bluuebunny/crossref_metadata_2025 huggingface dataset:
Nutrient Enhancement of Ready to Eat Traditional Foods with Garden Cress Seeds
Authors: Jain Tanu , Grover Kiran
Published: April 2017

Garden cress has been considered as an important nutritional and medicinal plant in India due to its health promoting properties. The seeds are rich in macro as well as micronutrients. It can be said like garden cress seeds are packed with power of nutrients. Being highly nutritious, the seeds can be supplemented in traditional recipes to improve nutritional status of population. So, the present investigation was carried out to bring enhancement of nutrients in ready to eat traditional foods with the supplementation of garden cress seeds. Four traditional foods viz. pinni, panjiri, laddu and burfi were developed using standard methods which were treated as control and for experimental recipes, 10 % garden cress seeds were supplemented in the standard methods. Both control and experimental recipes were subjected to nutritional analysis. The results showed that nutritional value increased with the supplementation of garden cress seeds. Burfi was found with highest protein, fat and iron content while pinni was found with highest fibre, calcium and zinc content. In vitro digestibility for starch and protein was found to be decreased and antinutritional factors were found to be increased with the addition of garden cress seeds supplementation.
World Phosphorus Use Efficiency in Cereal Crops
Authors: Dhillon Jagmandeep , Torres Guilherme , Driver Ethan , Figueiredo Bruno , Raun William R.
Published: April 2017

Core Ideas

A current estimate of global P use efficiency for cereal production is not available.

This study shows that world P use efficiency for cereal crops is low.

Using the difference method, average world P use efficiency from 1961 to 2013 was 16%.

A current estimate of global phosphorus use efficiency (PUE) for cereal production is not available. The objectives of this paper were to estimate PUE for cereal crops grown in the world and to review methods for improvement. Phosphorus use efficiency was determined using world cereal harvested area, total grain production, and P fertilizer consumption from 1961 to 2013, in addition to assumptions established from previous literature. World PUE of cereal crops was calculated using both balance and difference methods. Using the balance method, cereal grain P uptake is divided by the P fertilizer applied. Alternatively, the difference method accounts for P coming from the soil and that is subtracted from applied P. Utilized in this analysis is the estimate that cereal production accounts for 61% of the total harvested cropland. Cereal grain yields increased from 1.35 to 3.90 Mg h−1 between 1961 and 2013. In 1961, the world's fertilizer P consumption was 4,770,182 Mg and increased to 16,662,470 Mg of P fertilizer by 2013. This represents a 3.5× increase in P fertilizer consumption over 53 yr. Phosphorus use efficiency estimated using the balance method was 77%. Using the difference method, PUE for cereal production in the world was estimated to be 16%.
Heat‐Induced Leaf Senescence Associated with Chlorophyll Metabolism in Bentgrass Lines Differing in Heat Tolerance
Authors: Rossi Stephanie , Burgess Patrick , Jespersen David , Huang Bingru
Published: April 2017

Leaf senescence is characterized by decreased chlorophyll content in leaves. The objectives of this study were to determine whether heat‐induced chlorophyll decline is due to inhibited chlorophyll synthesis or accelerated chlorophyll degradation and to determine whether genetic variations in heat tolerance of bentgrass (Agrostis spp.) species were associated with differential chlorophyll‐enzymatic responses to heat stress. Five turfgrass lines, including two transgenic creeping bentgrass (A. stolonifera L.) lines overexpressing isopentenyl transferase (ipt) gene ligated to a senescence‐activated promoter (SAG12) or heat shock promoter (HSP18.2) for controlling cytokinin synthesis, two thermal bentgrass (A. scabra Willd.) lines, and a wild‐type (WT) creeping bentgrass (‘Penncross’) were subjected to heat (38/33°C, day/night) or optimal temperature (22/18°C, day/night) (nonstress) for 42 d in growth chambers. The physiological parameters of turf quality, chlorophyll content, chlorophyll index, and dark green color index were measured. The data suggested significant genetic variations in the level of heat‐induced leaf senescence among the bentgrass lines. The enzyme activity of a key chlorophyll‐synthesizing enzyme, porphobilinogen deaminase, did not differ significantly across all the lines after 42 d of heat stress. The activities of chlorophyll‐degrading enzymes, including chlorophyllase and chlorophyll‐degrading peroxidase, increased significantly after heat stress, whereas pheophytinase activity was unchanged. Heat‐tolerant transgenic lines and thermal bentgrass maintained significantly lower activities of chlorophyll‐degrading enzymes than the WT under heat stress. Heat‐induced chlorophyll loss in bentgrass could be mainly due to accelerated chlorophyll degradation. Selecting for low chlorophyll degradation enzyme activity will help to facilitate the development of elite stay‐green bentgrass lines.
Characterization of Seed Rot Resistance to Pythium aphanidermatum in Soybean
Authors: Urrea Keiddy , Rupe John , Chen Pengyin , Rothrock Craig S.
Published: April 2017

The soybean [Glycine max (L.) Moench.] cultivar ‘Archer’ has a single gene for resistance to hypocotyl infection by Pythium aphanidermatum (Rpa1) but it is not known if this source of resistance limits pre‐emergence damping‐off caused by this pathogen. Resistance in Archer to pre‐emergence damping‐off caused by P. aphanidermatum was characterized in 84 F2:6 soybean lines derived from a cross of ‘Archer’ (the resistant parent) and ‘Hutcheson’ (the susceptible parent). The lines and parents were evaluated for percent germination at 7 days and percent stand at 14 days via a seed plate assay and an infested vermiculite assay, respectively. The lines were assayed with 5403 single‐nucleotide polymorphism (SNP) markers and the results compared with the assay data. Seed germination and plant stands for the Archer × Hutcheson population fit the model for a quantitative trait indicating that Pythium resistance was controlled by multiple genes or quantitative trait loci (QTLs). Two QTLs were identified by each of the two phenotyping methods on chromosomes 4 and 7. The QTL on chromosome 4 explained 8.29 and 13.76 % of the variation and the QTL on chromosome 7 accounted for 4.5 and 13.85 % of the variation in the seed plate and infested vermiculite assays, respectively. Heritability of resistance was 0.8534 and 0.6955 in the seed plate and the infested vermiculite assays, respectively, indicating that Pythium resistance from Archer could successfully be incorporated into soybean breeding programs. These QTLs were not associated with Rpa1, the gene for resistance to hypocotyl symptoms.
The Use of Crop Wild Relatives in Maize and Sunflower Breeding
Authors: Warburton Marilyn L. , Rauf Saeed , Marek Laura , Hussain Mubashar , Ogunola Oluwaseun , de Jesus Sanchez Gonzalez José
Published: April 2017

Conservation of crop wild relatives (CWR) has always been predicated on the promise of new and useful traits, and thus modern genetics and genomics tools must help fulfill the promise and continue to secure the conservation of these resources. However, the vast genetic potential present in CWR is often difficult to tap, as identification of superior alleles can be hampered by the effects of the environment on expression of these alleles and masked in different genetic backgrounds; transfer of superior alleles into breeding pools to create new crop varieties can be slow and expensive. Some crop species have been more amenable to introgression of traits from wild relatives than others. In some cases, these species may be less diverged from their wild ancestors, which become a good source of mono‐ to oligogenic traits, many of which are more qualitative in nature, and sometimes of quantitative traits. Sunflower (Helianthus annuus L.) is an introgression success story, and many traits, including cytoplasmic male sterility, herbicide tolerance, drought and biotic stress resistance, and modified fatty acid profiles, have been introgressed into the cultivated gene pool from wild relatives without depression of oil yield and quality. Others, including maize (Zea mays L.), have shown little progress in widening the cultivated gene pool using exotic sources due to temporary yield depression, potential for loss of quality, and disturbance of current logistical habits. Here, we review the breeding history of sunflower and maize and explore variables that have limited the use of CWR in some species and allowed success in others. Surprisingly, in both sunflower and maize, biological limitations are similar and smaller than expected and appear to be surmountable with sufficient determination. Possible new technologies and policies to allow a deeper mining of these genetic resources in all crop species are discussed.
PENGARUH TINGKAT PENDAPATAN DAN KEPUASAN MENERIMA BEASISWA TERHADAP KEBAHAGIAAN PSIKOLOGIS MAHASISWA PROGRAM DUAL MODE SYSTEM DI STAI STAISTAI STAI PATI TAHUN 2013
Authors: Fatah Ahmad
Published: April 2017

Abstract

This study aims to determine the effect of the level of income and satisfaction
received scholarships to students of the psychological happiness Dual Mode
System at the Islamic Institute of Pati in 2013, using a quantitative approach
with three variables: the level of income, the satisfaction of receiving a scholarship and psychological happiness. The study population was all students of the Dual Mode System totaling 117 students. Samples authors take 25% of polulasi, as many as 30 students. Analysis of this study using multiple regression with three steps: a preliminary analysis, hypothesis testing and analysis of further analysis. Results of this study was no effect of income level (X1) with psychological happiness (Y) student Dual Mode System in STAI Starch 2013. Thus the first hypothesis which says "There is a significant relationship between the income level of students to students of the psychological happiness Dual Mode system in sTAI Pati "is rejected. There is an effect of satisfaction received scholarships (X2) with psychological happiness (Y) student Dual Mode System in 2013. So STAI Pati second hypothesis ie "There is significant relationship between satisfaction received scholarships to students of the psychological happiness Dual Mode System in STAI Starch" accepted as true. The effect was of 18.3%, and the remaining 81.7% is influenced by other variables that have not been examined by the authors. No effect of income level (X1) and the satisfaction of receiving a scholarship (X2) with psychological happiness (Y) student Dual Mode System in 2013. So STAI Pati third hypothesis that "There is significant relationship between the level of income and satisfaction received a scholarship to happiness psychological student Dual Mode System d sTAI Starch "rejected.

Keywoard: tingkat pendapatan, kepuasan menerima beasiswa, kebahagiaan
psikologis
SISTEM PENDIDIKAN NASIONAL DAN PENDIDIKAN ISLAM
Authors: Muthoifin Muthoifin
Published: April 2017

Abstract

Thee focus of this research is the pro" le of Ki Hadjar Dewantara, his educational thought based on the perspective of Islamic education review, the research is focused on the aspects of the conception of education issues, including: basic, content and education systems. The research method used is the libraries research. By approaching to the history and biography of Ki Hadjar.
While the data collection consists of primary and secondary data sources. Techniques of data analysis was using content analysis, descriptive, comparative and inductive. The results of the study. 1, the concept of education Ki Hadjar focused on aspects of guidance to children in order to achieve happiness based on the nature of nature. ! is is not consistent with the concept of Islamic
education that focused on aspects of worship and Tawheed based on divine revelation. 2, Ki Hadjar’s basic education is the principle Pancadarma, which of the " ve principle is explicitly no principle of divinity, it is contrary to basic Islamic education which is based on al-Quran and al-Sunnah. 3) Ki Hadjar’s education system, good goals, curriculum, methods, teachers, students and the evaluation does not lead and is tied to the value of faith and worship, it is also not in line with the Islamic education system has always associate with both religious values .

Keywords: Education system, Ki Hadjar Dewantara, Islamic education
Validation of evapotranspiration and its long-term trends in the Yellow River source region
Authors: Liu Rong , Wen Jun , Wang Xin , Wang Zuoliang
Published: April 2017

In this paper, the ground observations were compared to the ERA-Interim, NCEP-DOE AMIP-II Reanalysis, MODIS ET product, and emerging offline SEBS ET data sets in the Yellow River source region of the Tibet Plateau. In general, the slopes of linear least squares exhibit differences, with ERA-Interim, NCEP–DOE, MOD16, and SEBS slopes of 0.88 ± 0.05, 0.64 ± 0.07, 0.66 ± 0.17, and 1.24 ± 0.97 respectively. ERA-Interim was found superior with ground observations to others; therefore, it provided a good representation of the study area. Based on the ERA-Interim ET product, the Sen's slope estimator and the Mann–Kendall (MK) test were applied to quantify the significance of the shifts in trends, while the moving t-test and MK test characterized abrupt changes. The results show that the Yellow River source region experienced a statistical increase in evapotranspiration (ET) in the northern part and a decrease in the southern part of the region from 1979 to 2014 at rates of approximately 1.65 and −0.50 mm/yr, respectively. The shift in the annual ET trend was more pronounced, and abrupt changes were detected in the 1980s. Precipitation was the most dominant factor affecting ET variation, whereas surface temperature was the least influential.
A family of the incomplete hypergeometric functions and associated integral transform and fractional derivative formulas
Authors: Srivastava Rekha , Agarwal Ritu , Jain Sonal
Published: April 2017

Recently, Srivastava et al. [Integral Transforms Spec. Funct. 23 (2012),
659-683] introduced the incomplete Pochhammer symbols that led to a natural
generalization and decomposition of a class of hypergeometric and other
related functions as well as to certain potentially useful closed-form
representations of definite and improper integrals of various special
functions of applied mathematics and mathematical physics. In the present
paper, our aim is to establish several formulas involving integral transforms
and fractional derivatives of this family of incomplete hypergeometric
functions. As corollaries and consequences, many interesting results are
shown to follow from our main results.
Prolonged Elimination of Negative Feedback Control Mechanisms Along the Insulin Signaling Pathway Impairs β-Cell Function In Vivo
Authors: Isaac Roi , Vinik Yaron , Boura-Halfon Sigalit , Farack Lydia , Streim Sarina , Elhanany Eytan , Kam Zvi , Zick Yehiel
Published: April 2017

Cellular stress and proinflammatory cytokines induce phosphorylation of insulin receptor substrate (IRS) proteins at Ser sites that inhibit insulin and IGF-I signaling. We therefore examined the effects of mutation of five “inhibitory” Ser phosphorylation sites on IRS2 function in transgenic mice that overexpress, selectively in pancreatic β-cells, either wild-type (WT) or a mutated IRS2 protein (IRS25A). Islets size, number, and mRNA levels of catalase and superoxide dismutase were increased, whereas those of nitric oxide synthase were decreased, in 7- to 10-week-old IRS25A-β mice compared with IRS2WT-β mice. However, glucose homeostasis and insulin secretion in IRS25A-β mice were impaired when compared with IRS2WT-β mice or to nontransgenic mice. This was associated with reduced mRNA levels of Glut2 and islet β-cell transcription factors such as Nkx6.1 and MafA. Similarly, components mediating the unfolded protein response were decreased in islets of IRS25A-β mice in accordance with their decreased insulin secretion. The beneficial effects of IRS25A on β-cell proliferation and β-cell transcription factors were evident only in 5- to 8-day-old mice. These findings suggest that elimination of inhibitory Ser phosphorylation sites of IRS2 exerts short-term beneficial effects in vivo; however, their sustained elimination leads to impaired β-cell function.
Validation of dementia coding in hospital admissions, death and primary care data
Authors: Wilkinson Tim , Schnier Christian , Ly Amanda , Sudlow Cathie
Published: April 2017

ABSTRACT

ObjectivesDementia is a major public health concern worldwide and consequently there is an urgent need to expedite research into its causes so that preventative strategies can be sought. Given that dementia is likely to be the result of a complex interplay of many factors, large study populations are required in order to detect effects reliably. UK Biobank (UKB) is a large, population-based, prospective cohort study of over 503,000 participants aged 40-69 years when recruited between 2006 and 2010. Participant follow up is chiefly via linkage to routinely-collected health datasets such as hospital admissions, death registrations and increasingly, to primary care data. In this pilot study we sought to estimate the accuracy of using these routine data sources to identify dementia outcomes in UKB participants.

ApproachWe created a list of ICD-10 and primary care (Read version 2) dementia codes, with the intention of maximising positive predictive value (PPV) over sensitivity. We identified UKB participants who were recruited in Edinburgh and had at least one dementia code in any of the three data sources. We searched the NHS Lothian electronic medical record (EMR) for each participant and extracted all relevant letters and investigation results. Participants were excluded if no EMR entry for that patient could be found. A neurologist adjudicated on whether dementia was present or not based on the extracted case record, providing the reference standard to which the coded data were compared. The PPV was then calculated for each data source individually and combined. A subgroup analysis was performed on participants who had a dementia code across more than one dataset.

ResultsAmong 17,000 Edinburgh-based participants (median age 57 years at recruitment in 2007/8), hospital and death data were available to 2012 with primary care data for 12,000 to 2013. 46 participants had a dementia code in at least one data source. 44 of these had available EMR data. PPVs for dementia were 41/44 (93%, 95% CI 81-99) overall, 13/15 (87%, 95% CI 60-98) for hospital admissions, 2/2 (100%, 95% CI 16-100) for death registrations, 33/34 (97%, 95% CI 85-100) for primary care, and 7/7 (100%, 95% CI 59-100) for participants with codes in ≥2 datasets.

ConclusionRoutinely-collected health data may be sufficiently accurate to identify dementia outcomes in UK population-based cohorts. We plan to extend this study to longer follow-up times and other regions to increase sample size, investigate dementia subtypes and assess generalisability.
Social and geographical inequalities in school starting age in Australia: a population data linkage study
Authors: Hanly Mark , Falster Kathleen , Craven Rhonda , Jorm Louisa
Published: April 2017

ABSTRACT

ObjectiveIn Australia’s most populous state, New South Wales (NSW), children must start school in the year they turn five, unless they are born between February-July, in which case they can delay starting until the year they turn six. Consequently, children start their first year of school aged 4.5-6 years. This may translate into a wide range of developmental ability in the classroom in the first year of school and may impact on the magnitude of inequalities in longer-term educational outcomes. To inform how this policy currently translates into the demographic composition of NSW classrooms, this study aims to identify child, family, and area-level characteristics associated with the practice of delaying school entry.

ApproachThe ‘Seeding Success’ study cohort (N=154,936) includes an almost complete population of children who started school in NSW in 2009 or 2012, and were born in NSW, identified by linking the Australian Early Development Census (AEDC) data to perinatal and birth registry data. Restricting this analysis to the 88,716 (57%) children born in February-July, we defined ‘delayed school entry’ as children who were eligible to start school the previous year (i.e. 2008 or 2011), but started in the AEDC data collection years (i.e. 2009 or 2012). Multilevel regression models were used to investigate child, family and area-level characteristics associated with delayed school entry.

ResultsThe prevalence of delayed school entry was 46% in the 2009 AEDC cohort and 47% in the 2012 AEDC cohort. Boys and children born closer to July were more likely to be delayed, as were children of older mothers. Prevalence of delay was similar in Aboriginal and non-Aboriginal children, however, children of mothers born overseas were less likely to delay school entry compared to Australian-born mothers. Delaying was less common in major cities compared to remote and regional areas, and less common in socio-economically disadvantaged areas.

ConclusionChildren born in February-July who live in socio-economically disadvantaged urban areas are more likely to start school up to a year earlier than their peers, with poorly understood educational consequences. The current policy on school starting age results in an 18-month age range in classrooms, which may be challenging for teachers and confusing for parents who need to make a decision regarding their child’s ‘school readiness’. It is likely that access and affordability of childcare during the study period impacted on parent’s decisions about when to send their children to school.
Establishing data linkage between welfare and health data in the UK: Overcoming barriers to linking government datasets
Authors: Katikireddi S Vittal , Leyland Alastair
Published: April 2017

ABSTRACT

ObjectivesEmployment and welfare policy have major impacts on population health and health inequalities. We sought to develop a novel data linkage between administrative welfare data (held by the UK Government’s Department for Work and Pensions, DWP) and health records (from the National Health Service, NHS). We describe the challenges we faced establishing this linkage and explain how they have been overcome over five years.

ApproachNational Records Scotland (NRS) is the organisation responsible for statutory demographic data in Scotland, including conducting the decennial census, registering births and deaths. They will act as a Trusted Third Party to facilitate linkage under Scots common law. This work will be supported by the UK’s Administrative Data Research Network. Following a successful pilot, a further project is intended to link data for England and Wales (subject to further applications).

ResultsThe Work & Pensions Longitudinal Study (WPLS) is a person-level longitudinal dataset that links benefit and programme information held by DWP since January 2004 with employment records from Her Majesty’s Revenue & Customs for people who have had a benefit spell. The WPLS allows transitions between different benefits and/or employment statuses to be ascertained, including timing of transitions and salaried income post-employment. However, the WPLS includes very limited health information.

NHS Scotland has exceptional administrative health records, including person-level information on deaths, hospital admissions (including admission/discharge dates, diagnoses, procedures etc.), cancer registrations (including type, stage, treatment) and community prescriptions. A particular strength is the availability of a unique population identifier which facilitates deterministic linkage across health records.

Key issues that needed to be addressed to facilitate the linkage included identification of appropriate research questions that were of high priority to government policymakers, the availability of research infrastructure and reassurances about data security. However, delays in establishing the linkage have been common – particularly as a consequence of the multiple organisations involved and time constraints on public sector staff required to process the linkage.

Research topics to be investigated include improved prediction of health and welfare outcomes, investigating the health impacts of job insecurity and evaluating impacts of welfare reform.

ConclusionEvidence to improve alignment between health and welfare goals will be achieved through linkage of administrative records in this five year research programme. It has been essential to consider how best to achieve public benefit and minimise privacy risks, while ensuring the needs of policymakers are central to the development of the research.
Using record linkage to demonstrate the benefits of maternal influenza immunisation in Western Australia
Authors: Regan Annette , Moore Hannah , De Klerk Nicholas , Shellam Geoffrey , Effler Paul
Published: April 2017

ABSTRACTObjectivesPregnant women are the highest priority for seasonal influenza vaccination. Previous research has found maternal immunisation may not only reduce respiratory infections in mothers and infants, but also prevents adverse birth outcomes. Although the vaccine has been offered to pregnant women under the National Immunisation Program since 2009, no population-based study has yet evaluated its impact on neonatal health in Australia.

ApproachWe established a large retrospective cohort of 58,615 births between 2012 and 2013 in Western Australia using data linkage of state-held maternal vaccination records, birth registrations, hospital inpatient records, and midwives notifications. Cox regression models were used to compare the adjusted relative hazard (HR) of adverse birth outcomes and hospital admission for an acute respiratory illness (ARI) by vaccination status.

ResultsIn total, 5,241 (8.9%) of infants were born to vaccinated mothers. Between 2012 and 2013, there were 23.6 ARI admissions per 1,000 infants <6 months and 2.8 ARI admissions per 1,000 pregnant women. Influenza vaccination was associated with a 51% reduction in stillbirth (aHR: 0.49; 95% CI: 0.29-0.84) and a 25% reduction in infant admissions in the first six months of life (aHR: 0.75; 95% CI: 0.56-0.99). Most of the reduction in ARI admission in infants was observed when vaccination occurred in the third trimester (aHR: 0.68; 95% CI: 0.47-0.95).

ConclusionsOur findings support the neonatal health benefits afforded by maternal influenza immunisation and underscore the importance of offering and promoting influenza vaccination to pregnant women. Considering more than 90% of women who choose to be immunised do so to protect their infant, these results could be used to powerfully promote maternal immunisation.
Data visualisation to support decision making and equitable healthcare service provision.
Authors: Whyatt David , Kok Mei Ruu , Yap Matthew , Tuson Matthew , Boruff Bryan , Turlach Berwin
Published: April 2017

ABSTRACTObjectivesThe aim of this research is to explore current advances in data visualisation technology to improve the analysis of health service utilisation data to support decision making and equitable health care service provision.ApproachMulti-dimensional mapping allows for informative presentation of many types of spatial and geographical data. It allows for the visualisation, question, analysis, and interpretation of data to identify relationships, patterns, and trends. Such techniques can be used to identify patterns in healthcare utilisation relative to a point in time. This can be calendar time, where the event may be a change in services (such as the building of a new hospital) or a change in policy or practice across the system. Or it may be relative time, where the event is a transition in a patient’s health or a new diagnosis.Patterns recognised through such data visualisations may be the result of apophenia, i.e. where patterns are observed in what is essentially random information. Thus, data visualisations such as these are a method to help generate hypotheses which can then be rigorously testing using statistical methods.The entire linked Western Australian Data Collections from 2002-2015 (including population-wide hospital admissions, emergency department presentations, cancer registry records, mental health care, maternity records, and mortality records) were examined. Both changes in the source (patient residential location) and target (location of service used) were visualised. Hypotheses generated were then statistically examined.ResultsThree analyses will be presented. Mean emergency department (ED) presentations follow a specific pattern of rising and falling in the years around a diagnosis of heart failure. The geospatial utilisation of ED over time will be visualised and areas of high and low use of ED will be identified. Mental healthcare involves both ED presentations and inpatient services. The geospatial pattern of ED and inpatient service use by mental health patients over time will be visualised and implications for provision of healthcare services discussed. Finally, in a specific current example, the closure of a metropolitan ED and the subsequent opening of a nearby ED has changed the local population’s pattern of ED use. These changes will be visualised.ConclusionAdvanced methods of data visualisation improve the analysis of large population based datasets to support decision making and equitable health care service provision.
For the greater good? Patient and public attitudes to use of medical free text data in research
Authors: Ford Elizabeth , Stockdale Jessica , Jackson Richard , Cassell Jackie
Published: April 2017

ABSTRACTObjectivesElectronic health records (EHRs) contain rich information for understanding health conditions and their treatment. A large proportion of clinical information in EHRs is stored in narrative free text. This text is currently under-utilised due to privacy concerns, as it is harder to remove patient identifiers from text than from structured data. Automated de-identification of clinical text is now possible using heuristic or machine-learning-based systems. We conducted a review of the literature on patient and public understanding and attitudes towards the use of patients’ medical data for research, particularly seeking views on free text. The aim was to inform and develop a governance framework for the de-identification and use of medical free text for research, and to instigate a wider discussion on the topic. ApproachWe undertook a systematic search in Web of Science and ScienceDirect with terms such as “public attitudes” and “electronic health records”. 3480 results were sifted by title, abstract and full text. Forty-two articles were retained for review, these reported on studies of patient and public perceptions, understanding and attitudes towards the use of patients’ medical data in research. ResultsResearch participants were positively inclined towards information in records being used in research “for the greater good”. However, no clear patterns by age, ethnicity, education level or SES emerged as to who was more favourable to data use. Participants generally trusted health care professionals and public sector researchers with de-identified medical data, whereas government health agencies and commercial entities were not trusted. No explicitly feared harms associated with data use were articulated. However the general objections appeared to be a dislike of personal data being exploited for commercial gain, and a dislike of personal data being moved around and used without personal knowledge or consent. Notably the use of EHR medical text for research did not emerge as a specific patient/public concern. De-identification was important to participants but text was not identified as a distinct privacy risk.ConclusionThis review demonstrates that transparency about data usage, and working “for the greater good” rather than financial gain, appear to be the most important public concerns to be addressed when using patients’ medical data. Governance frameworks for using EHRs must now be enhanced to provide for the use of medical text. This will involve informing both regulators and the public about the current capabilities of automated de-identification, and developing other assurances to safeguard patients’ privacy.
CHA2DS2-VASc Calculations in Patients with Atrial Fibrillation receiving oral anticoagulants in Scotland: an analysis of linked administrative data
Authors: Zeng Wenjie , Mueller Tanja , Godman Brian , Alvarez-Madrazo Samantha , Bennie Marion
Published: April 2017

ABSTRACT

ObjectivesPatients with atrial fibrillation (AF) have an increased risk of developing stroke, and oral anticoagulants (OACs) are commonly used in stroke prevention. The CHA2DS2-VASc score has been proved to be a simple and effective tool for stroke risk assessment which guides the selection of treatment with OACs. This score is calculated using disease diagnoses; however, a range of different versions exist, making comparability questionable.

The aim of this study was to compare CHA2DS2-VASc scores in OAC treated patients with a hospital-confirmed diagnosis of AF in Scotland using different subsets of ICD-10 codes.

Approach This is a retrospective study, covering AF patients in Scotland who received at least one prescription for any OAC between January 2009 and June 2014. The Prescribing Information System (PIS) was used to identify patients with OAC prescriptions, while the Scottish Morbidity Records (SMR) provided patients’ diagnoses. Different sets of ICD-10 codes, using varying definitions, were used to classify the stroke risk in AF patients in order to account for heterogenous definitions applied in previously published studies. The main differences in codes used were the inclusion or exclusion of unclassified stroke (ICD-10 code I64), and the inclusion of pulmonary embolism (PE) (I26) as either “prior thromboembolic event” or “vascular disease”.

ResultsIn our study, a cohort of 71012 AF patients with OAC prescription were analysed. Using narrow disease definitions, 18.15% of patients were categorised as being at low risk of stroke (score 0-1), 74.80% at medium risk (score 2-5), and 7.04% at high risk (score 6-9). With an extended disease definition, including PE in “prior thromboembolic event”, 14.81% of patients were at low risk (score 0-1), 72.60% at medium risk (score 2-5), and 12.59% at high risk (score 6-9); while including PE in “vascular disease”, 14.99% of the patients had a score 0-1, 73.54% a score 2-5, and 11.48% a score 6-9.

Conclusion The change in score definitions makes a difference mainly in the number of patients categorised as very low risk or high risk. Standardisation in ICD-10 code definition of risk diseases could be useful in order to make the results comparable from different studies and further evaluate OAC choice according to risk group.
Privacy protected graphical functionality in DataSHIELD
Authors: Avraam Demetris , Gaye Amadou , Isaeva Julia , Burton Thomas , Wilson Rebecca , Turner Andrew , Burton Paul
Published: April 2017

ABSTRACT

ObjectivesIn several disciplines such as in biomedicine and social sciences the analysis of individual-level data or the co-analysis of data from different studies requires the pooling and the sharing of those data. However, sharing and combining sensitive individual-level data is often prohibited by ethico-legal constraints and other barriers such as the control maintenance and the huge sample sizes. The graphical illustration of microdata is also often forbidden as can potentially be unsecured on the identification of sensitive information. For example the plot of a standard scatterplot is disclosive as can explicitly specify the exact values of two measurements for each single individual.

ApproachDataSHIELD (www.datashield.ac.uk) is a novel approach that allows the analysis of sensitive individual-level data and the co-analysis of such data from several studies simultaneously without physically pooling the data.

ResultsDataSHIELD functionality consists of several functions that provide the flexibility of performing data analysis through different statistical techniques. A part of this environment includes a number of graphical-related functions for the graphical illustration of the statistical properties and relationships between different variables. We overview the graphical functions in DataSHIELD (ds.histogram, ds.heatmapPlot, ds.contourPlot) and demonstrate a number of new functions including ds.scatterPlot and ds.boxPlot developed based on the application of different computational approaches like the k-Nearest Neighbours algorithm and ensuring privacy protected analysis.

ConclusionDataSHIELD graphical functionality has certain methodological features for the representation of the relationships between different variables preserving their statistical properties and assuring the data privacy protection. These graphical approaches can be used or enhanced for application in various areas where confidentiality and information sensitivity is considered, for example in longitudinal data and survival analysis, in epidemiological studies, in geospatial analysis and several others.
A new R-based statistical software package for fitting multivariate generalized linear mixed models to large and complex datasets
Authors: Berridge Damon , Crouchley Robert , Grose Daniel
Published: April 2017

ABSTRACT

ObjectiveTo demonstrate the efficiency and efficacy of the new freeware MGLMM in the statistical modelling of large and complex datasets.

ApproachThe new R-based software MGLMM (shortly to become available on the CRAN website https://cran.r-project.org/) can be used to fit a range of different multivariate generalized linear mixed models, thereby permitting a better representation of the multivariate nature of many complex socio-economic processes which may involve a range of different response types. The software MGLMM will also set records for the time taken to fit these complex models to large sets of data. The efficiency and efficacy of this new software will be demonstrated by way of a number of applications.

One such example will come from the STAR Project in which pupils were followed from kindergarten in 1985 (aged 5) to 1989 (third grade, aged 8). The pupils were assessed on their ability in both mathematics and English on an annual basis between 1985 and 1989. At the end of the kindergarten year, some of the students were reallocated to different class sizes in order ‘to achieve sexual and racial balance and to separate incompatible children’. In the fourth grade, the pupils returned to regular classes and the experiment ended.

We can regard the two score variables ‘Maths’ and ‘English’ as constituting repeated, correlated, bivariate continuous data. We will use the new package MGLMM to apply a series of bivariate normal mixed models with correlated random effects. These models will allow us to distinguish the role of prior attainment in mathematics and English on current attainment in mathematics and English in an experimental setting, for pupils in small and regular class sizes. The models will permit an examination of the effect of class size on this bivariate response, whilst controlling for a set of individual-level confounding factors such as gender and age.

ResultsWe will present the results of these analyses, thereby demonstrating the efficacy of MGLMM. We will also compare the performance of the new software with existing packages such as Stata.

ConclusionsWe will have demonstrated the gain in efficiency through the use of MGLMM, compared to other standard software packages, in the statistical modelling of large and complex datasets.
Identification and validation of myocardial infarction and stroke outcomes at scale in UK Biobank
Authors: Schnier Christian , