasibility, acceptability, and sustainability. To examine effect on prescribing behaviors, we collected monthly aggregate data from the electronic medical record and performed multiple linear regression to examine and compare change in CGM prescriptions over the 3 years of transformation.

RESULTS

In total, we included 1,357 adults with type 1 diabetes in the analysis (mean ± SD age 38 ± 18 years; 30% Black [n = 406], 45% Hispanic [n = 612], 12% White [n = 164]; and 74% publicly insured [n = 1,004]). During the period of transformation, CGM prescription rates increased overall from 15% to 69% (P < 0.001). Improvements were seen equally among Black (12% to 72%), Hispanic (15% to 74%), and White adults (20% to 48%) (between-group P = 0.053).

CONCLUSIONS

Diabetes practice transformations that target equity, offload provider burdens, and focus on feasible sustainable stakeholder-driven solutions can have powerful effects on provider prescribing behaviors to reduce root causes of inequity in CGM among underserved adults with type 1 diabetes. Continued focus is needed on upstream determinants of downstream CGM use.
Range of Risk Factor Levels, Control and Temporal Trends for Nephropathy and End-stage Kidney Disease in Patients with Type 1 and Type 2 Diabetes
Authors: Halminen Janita , Sattar Naveed , Rawshani Araz , Eliasson Björn , Eeg-Olofsson Katarina , Bhatt Deepak L , Rawshani Aidin
Published: September 2022

  

Objective

To investigate trends, optimal levels for cardiometabolic risk factors, and multifactorial risk control in diabetic nephropathy and end-stage kidney disease (ESKD) in patients with diabetes and matched controls. 

Research Design and Methods

This study included 701,622 patients with diabetes from the Swedish National Diabetes Register and 2,738,137 controls. Trends were analyzed with standardized inc­idence rates. Cox regression was used to assess excess risk, optimal risk factor levels, and risk according to the number of risk factors, in diabetes. 

Results

ESKD incidence among patients with and without diabetes initially declined until 2007 and increased thereafter, whereas diabetic nephropathy decreased throughout follow-up. In patients with diabetes, baseline values for glycated hemoglobin, systolic blood pressure, triglycerides, and body mass index were associated with outcomes. Hazard ratio for ESKD in patients with type 2 diabetes who had all included risk factors at target was 1.60 (95% CI, 1.49–1.71) compared with controls, and in type 1 diabetes 6.10 (95% CI, 4.69–7.93). Risk for outcomes increased in a stepwise fashion for each risk factor not at target. Excess risk for ESKD in type 2 diabetes showed a hazard ratio of 2.32 (95% CI, 2.30–2.35) and in type 1 diabetes, 10.92 (95% CI, 10.15–11.75), compared with controls.

Conclusions

Incidence of diabetic nephropathy has declined substantially, whereas ESKD incidence has increased. Traditional and modifiable risk factors below target levels were associated with lower risks for outcomes, particularly notable for the causal risk factors of SBP and HbA1c, with potential implications for care. 
Laying the Foundation for Real-World Evidence Studies of Psoriatic Disease in Newfoundland and Labrador
Authors: Badaiki Winifred , Pyper Evelyn , Lester Kendra , Skeard Janelle , Penney Michelle , Shin Janey , Fisher Brenda , Hew Huong , Gulliver Susanne , Gulliver Wayne , Rahman Proton
Published: September 2022

The Janssen and Newfoundland and Labrador Health Innovation Partnership (JANL-HIP) was established to carry out Real-World Evidence (RWE) projects to generate evidence about disease pathways, healthcare delivery, the effects of clinical interventions. Doing so will support and influence clinical decision-making in Newfoundland and Labrador (NL). This case study describes the foundational elements necessary for a~real-world evidence~generation project in NL and may provide learning for the effective execution of real-world studies in other jurisdictions. It uses an ongoing project in psoriatic disease in NL to illustrate the partnership and the benefits of RWE studies. Ultimately, the JANL-HIP RWE project aims to inform decisions that will drive improvements in health outcomes, system delivery, and policy mutually beneficial to health ecosystem stakeholders.
The impact of opioid agonist treatment on fatal and non-fatal drug overdose among people with a history of opioid dependence in NSW, Australia, 2001-2018: findings from the OATS retrospective linkage study.
Authors: Jones Nicola , Degenhardt Louisa , Hickman Matthew , Nielsen Suzanne , Larney Sarah , Dobbins Timothy , Ali Robert
Published: September 2022

ObjectivesThere are critical periods of mortality risk at onset and cessation of opioid agonist treatment. We aim to determine whether non-fatal overdose followed the same pattern as fatal overdose, comparing the first 4 weeks of treatment and treatment cessation and the remainder time off treatment, with the remainder treatment time, to determine intervention markers.
ApproachRetrospective cohort study of people with a history of opioid agonist treatment using linked New South Wales data. The incidence of non-fatal overdose hospitalization; emergency department presentation; and fatal overdose from national death records were compared. Rates were calculated using generalized estimating equations adjusting for demographics, year, and recent health and incarceration events.
ResultsThe rate of an emergency department drug overdose presentation was highest. It was more than three-fold the rate of opioid non-fatal overdose hospitalisation and 14 times higher than fatal opioid overdose. It was also twice the rate of non-opioid non-fatal overdose hospitalisation.
Fatal overdose was lowest while in treatment. This differed from the measures of non-fatal overdose, the overdose rate was elevated in the first four weeks in treatment as well as the first four weeks post treatment.
ConclusionsRetention on opioid agonist treatment is protective against drug related overdose. There is elevated risk of non-fatal overdose at treatment initiation that is not evident for fatal overdose, however the first month of treatment cessation is a critical period for both non-fatal and fatal overdose. These findings emphasize the importance of treatment retention and interventions for polysubstance overdose at cessation.
Potentially inappropriate prescribing in long-term care residents and its association with probable delirium.
Authors: Webber Colleen , Milani Christina , Watt Christine , Bush Shirley , Lawlor Peter , Casey Genevieve , Bjerre Lise , Pugliese Michael , Knoefel Frank , Momoli Franco , Thavorn Kednapa , Tanuseputro Peter
Published: September 2022

Objective: Medications can increase the risk of delirium due to drug toxicities, polypharmacy, and drug interactions. This study examined potentially inappropriate prescribing (PIP) of medication and its association with probable delirium among long-term care residents.
Approach: We conducted a cross-sectional study of long-term care residents in Ontario, Canada between January 1, 2016 and December 31, 2019. Routinely collected long-term care resident assessment data from the Resident Assessment Instrument – Minimum Dataset (RAI-MDS) was linked to prescription claims data to ascertain probable delirium and medication use in the two weeks preceding the index assessment. PIP was measured via the STOPP/START criteria and Beers criteria, with residents classified as having 0, 1, 2, or 3+ PIPs. Associations between PIP and probable delirium was assessed via bivariate and multivariable logistic regression models.
ResultsThe study population included 171,190 long-term care residents. The mean age was 84.5 years, 66.8% were female, and 62.9% had dementia. Probable delirium was documented on 3.7% of resident assessments. Over half (51.8%) of residents had 1+ PIP and 21% had 3+ PIPs according to the STOPP/START criteria. The odds of probable delirium increased as the number of PIPs increased. Probable delirium was 1.86 times more likely (95% confidence interval 1.74-1.98) in residents with 3+ PIPs compared to those with no PIPs after confounder adjustment. Similar findings were observed when PIP was evaluated using the Beers criteria.
ConclusionThis population-based study highlighted that potentially inappropriate medication prescribing was highly prevalent and was significantly associated with the increased likelihood of probable delirium among long-term care residents.
Avoiding the Peak of Inflated Expectations: Common Misconceptions in Population Data Research.
Authors: Christen Peter , Schnell Rainer
Published: September 2022

