bluuebunny/crossref_metadata_2025 huggingface dataset:
Developing a model of industry-based practicum learning
Authors: Sudarsono Bambang , Sukardi Thomas
Published: April 2017

The study was to: (1) produce a practicum learning model that might be applied by the lecturers of Automotive Engineering Education Program as the center of Light Vehicle Engineering (LVE) Study Program prospective teachers in the vocational high schools (VHS); (2) identify the automotive industry-oriented competence aspects in practicum learning needed by the LVE Study Program prospective teachers in the VHS; (3) identify the degree of implementatibility of the practicum learning model that had been developed for the LVE Study program prospective teachers in the VHS; and (4) identify the effectiveness degree of the practicum learning model that had been developed for the LVE Study Program prospective teachers in the VHS. The model development in the study referred to the research and development model proposed by Richey and Klein. The research subjects were the students of Automotive Engineering Education Study Program Muhammadiyah University Purworejo. Then, the research objects were Toyota Magelang Company, the Daihatsu Armada Company and the Ultratune Company Gadjah Mada University. The results of the study show that: (1) the competency aspects developed in the P2BI Model for the students who refer the LVE Study Program prospective teachers include the affective aspect, the cognitive aspect and the psychomotor aspect; (2) the improvement of the affective, the cognitive and the psychomotor aspect has met the “Very Good” criteria; (3) the students’ activities in the implementation of the P2BI Model Stages have been very good; and (4) the students’ responses toward the P2BI Learning Model have been very positive.Keywords: learning model, practicum learning, LVE Study Program prospective teachers PENGEMBANGAN MODEL PEMBELAJARAN PRAKTIK BERBASIS INDUSTRIAbstrakTujuan penelitian ini adalah untuk: (1) menghasilkan model pembelajaran praktik yang dapat diterapkan oleh dosen pendidikan teknik otomotif sebagai penghasil calon guru SMK Program Keahlian Teknik Otomotif (PKTO), dan (2) mengetahui aspek-aspek kompetensi pada pembelajaran praktik yang dibutuhkan calon guru SMK PKTO. Model pengembangan dalam penelitian ini mengacu model research and development dari Richey and Klein. Subjek penelitian adalah mahasiswa Program Studi Pendidikan Teknik Otomotif Universitas Muhammadiyah Purworejo. Objek penelitian di PT. Toyota Magelang, PT. Daihastu Armada dan PT. Ultratune UGM. Hasil penelitian ini adalah sebagai berikut. (1) Aspek-aspek kompetensi yang dikembangkan pada model P2BI bagi mahasiswa calon guru SMK PKTO adalah aspek sikap,aspek pengetahuan dan aspek ketrampilan. (2) Peningkatan aspek sikap, pengetahuan dan ketrampilan dengan kriteria sangat baik. (3) Aktivitas mahasiswa dalam pelaksanaan tahapan-tahapan model P2BI sangat baik dan (4) Tanggapan mahasiswa terhadap model pembelajaran P2BI sangat positif.Kata Kunci: model pembelajaran,pembelajaran praktik, calon guru SMK PKTO
Regular functions on dual split quaternions in Clifford analysis
Authors: Kim Ji , Shon Kwang
Published: April 2017

This paper shows expressions of a power series for the form of dual split
quaternions and provides differential operators in dual split quaternions.
The paper also represents a power series of dual split regular functions by
using a dual split Cauchy-Riemann system in dual split quaternions.
The actions on the generating functions for the family of the generalized Bernoulli polynomials
Authors: Alkan Mustafa , Simsek Yilmaz
Published: April 2017

In this paper, we study the generalization Bernoulli numbers and polynomials
attached to a periodic group homomorphism from a finite cyclic group to the
set of complex numbers and derive new periodic group homomorphism by using a
fixed periodic group homomorphism. Hence, we obtain not only multiplication
formulas, but also some new identities for the generalized Bernoulli
polynomials attached to a periodic group homomorphism.
Advanced methods for linking complex historical birth, death, marriage and census data
Authors: Christen Peter
Published: April 2017

ABSTRACT

ObjectiveRecent years have seen the development of novel techniques for linking complex types of data that contain records about different types of entities, for example bibliographic databases with records about authors, publications, and venues. Advanced approaches have been devised to link individuals and groups of records. These approaches exploit both the similarities between record attributes as well as the relationships between entities. Rather than linking records about different types of entities, in this work we study the novel problem of linking records where the same entity can have different roles and where these roles can change over time.

ApproachWe specifically develop novel techniques for linking historical birth, death, marriage, and census certificates with the aim to reconstruct the population covered by these certificates over a period of time. Our techniques make use of constraints that consider roles, relationships, as well as time. Our first technique links certificates based on the specific roles of their individuals, and greedily selects pairs of certificates with the highest overall similarity while also considering 1-to-1 and 1-to-many linkage constraints. Our second hybrid technique combines graph, group, and temporal linkage, and also considers relationship information between individuals and groups. We compare these techniques with state-of-the-art group, collective, and graph-based linkage approaches.

ResultsWe evaluate our proposed techniques on real Scottish data from 1861 to 1901 that cover the population of the Isle of Skye. In total, these data sets contain 119,042 certificates for 234,365 individuals. As ground truth we have a set of life-segments of records manually linked by domain experts. Our results indicate that even advanced techniques have difficulty in achieving high linkage quality compared to careful manual linkage. Two reasons for this are the very small name pool in our data and the changing nature of people's personal details over time. Both our proposed techniques, however, significantly outperform traditional pair-wise attribute similarity and group linkage approaches, with the greedy role-based technique achieving better results than the hybrid technique.

ConclusionOur experiments on real data show that even with advanced linkage techniques that employ group, graph, relationship, and temporal approaches it is challenging to achieve high quality links from complex data such as birth, death, marriage and census certificates that span several decades. As future work we will improve all steps of our techniques with the goal of developing highly accurate, scalable, and automatic techniques for linking large-scale complex population databases.
The use of multi-sourced linked datasets in evaluating the Emergency Medical Retrieval and Transfer Service (EMRTS) CYMRU
Authors: Rawlinson David , Lyons Jane , Lyons Ronan A , Fry Richard J
Published: April 2017

ABSTRACT

ObjectivesEMRTS launched in April 2015 which saw consultants join critical care practitioners on air ambulance missions and emergency response vehicles. EMRTS delivers pre hospital, Emergency Department equivalent critical care for people in Wales with life or limb threatening injuries or illness from scene to definitive care. The evaluation will compare patients treated by EMRTS to cases both pre-EMRTs and EMRTS-offline (at night or bad weather) in improving survival and functional and quality of life outcomes.

ApproachThe evaluation will require the use of multiple datasets to follow patients from time of incident, throughout hospital care and to calculate post care health status. Electronic reporting forms will be used to measure incident details, patient vitals and all treatments/procedures pre hospital, creating the EMRTS dataset and cohort. Patients’ data will be linked to the Emergency Department Dataset (EDDS), Patient Episode Database for Wales (PEDW), Critical Care dataset, Trauma Audit and Research Network (TARN) and Intensive Care National Audit and Research Centre (ICNARC). TARN and ICNARC will provide data on patients transferred to English specialist care facilities.

ONS (Office of National Statistics) and WDS (Welsh Demographic Service) data will be used for demographic and survival analysis.

GIS techniques will be used on WAST (Welsh Ambulance Service Trust) data for time saved analysis in transferring patients to definitive care.

Following discharge from hospital patients will be interviewed six months and one-year post incident for longer-term functional and quality of life outcomes.

ResultsDatasets are currently being assembled for the service evaluation. Data will be encrypted and anonymized through NWIS (NHS Wales Informatics Service) to enable research through the Secure Anonymised Information Linkage (SAIL) facility. Results will include rate of survival, effect on length of hospital stay, time to definitive care, the use and appropriateness of EMRTs specific interventions and functional and quality of life outcomes.

ConclusionsTo allow for data collection the service evaluation is still in the early stages and will be compared with local and international data.
Lessons learned from linking to 2001 census in Scotland
Authors: Povey Chris
Published: April 2017

ABSTRACT

ObjectivesSHELS (Scottish Health and Ethnicity Linkage Study) linked Scotland's 2001 census to various hospital and death data sets with national coverage. Census ethnicity data were assigned to the study records to build a cohort of most of the Scottish population; included in the cohort were people with no health records.

ApproachCreate a lookup table of a person's census index to the Scottish eHealth index, the CHI, equivalent of English new national health number. A modified versionof the eHealth administrative matching system was used to satisfy census confidentiality requirements. There were two linkages performed in 2004 and 2008. 2004 was a feasibility run; the 2008 applied lessons learned from the previous linkage and used much more completely indexed health records.

ResultsThe first linkage produced match rate of 95% of 4.9 million 2001 census entries; the second 96%.

Conclusions

Lessons learned. Linking datasets using indexes is the most accurate and efficient way to produce study cohorts. Indices change over time; a methodology called 'reconciliation' was devised to retrospectively and continually adjust previously indexed (linked) records.

How to Track members who migrate out of the cohort. A linkage resource called a residential events dataset (RESEVENT) was built for the 2008 linkage run; it holds merged history of linkage identifier fields by date from january 2000 to the present based on GP registrations.

This introduces a time dimension to indexed linking.How to build RESEVENT like linkage resources; should they be census based? What should they contain? How to do daily national census and select controls for case/control cohorts from RESEVENT resource.

How postcode changes over time can be handled (reconciled) - same address, different postcode, but no address present. Proposal for an index of national indices based on national administrative datasets starting with NHS number (new and old NHSCR) and NI number to make linking even more efficient - this is not a RESEVENT resource; this resource would mean data need be matched to index only once, all subsequent linkages would be deterministic links of reconciled indices.
Severe parental mental illness is associated with lower school readiness in offspring: A linked data study
Authors: Bell Megan , Bayliss Donna , Glauert Rebecca , Harrison Amanda , Ohan Jeneva
Published: April 2017

ABSTRACT

ObjectivesPrevious research has demonstrated an association between parental mental illness and adverse developmental outcomes in their offspring. If parental mental illness impacts on child development such that their offspring do not optimally develop the skills and abilities required for academic success, the effects may be long lasting. To date, the majority of research in this area has focused on maternal depression, with much less attention paid to other diagnostic groups or mental illness in fathers. It is important that we better understand the impact of parental mental illness on children’s development, so that the child’s needs may be incorporated into treatment alongside interventions for the parent. Data linkage provides us with a unique opportunity to conduct a comprehensive evaluation of this association.

ApproachData from the Australian Early Development Census (AEDC) was used as a measure of early childhood development in five domains (physical health, social competence, emotional maturity, language and cognitive skills, and communication skills and general knowledge). Data were available for 22,890 Western Australian children aged 5-6 years, whose 2009 AEDC scores were linked to data on parental psychiatric hospitalisations. We identified parents with diagnoses of a range of mental illness diagnoses; parents who had more than one diagnosis; and mental illness in both mothers and fathers. Models were adjusted for child, parent and community socio-demographic characteristics.

ResultsA total of 1069 mothers and 656 fathers had an inpatient psychiatric admission during the study period. The most prevalent diagnoses for both mothers and fathers were mood disorders, anxiety disorders, and substance abuse. Adjusted odds ratios with 95% confidence intervals were estimated for each AEDC domain using logistic regression. Parental mental illness was found to be associated with increased risk of offspring being developmentally vulnerable, compared to outcomes for children of parents without a psychiatric hospitalisation. This effect was equivalent for both parents, and was evident after controlling for socio-demographic factors.

ConclusionThese findings add support to recommendations that mental health professionals consider the impact of their patient’s psychiatric symptoms on the developing child when planning treatment. The study also shows that it is important to ensure that fathers are not overlooked in assessment and intervention. Family-based approaches to adult psychiatric care could meet the dual needs of intervention for parents and preventative measures for their offspring. These findings can inform policy regarding the importance of integrating and coordinating services to meet the needs of the family.
CanIMPACT: Understanding complexities, variation, and disparities in the breast cancer care continuum in Five Canadian provinces using administrative data
Authors: Groome Patti , Winget Marcy , Jiang Li , Decker Kathleen , Kendell Cynthia , Krzyzanowska Monika , Li Dongdong , Lofters Aisha , McBride Mary L , Mittmann Nicole , Moineddin Rahim , Porter Geoff , Turner Donna , Urquhart Robin , Grunfeld Eva
Published: April 2017

ABSTRACT

ObjectiveCanIMPACT is a multi-province Canadian research team funded to understand the interplay between primary and oncology breast cancer care. A first step was to describe current practice and inter/intra-provincial care variation across the care continuum using provincial administrative health data. Here we describe the inter-provincial process and analysis plans.

ApproachOur multi-disciplinary team includes five Canadian provinces: British Columbia, Alberta, Manitoba, Ontario and Nova Scotia. Cohorts consist of all breast cancers diagnosed from 2007 to at least 2011 in each of the five provinces. Common databases include cancer registries, census area-level income and rurality, outpatient physician claims, ambulatory care and inpatient hospitalizations. Other databases with laboratory, pharmacy, emergency services, and immigration data were available in some provinces. Common data elements across provincial datasets were identified, and a standardized methodology was developed.

ResultsCommon data processing and analysis plans were finalized over 24 months; provinces refined details as per local context while maximizing methodological comparability. Basic descriptive analyses plus 18 phase-specific and 3 longitudinal analyses have been planned. Six plans for the diagnostic phase focus on identifying modifiable disparities in access and outcomes; 8 plans for the treatment phase focus on variation in chemotherapy treatment patterns, quality/safety, and utilization of primary care services; 4 plans for the survivorship phase focus on adherence to guidelines for follow-up breast cancer care, other chronic diseases and preventive care; 3 longitudinal analyses assess factors related to changes in utilization of chronic disease services over the cancer care continuum.

ConclusionsWe have shown it is feasible to develop and standardize data processing and analyses across multiple provinces to address important cancer care questions across the continuum. This work will inform comparisons and improvements in Canadian cancer care. This effort has also helped increase research capacity in health services research.
The Health and Economic Impacts of Structural Energy Performance Investments in Wales: An Evaluation of the Arbed Programme
Authors: Johnson Rhodri , Rodgers Sarah , Watkins Alan , Poortinga Wouter , Grey Charlotte , Jiang Shiyu , Anderson Pippa , Lyons Ronan A
Published: April 2017

ABSTRACT

ObjectivesOver £68M was invested in a housing regeneration programme (Arbed) in 2010-2011 to improve the energy performance of houses in a number of deprived areas across Wales. Houses within the areas were retrofitted with measures, such as external wall insulation, solar hot water systems, solar panels and air source heat pumps. The study aims to establish whether such interventions improve residents’ physical and mental health, and the economic impact of change in health outcomes.

ApproachAddress and intervention data were collected from 28 administrative centres and anonymously linked within the SAIL (Secure Anonymised Information Linkage) databank. Two comparator groups were created, one consisting of social houses, another from properties situated in the most deprived areas of Wales. Individuals with continuous residence of at least 60 days over a 10 year period were selected to create a dynamic cohort. Data on emergency hospital admissions and primary care records were extracted from SAIL to assess the impact of investments on healthcare utilisation for cardiovascular and respiratory conditions. Healthcare utilisation data also contributed towards an economic evaluation and excess winter admissions analyses.

ResultsThe final dataset comprises data from over half a million people contributing more than 3 million person years of exposure time to build up trends of hospital admissions across the study period. The intervention cohort consists of over 35,000 people, with about 7,000 separate hospital admissions recorded for our primary outcome. The analysis is based on a pooled time series regression using a difference-in-difference approach to estimate the health impact of the programme.

Conclusion Retrospective analysis of such a natural experiment using routinely collected health data is possible using data linkage techniques. Final results will show whether social programmes to improve energy efficiency to homes in fuel poor areas have a wider impact on the healthcare resource utilisation of residents. We discuss the requirement for more standardised, accurate and timely data capture at the time of such economic investments to ensure the future feasibility of such studies.

This project was funded by the National Institute for Health Research, Public Health Research (PHR) program (project number 11/3020/05)(http://www.nets.nihr.ac.uk/projects/phr/11302005).
Linking the Australian Childhood Immunisation Register to population-based perinatal datasets to assess coverage in at-risk groups
Authors: Moore Hannah , McCallum Lisa , Fathima Parveen , De Klerk Nicholas , Liu Bette , Snelling Tom , Blyth Christopher , McIntyre Peter , Gidding Heather
Published: April 2017

ABSTRACT

ObjectiveImmunisation remains one of the most important public health interventions. However, linkage of population-based immunisation registers to perinatal and health outcome datasets to evaluate immunisation programs is limited. We have conducted the first-ever linkages of immunisation records from Australia’s Childhood Immunisation Register (ACIR) for the purposes of evaluating Australia’s unique national immunisation program. As an initial outcome of our linkage study we present estimates of pneumococcal conjugate vaccine (PCV) coverage for the 3rd dose assessed at 12 months of age in extremely preterm children (gestational age <28 weeks), in whom a funded vaccination program was established in 2001 prior to a universal funded program for all children in 2005.

ApproachIndividual immunisation records from ACIR, hospital admissions, deaths and infectious diseases notifications were linked to perinatal records for a cohort of births from 1996 to 2012 in two Australian states. Three separate data linkage units were involved in the process with varying procedures for linkage. The perinatal datasets were used to identify extremely preterm children.

ResultsThe birth cohort for the study included 1,958,537 live births in New South Wales (1,492,399) and Western Australia (461,620). Linkage weights based on sensitivity and positive predictive value of >99% were used to identify immunisation records from ACIR to link to the birth cohort. A unique scrambled pin on ACIR was used to link immunisation records to birth cohort datasets. The final cohort consisted of 1,954,019 children with 95.5% linking to at least 1 ACIR record from a total of >26.6 million ACIR records. In 2001, coverage of the 3rd dose of PCV in extremely preterm children was 0.9% and increased to 69.1% in 2004 (overall coverage 2001-2004: 25.3%). From 2005 to 2012, coverage increased to an average of 89.7%.

ConclusionThese are the first results of cross-jurisdictional linkages of immunisation records to state-based administrative datasets in Australia. This process has identified some improvements that are needed to streamline future linkage projects of this scale. Linkage of perinatal datasets to ACIR has enabled us to assess the first-ever coverage estimates in specific medically at-risk population subgroups. Future analyses will focus on the predictors and timeliness of vaccination coverage and population based estimates of vaccine effectiveness.
Bespoke linkage of Public Health England laboratory data on gastrointestinal infections to the Clinical Practice Research Datalink: Ethics approval and a study proposal
Authors: Esan Oluwaseun , Fanshawe Thomas , Violato Mara , McCarthy Noel , Perera-Salazar Rafael
Published: April 2017

ABSTRACT

ObjectivesGastrointestinal (GI) infections are common. Most infections are self-limiting, with some people developing long-term sequelae following their GI infection. Currently, the surveillance of GI infections such as Campylobacter and Salmonella is primarily based on laboratory data held by Public Health England (PHE). Information on symptoms severity, treatment of infection and subsequent complications is not captured by this data source.

Electronic Health Records (EHR) provide a platform to assemble cohorts for long-term follow-up at relatively low costs. Record linkage of existing EHR provides a powerful resource to estimate the burden of complications following gastrointestinal Infections (GI) and the associated risk factors such as treatment of the primary GI infection.

A range of ethical and data governance approvals processes, motivated to protect patients and patient data, are required to allow use of routine and linked data for research. The aim of this project is to establish a bespoke linkage of PHE laboratory data on Campylobacter, non-typhoidal Salmonella (NTS) and verocytotoxin producing Escherichia coli (VTEC) to the Clinical Practice Research Datalink (CPRD, primary care records), hospital records and other secondary datasets in order to estimate the burden of complications following GI infections.

ApproachLinkage of laboratory data, primary care data, hospital records, deaths and deprivation index were proposed following an initial data completeness check of laboratory data on Campylobacter spp., NTS and VTEC over a ten year (2004-2014) period. Linkage plans were discussed with all relevant organisations. Finalised study protocols were completed and application for approval for linkage was submitted to the Independent Scientific Advisory Committee (ISAC) and the NHS Research Ethics Committee. An additional application was sent to the Confidential Advisory Group (CAG) to comply with section 251 of the UK NHS Act 2006 on accessing patient identifiable information.

ResultsISAC approval for CPRD linkage is dependent on CAG approval. Completion of data linkage will allow the measurement of complications following GI infections to be estimated more accurately than is possible using routine, unlinked population-level data. It allows the implementation of designs such as the case-crossover design for the investigation of patient-level risk factors such as use of antibiotics and their association with complications.

ConclusionsBespoke record linkage to CPRD can allow the measurement of risk of long-term sequelae following acute infections. Considerable time should be built into research timelines to allow completion of all ethical, governance and data access procedures.
Determining breast cancer recurrence following completion of active treatment: A novel approach using linked administrative health data
Authors: Preen David , Kemp-Casey Anna , Roughead Elizabeth , Lopez Derrick , Bulsara Max , Boyle Frances , Saunders Christobel
Published: April 2017

ABSTRACTObjectivesAlthough outcomes for the majority of women diagnosed with primary breast cancer are good, with five-year survival exceeding 90%, some women will experience cancer recurrence and ultimately die from the disease. It is important for patients, clinicians and health service planners to know the risk of recurrence once initial treatment for primary breast cancer is completed. However, none of Australia’s State or Territory cancer registries routinely report on cancer recurrence which could be used to evaluate this issue. To address this absence of direct reporting, we aimed to determine the incidence of cancer recurrence in Australian clinical practice after completion of treatment for primary breast cancer, using a range of linked health data sources.

ApproachWe performed a retrospective cohort study using linked health data from New South Wales (NSW), Australia. Data were linked from six data collections: i) Cancer Registry, ii) Admitted Patient Data Collection, iii) Pharmaceutical Benefits Scheme claims, iv) Medicare (outpatient) claims, v) Death Registry; and the vi) NSW 45 and Up Study. We identified 2416 women diagnosed with primary invasive breast cancer during 2003-2008 in NSW who had not had a recurrence by 18 months post-diagnosis. Unit-level hospital, pharmacy and outpatient claims were used to identify services indicative of recurrence. Incidence of recurrence was calculated and multivariate Cox regression used to identify baseline and active treatment characteristics predictive of cancer recurrence up to six years post-diagnosis.

ResultsA total of 217 women (9.0%) had a hospital, pharmacy or outpatient claim indicating breast cancer recurrence between 18 months and six years post-diagnosis. Overall annual cumulative incidence of recurrence was 3.3%. Recurrence was significantly higher for women with node-positive (4.8% vs. 2.5% annually, adjHR=1.7, 95%CI=1.3-2.3) or hormone receptor-negative (3.8% vs. 3.1% annually, adjHR=1.3, 95%CI=1.0-1.7) tumours. Women with tumours >2cm at diagnosis were more likely to experience recurrence within six years compared with those with a smaller initial tumour (4.8% vs. 2.7 annually, adjHR=1.5; 95%CI=1.1-2.0).

ConclusionsWomen with breast cancer in this Australian cohort experienced recurrence at 3.3%pa in the years following completion of treatment. Those at greatest risk of recurrence were women with node-positive or hormone-receptor negative tumours, or tumours >2cm at initial diagnosis, consistent with international findings. This method for ascertaining breast cancer recurrence can be used to assess population-level changes over time and to investigate the impact of specific treatments on outcomes in the absence of available Cancer Registry data.
The Western Australia Population-based Burn Injury Project: Using record linkage to examine long-term effects of burn injury
Authors: Duke Janine , Boyd James , Randall Sean , Fear Mark , Wood Fiona
Published: April 2017

ABSTRACTObjectivesWhile the most obvious impact of a burn is a visible scar, there are hidden impacts. The main contributors to adverse health outcomes after burns are the metabolic, inflammatory, immune and endocrine changes that occur in response to the initial injury. These responses have been shown to persist for at least three years after paediatric severe burns, with adverse effects to the circulatory and musculoskeletal systems. Recent evidence demonstrates that minor burns and severe burns can trigger these systemic responses. Currently, minimal data on the long-term effects of burns are available, and the data that do exist are primarily related to paediatric severe burns. We have used population-based record linkage to support a research program to shed light on the spectrum of long-term morbidity, expressed in terms of hospital admissions, experienced by burn patients to guide burn clinicians in the management of their patients. We report here our current findings of post-burn mortality and morbidity.ApproachA population-based longitudinal study using linked hospital morbidity and death data from Western Australia was undertaken of all persons hospitalised for a first burn injury (n=30,997) in 1980–2012 and a frequency matched non-injury comparison cohort, randomly selected from Western Australia’s birth registrations and electoral roll (n = 127,000). Crude admission rates and cumulative length of stay for disease-specific admissions were calculated. Negative binomial and Cox proportional hazards regression modelling were used to generate incidence rate ratios (IRR) and hazard ratios (HR), respectively, adjusting for sociodemographic and health factors. ResultsFor both paediatric and adult burn patients we identified increased long-term all-cause mortality (IRR, 95%CI: <15 years: 1.6, 1.3-2.0; 15-44 years: 1.8, 1.7-2.0; ≥ 45 years: 1.4, 1.3-1.5). Increased post-burn discharge health service use for cardiovascular diseases (IRR, 95%CI: <15 years: 1.3, 1.1-1.6; 15-44 years: 1.6, 1.4-1.7; ≥ 45 years: 1.5, 1.4-1.6) and musculoskeletal conditions (IRR, 95%CI: <20 years: 1.9, 1.7-2.1; ≥ 20 years: 2.0, 1.9-2.1) were also found. Analyses found significantly elevated admission rates for minor and severe burns. Adjusted HRs identified time periods after discharge where burn patients experienced significantly elevated disease-specific incident admissions (results not provided).ConclusionsBoth minor and severe burns were associated with increased long-term cardiovascular and musculoskeletal morbidity and mortality. These results identify treatment needs for burn patients for a prolonged time after discharge. Further research that links primary care and pharmaceutical data is required to facilitate identification of at-risk patients and appropriate treatment pathways to reduce post-burn morbidity.
Preparing linked population data for research: cohort study of prisoner perinatal health outcomes.
Authors: Hilder Lisa , Walker Jane , Levy Michael , Sullivan Elizabeth
Published: April 2017

ABSTRACTObjectivesThis paper assessed linkage quality and describes the generation of population representative samples of perinatally exposed and non-exposed mothers for cohort analysis and “own-control” analysis from the linked data. ApproachA study of pregnancy outcomes related to pregnancy in prison in New South Wales, Australia, used record linkage to add information about incarceration and serious mental health morbidity (MHM) to birth data. MHM data were oversampled and all available prisoner alias identities were requested for the linkage. Data custodians applied restrictions limiting the control group to a sample of unlinked records and required that year and person age in days be used instead of dates for all events. Linkage was performed by a dedicated state-wide data linkage authority.Multiple-matched identities were counted. Linked data was assessed to quantify duplicated births; excessive births; non-chronological progression of year of birth and to maternal age; concurrent pregnancies; concurrent incarcerations; and conception during incarceration. Exposure status was determined by interrogation of the temporal relationships of all incarceration periods with each to identify prisoner maternities. Maternities with incarceration status for each mother distinguished prisoner mothers from prisoner controls. The subset of prisoner mothers with both types maternity were “own controls”. Standard descriptive statistics are used to provide population prevalence of exposures and compare data quality across study stratified population sub-groups.ResultsLinked records for 3,260 prisoners and 3087 women who had given birth were resolved to 3085 unique person records. Linked person records inconsistent with a singular identity based on maternity factors only were within the predicted limit of the false positive rate set by the linkage authority (<0.5%) for non-prisoners with no mental health morbidity, but were twice as high for women with MHM (RR 2.2; 95%CI 1.9, 2.6) and tenfold higher among prisoners (RR 9.9; 95%CI 8.2, 11.9). The 2,589 prisoners not excluded comprised 558 prisoners (238 “own controls”) pregnant while in prison and 2,031 prisoner controls. The population estimated from study data represents 99.7% of the 404,144 women who actually birthed in NSW, of whom <1% were prisoners (68% with MHM) and 7% had serious mental health morbidity. ConclusionAlthough not set up to test use of alias identities for record linkage, these results suggest that the expected improved linkage sensitivity from including aliases was offset by reduced linkage specificity. The capacity to report results for prisoners against the whole population increased their utility.
Neonatal and infant readmissions for late preterm and early term babies in Ontario and England: a cohort study using linked population-level healthcare data
Authors: Harron Katie , Gilbert Ruth , Guttmann Astrid , Cromwell David , Van der Meulen Jan
Published: April 2017

ABSTRACTBackgroundBabies born late preterm (34-36 weeks gestation) or early term (37-38 weeks) are at increased risk of unplanned readmissions compared with full-term babies. We examined differences in neonatal and infant outcomes in England and Ontario.

MethodsLinked maternity-baby hospitalisation data were extracted from two universal healthcare systems, Ontario (n=702,565; 2005-2013) and England (n=1,165,375; 2011-2013). We modelled rates of unplanned readmissions within 30-days post-discharge of delivery, and readmissions, emergency department (ED) visits, deaths and total inpatient days within 12-months post-discharge, adjusting for neonatal, maternal and delivery factors.

ResultsThe median newborn length of stay was 4 and 5 days in Ontario and England respectively for late preterm babies, and 2 days in both countries for early term babies. Early neonatal readmissions were lower in Ontario: 4.8% of early term and 7.2% of late preterm babies compared with 8.3% and 11.4% respectively in England (p<0.05). Within 12-months post-discharge, 9.6% of early term and 13.5% of late preterm babies were readmitted in Ontario compared with 24.0% and 30.5% in England (p<0.05); total inpatient days per 100 babies were 36.5 for early term and 61.9 for late preterm (Ontario) compared with 62.7 and 107.6 (England). Infant mortality (0.1-0.4%) and ED visits (40-44%) were similar between countries.

ConclusionsUnplanned readmissions and total inpatient stay are significantly higher in England than Ontario for early term / late preterm babies, despite similar ED attendances and lengths of newborn stay. Further investigation of differences in healthcare practices between countries should evaluate access to paediatric primary care and thresholds for admission.
Clinical Validation of the UKMS Register Minimal Dataset utilising Natural Language Processing
Authors: Middleton Rod , Akbari Ashley , Lockhart-Jones Hazel , Jones Jemma , Owen Charlotte , Hughes Stella , Gain Richard , Ford David
Published: April 2017

ABSTRACT

ObjectivesThe UK MS Register is a research project that aims to capture real world data about living with Multiple Sclerosis(MS) in the UK. Launched in 2011, identified data sources were: Directly from People with MS (PwMS) via the internet, from NHS treatment centers via ‘traditional’ database capture and by linkage to routine datasets from the SAIL databank.

Data received from the NHS, though ‘gold standard’ in terms of diagnosis, is dependent on clinical staff finding both time and information to enter into a clinical system. System implementations across the NHS are variable, as is clinical time. Therefore, we looked to other complementary methodologies.

ApproachThe Clix enrich natural language processing (NLP) software was chosen to see if it could capture a portion of the MS Register minimum clinical dataset, the software matches clinical phrases against SNOMED-CT.40 letters, from 2 NHS Trusts, from 28 patients were loaded. The letters were a mix of MS patients with differing disease subtypes and were dictated by Neurologists, Specialist General Practitioners and MS Specialist Nurses. 20 of the letters were in docx format and 20 as PDF.

The letters were parsed by a domain expert for clinical content, scored by data item for sensitivity and specificity. Next the output from the software was scored by another researcher to see if the 12 relevant clinical concepts from the Register dataset had been elicited. Lastly a ruleset was created to look for particular clinical concepts and scored in the same way.

ResultsOf the 40 letters one failed to load, the rest were analysed for the specific data items. Date related items were clearly challenging, with only 7% of appointment dates being matched and 22% for date of diagnosis. MS Type (93.3%) and EDSS score (93.75%) were well recognised, additionally symptoms of MS that would be poorly reported in traditional databases were recognised, with fatigue being well highlighted (78.5%) and gait and walking issues (68.7%)

Of concern, were a number of false positive results in DMT’s with 15% patients being identified as being on a DMT when this was just being ‘considered’.

ConclusionThe NLP pathway could be extremely useful for obtaining hard to capture clinical data for the Register. Further work is needed to reduce errors, even with the current minimal configuration, it's possible to ascertain MS Type, functional score of MS, current medication and potentially disabling symptomology within the condition.
Data linkage of routinely collected electronic health records to characterise risk factors associated with antibiotic resistance in urinary isolates: an exemplar of NHS Scotland’s Infection Intelligence Platform
Authors: Fletcher Eilidh , Kavanagh Kim , Malcolm William , Wiuff Camilla , Reid Nicholas , Deshpande Ashutosh
Published: April 2017

ABSTRACT

ObjectivesUrinary tract infections (UTIs) are amongst the most common infections treated in community and hospital settings. Initial antibiotic treatment of UTI is usually empirical, that is, where the prescriber has no definitive information on the organism or its antibiotic sensitivity.. Overall the prevalence of antimicrobial resistance is increasing, and specifically so for antibiotics commonly used for UTI.

By linking NHS surveillance data to routinely collected administrative health data this study aims to investigate risk factors for antibiotic resistance in urine samples

ApproachAll positive urine samples included in the “Surveillance of Antimicrobial Resistance in Urinary Isolates in Scotland” dataset in the period from January 2012 to June 2015 (all NHS Health Boards in Scotland submit susceptibility data for up to eleven antibiotics on 400 positive urinary samples per quarter) were analysed. Cases were assigned a resistance status of Sensitive, Resistant or Multi-drug resistant based on the antibiotic susceptibility data recorded.

Using the NHS Scotland Infection Intelligence Platform all cases were linked to national coverage data: (i) hospital discharge data to create the Charlson score for comorbidity and (ii) patient-level community prescribing data to measure cumulative antibiotic exposure (number of defined daily doses) in the 3 months prior to infection. Risk factors associated with the infection susceptibility to antibiotics were assessed using multivariable multinomial logistic regression.

Results40,984 positive urine samples were examined. Overall 29.0% were sensitive, 48.1% resistant and 22.9% multi drug resistant. Around a third of the cases (33.9%) had no antibiotic prescribing in the 3 months prior to infection. Age, care home residence and increasing comorbidity were both found to be associated with resistance and multidrug resistance. Cumulative antibiotic exposure had a clear dose-response effect. Those with 1-7DDDs were 1.2 times (95% CI: 1.11-1.29) more likely to have a multidrug resistant infection (compared to a sensitive infection) rising to 7.45 times (95% CI: 95% CI 6.45-8.6) for 29+ DDDs. Similar dose response held for resistant infection but at a lesser scale (1-7DDDs OR=1.36 (95% CI: 1.2-1.5) rising to OR=3.04 (95% CI: 2.38-3.89).

ConclusionA clear effect of cumulative antibiotic exposure in the community and multidrug resistance in UTI cases has been demonstrated. Such quantification is key to ensuring and supporting robust antimicrobial stewardship policy and will form the evidence base for development of prescribing decision support tools for more patient centred treatment of UTI.
Information Management at a Health Services Research Organization in Toronto, Ontario, Canada: Moving from Identifiable Data to Coded Data
Authors: Thurairasu Lisa , Chong Nelson
Published: April 2017

ABSTRACTObjectivesA health services research organization in Toronto, Ontario, Canada conducts population-based research to improve the health of Canadians in seven main areas: (1) cancer, (2) cardiovascular disease, (3) chronic disease and pharmacology, (4) health system planning and evaluation, (5) kidney, dialysis and transplantation, (6) mental health and addictions, and (7) primary care and population health. The Information Management (IM) team within the Data Quality and Information Management (DQIM) department at our non-profit organization is an integral component for upholding privacy and confidentiality policies and procedures while facilitating quality research using different types of data such as health administrative, third-party, primary data collection, and electronic medical records (EMR).

MethodsThe IM team is responsible for receiving data, encoding direct personal identifiers, screening for unnecessary identifiers, performing probabilistic data linkage when necessary, importing the data to the Research Analytics Environment (a client/server Linux-based system), and destroying the data according to the terms stipulated in the executed data sharing agreement. The purpose of the presentation is to detail the above steps of processing data to protect individuals’ identities yet preserve the usefulness of carrying out research. The presentation will include aspects from importing data into SAS to storage and encoding of personal identifiers to probabilistic data linkage, which involves maximizing linkage with other datasets at the organization. Linking data at the organization involves the encryption or encoding of health card numbers to “Key Numbers.”

ResultsThe processing practices used at the organization comply with Canadian privacy laws such as the Personal Health Information Protection Act (PHIPA) as well as organizational policies and Research Ethics Board approvals. The approaches used to conceal individual identities yet allow linkage to various data sources can be modelled by other health agencies, ministries, and non-health related organizations that work with sensitive data but face challenges in maintaining both privacy and research quality. Our organization strives to make processing as efficient as possible and create maximum linkability to the various data sources in house while upholding privacy and confidentiality.
Custodian Controlled Data Repository - supporting the timely, easy and cost effective access to linked data
Authors: Radbone Christopher , Adams Suzi
Published: April 2017

ABSTRACTObjectivesIn response to Data Custodian and Researcher's request to assist improving the timeliness and ease of data extractions, SA NT DataLink established the Custodian Controlled Data Repository (CCDR). Issues including conflicting work priorities and limited resources do prevent timely data extractions. SA NT DataLink, as a trusted third party enable Custodians to hold separate copies of their de-identified content data ready for timely release. The CCDR is opt-in for Custodians. Its key strength being the data remains under the control of participating Custodians, with Custodians updating and correcting their data. SA NT DataLink staff are work with Data Custodians to clean, standardise, update and prepare data in advance of anticipated approvals, including spatial enabled GIS variables. SA NT DataLink staff work under the direction of the Data Custodians, taking responsibility for preparing the data extractions required for the approved project.

ApproachThe SA NT DataLink Custodian Controlled Data Repository (CCDR) takes advantage of the Secure Unified Research Environment (SURE), which is a secure remote access data laboratory operated by the Sax Institute in Sydney Australia. Using thin client and two-factor authentication, Data Custodians from South Australia and across Australia are able to securely store and maintain de-identified copies of their content data in SURE, ready for standardisation, quality review, and more timely release for approved use and data linkage projects.

ResultsThe CCDR functional diagram provides an understanding of the data flow and processes that support more timely, easy and cost effective collation and provision of de-identified and privacy protected data. The Curated Gateway feature of SURE manages all the data coming into and being released from the Repository. Agreed regular updates of Data Custodian's data is able to be stored into their sub-directory, with access to the sub-directory managed by authentication and passwords. The SA NT DataLink Analysts is able to perform the role of data integrator for approved projects and use, also running privacy protecting algorithms and verification of the data being provided against the approvals.

ConclusionThe CCDR securely stores the de-identified data ready for it to be integrated and released to Researchers. Use of secure remote access technologies allows Data Custodians to maintain control of their preloaded and pre-cleaned data in CCDR. In doing so this allows Custodians to authorise the use, from which SA NT DataLink staff dedicated to working only in the CCDR, integrate and release the data in a more timely manner.