ObjectivesDatabases covering full populations are increasingly used for research studies. Their massive size is often mistaken as a guarantee for valid inferences on the population of interest. However, population data have characteristics that make them challenging to use. We discuss misconceptions about how population data were captured, processed, and linked.
ApproachWe define population data as data about people at the level of a population. The focus on populations is important, as it refers to the scale and complexity of such data, which make manual processing and data quality assessment challenging. Personal data include quasi-identifiers such as names and addresses, as well as microdata such as people’s medical details.
Little consideration has been given to how assumptions about population data can influence the outcomes of a research study. Only few publications describe experiences or challenges when dealing with population data. Many of the misconceptions we discuss are therefore drawn from our experiences over decades working with real-world population databases in collaborations with both private and public sector organisations.
ResultsWe identified 32 misconceptions about population data, 21 due to how data are captured (among them “a database contains all individuals in a population”, “records in a population database always refer to real people”, “data definitions are unambiguous”, and “missing data have no meaning”); four due to data processing (including “data processing is always correct” and “metadata are correct, complete, and up-to-date”); and seven due to data linkage (such as “a linked data set corresponds to an actual population”, “a linked data set is unbiased”, and “linkage error rates are independent of database size”).
ConclusionDue to misconceptions like those we have identified, careful consideration is needed when personal data at the level of populations are used for research studies. There are no (simple) technical solutions to detect and correct many of these misconceptions; heightened awareness is required by anybody working with population data. We will provide recommendations to help recognise and overcome such misconceptions.
Linked routine health data enables estimation of transition point to adult healthcare and better assessment of changes in emergency care.
Authors: Jarvis Stuart , Richardson Gerry , Flemming Kate , Fraser Lorna
Published: September 2022

ObjectivesTo estimate point of transition from paediatric to adult healthcare from routinely collected healthcare records and to use this to compare emergency care use pre- and post transition for young people with life-limiting conditions.
ApproachRoutinely collected healthcare records were obtained from the Clinical Practice Research Datalink. These included linked primary care and hospital (inpatient, outpatient and A&E) records and death and deprivation data. The data were used to identify young people (12-23 years)with life-limiting conditions, diabetes and no long term conditions. Methods were developed to estimate point of transition from paediatric to adult care by classifying treatment specialties recorded in inpatient and outpatient care as paediatric or adult. These were compared and a favoured method selected. Emergency hospital care use was then compared, pre- and post-transition to adult care for the three groups.
ResultsThe last inpatient or outpatient record classified as paediatric care was chosen as the transition point. Simulation showed that this had the potential for far greater sensitivity to changes at transition (~20% difference in detected effect size) than using a simple age cut-off. Application of the method to the data showed significant increases in emergency inpatient admissions (by 29%, 95% confidence interval 14-46%) and A&E visits (by 24%, 95% confidence interval 12-38%) post- compared to pre-transition in the life-limiting conditions group, but no increases for the diabetes or no long term conditions groups, suggesting that transition has little effect for these groups.
ConclusionLinked, routinely collected healthcare records, combined with estimating transition point from the data, provide a more sensitive method for detecting changes at transition with reduced risk of misclassification bias. There is an increase in emergency care after transition, with negative effects on young people, families and cost implications for providers.
Developing a new Governance Approval Process to support federated discovery and meta-analysis of data across the UK through the CO-CONNECT project.
Authors: Jefferson Emily , Johnston Jenny , Milligan Gordon , Quinlan Phil
Published: September 2022

Objectives To develop a new approval process for federated data custodians to install and support a new platform which enables researchers to run from one website, instantaneous, aggregate-level queries to determine the number of patients in each dataset which meet their research criteria.
To agree security controls across data custodians which protect patient confidentiality whilst also providing this new automated capability for researchers and reducing the burden on each data custodian to manually provide the information.
ApproachThe COVID - Curated and Open aNalysis aNd rEsearCh plaTform (CO-CONNECT) has integrated a Cohort Discovery Tool into the Health Data Research (HDR) UK Innovation Gateway website and is connecting >50 different federated datasets. The underpinning architecture is novel, without precedent at such a scale in the UK. We found that although each data custodian recognised the benefits of the platform, many were unclear of the process to formally approve this new model. We have worked across data custodians to co-develop the required new processes and document the security controls.
ResultsWe found vast differences in technical knowledge and infrastructures across different data custodians, especially across small research groups hosting data on consented research cohorts verses larger organisations who host and manage routinely collected data. A model for approvals evolved for these 2 separate groups:
Consented research cohorts: a 2-stage process of a pre-assessment for the need for a DPIA and/or completed DPIA. All returned a positive outcome which deemed no personal identifiable information was being used.
Unconsented population level data: 4 different documents were required each being approved by different committees within each data custodian: DPIA, Data Access Application, Security Risk Assessment, Disclosure Control Assessment.
As the model was novel to many data custodians, we developed many different explainer videos and detailed step by step instructions.
ConclusionWe recommend a new approvals process for new technologies/models is developed to support initiatives which are not covered by the traditional data access request process. Increased investment in teams which approve data governance and IT security applications which have been overwhelmed by the increased demand for their services to review COVID-19 related projects would be welcomed.
Data Integration in the time of COVID: Getting to Yes with Enterprise-Wide Data Governance.
Authors: Nelson Amy Hawn
Published: September 2022

ObjectivesThis presentation describes a successful framework for developing and implementing processes to support intradepartmental data access, integration, and use in the US. This case study describes on-going streams of work, 2019-present, to implement a new legal framework and data governance approach across a large health and human service agency.
ApproachThis work is conducted in partnership with a state agency and university-based researchers. The case study relies upon participatory action research as the primary approach, using mixed methods to inform inquiry, including interviews and deliberative dialogue to support action. An initial Data Landscape Overview was conducted from 2019-2020 through on-going meetings, document review, a survey of legal agreements, weekly calls with the Department’s Data Office, and structured interviews with 44 individuals. Deliberative dialogue has informed on-going action steps from 2020 to today as we have co-created a data governance roadmap, specifically focused on data governance and a new legal framework.
ResultsThis work was performed in the context of a data strategy across five pillars: data governance & legal framework; workforce development & data literacy, data quality, data infrastructure, and data use. We focused on the first pillar—governance and legal frameworks. Drawing upon departmental exemplars and through deliberative dialogue with legal counsel, we built a new legal framework and successfully executed a three-tier legal approach using an Intradepartmental Memorandum of Understanding, Data Sharing Agreement, and Data Use Agreement. To date, we have co-created a department wide Data Sharing Guidebook, which includes a range of data pathways and data request processes; processes for developing high value data asset inventories; parameters for legal use; and clearly defined department-wide data governance—all operationalized within the established legal framework.
ConclusionOur work provides a model for large agencies to collaboratively develop and implement data governance (even during a pandemic). We are grounded in the understanding that data sharing is hard, and more relational than technical. Our goal is long-term sustainability, and therefore people have been central through all work streams.
Linking Canadian Administrative Data: Income Trajectories, Residential and School Mobility, and Grade 3 Academic Achievement.
Authors: Lee Janelle Boram , Wall-Wieler Elizabeth , Roos Leslie L
Published: September 2022

ObjectiveThe objective is to examine the association between trajectories of childhood residential and school mobility and academic achievement (literacy, numeracy) in Grade 3 using linked whole-population administrative data in Manitoba, Canada. Secondarily, we assessed childhood residential/school mobility based on neighbourhood income levels (moving in/out of low- or mid-/high-income neighbourhoods).
ApproachThis retrospective cohort study used linkable, de-identified administrative data (health, education, national census, provincial survey) from the provincial Population Research Data Repository housed at the Manitoba Centre for Health Policy (MCHP). Among kindergarteners from 2005 to 2014 (n = 83,894), those not having continuous residency in Manitoba, valid education assessments, and relevant family-level covariates were excluded. We followed this eligible cohort from kindergarten to Grade 3 based on various neighbourhood income trajectories of residential and school mobility. To assess Grade 3 literacy and numeracy scores based on trajectories, log-binomial regression models were conducted using SAS® version 9.4.
ResultsThe total cohort included 36,754 children; at the end of kindergarten, 14.2% resided in low-income neighbourhoods, and 84.8% lived in mid-/high-income neighbourhoods. Moving between two low-income neighborhoods between kindergarten to Grade 3 was associated with an increased risk of poor Grade 3 numeracy and literacy scores (numeracy aRR=1.39 [1.16,1.67]; literacy aRR=1.31 [1.08,1.59]). When moving between neighborhood income levels, the association was stronger for children moving into low-income neighbourhoods (e.g., mid-/high-income to low-income: numeracy aRR=1.41 [1.19,1.67]) than children moving into mid/high-income neighbourhoods (e.g., low-income to mid-/high-income: numeracy aRR=1.31 [1.08,1.59]). Changing schools between kindergarten and Grade 3 was also associated with poorer numeracy and literacy scores in Grade 3 (numeracy aRR=1.31 [1.22,1.40]; literacy aRR=1.34 [1.24,1.44]); however, the strength varied based on residential mobility patterns.
ConclusionMoving homes/schools can differentially impact children’s educational attainment depending upon the income level of residing neighborhood(s). Stakeholders should recognize different levels of risks related to mobility and provide support accordingly to reduce the adverse impact. Support systems should be tailored to not only children but also families and neighbourhoods.
Defying Expectations: Can We Identify Neighbourhoods with “Other Than Expected” Developmental Outcomes?
Authors: Duku Eric , Forer Barry , Pottruff Molly , Guhn Martin , Janus Magdalena
Published: September 2022

ObjectivesTo contribute to the evidence on the association between neighbourhood-level child development in Kindergarten and neighbourhood SES, our objective was to quantify the sociodemographic and child development characteristics of the neighbourhoods that “defy expectations”: high SES neighbourhoods with much-worse-than-expected child outcomes, and low SES neighbourhoods with much-better-than-expected child outcomes.
ApproachUsing exploratory and model-based Latent Profile Analysis (LPA), we identified homogenous profile groups of 2038 customized Canadian neighbourhoods using ten SES indicators. We identified the most parsimonious number of profile groups and validated and characterized the derived groups of neighbourhoods using neighbourhood and aggregated child characteristics. Next, as our outcome, we created quartile groups for developmental vulnerability risk, measured with the Early Development Instrument (EDI), to match the number of derived neighbourhood profile groups. Last, we used contingency table analysis to identify neighbourhoods that defy expectations, and then characterized these neighbourhoods using descriptive statistics and correlational analysis.
ResultsThe LPA identified four neighbourhood SES groups which we labelled “Low” (31.6%), “Low-moderate” (12.7%), “High-moderate” (38.4%) and “High” (17.4%). These four SES groups were cross-tabulated with quartile groups of EDI vulnerability risk. Inspection of the resulting 4-by-4 contingency table showed that within the “Low” SES profile group 57 (8.9%) neighbourhoods had much-better-than-expected developmental vulnerability risk. Conversely, within the “High” SES profile group, 12 (3.4%) neighbourhood had much-worse-than-expected developmental vulnerability risk. Additionally, these analyses identified large provincial differences in the proportion of neighbourhoods that defy expectation. In 12 provinces and territories in the study, the proportion of neighbourhoods that defied expectations within each province ranged from zero to 50%.
ConclusionThe identification of neighbourhoods that defy expectations contributes to our understanding of neighbourhood factors influencing child development. Using mixed-methods approaches, these neighbourhoods can be compared to nearby neighbourhoods from the same SES profile group that do not defy expectations, in an effort to identify contextual factors that differentiate them.
Diagnostic test accuracy for COVID-19: systematic review and meta-analysis protocol.
Authors: Daniels Helen , Owen Rhiannon K
Published: September 2022

ObjectiveAccurate diagnosis of COVID-19 infection is paramount to initiating appropriate measures for reducing spread. We aim to conduct a systematic review and meta-analysis, augmented by linked electronic health records, to assess the diagnostic test accuracy for COVID-19.
ApproachWe will search the following databases from November 2019 to February 2022: MEDLINE (PubMed), Embase, and Scopus, as well as reference lists of eligible studies and review articles. Keywords will relate to COVID-19 and diagnostic testing.
Eligible studies will use an appropriate study design (e.g. prospective and retrospective cohort and case-control) to assess the accuracy of any COVID-19 diagnostic test (including thoracic imaging, mass spectrometry, and serological tests) in all healthcare and community settings. Studies of participants under 18 will be excluded.
Data will be extracted using a piloted extraction form and bias will be assessed using the QUADAS-2 tool.
ResultsMain outcomes will include frequency statistics, sensitivity and specificity, and positive and negative predictive value. Paired forest plots will be used to illustrate sensitivity and specificity across studies. We will pool data on sensitivity and specificity in a Bayesian framework using a bivariate random-effects logistic regression model, where appropriate. Uncertainty in the estimates will be represented using 95% credible intervals.
A comparative framework will be developed to allow assessment of the comparative accuracy of diagnostic tests. Subgroup analyses will be undertaken for time since onset of symptoms, setting (including community and secondary care testing), and reference standard, where appropriate.
ConclusionResults of this review will be combined with routinely collected electronic health records from the DECOVID database to inform relationships between tests and subgroups for healthcare decision-making. New methodology developed as part of this review will be generalizable to the evaluation of diagnostic test accuracy in other diseases.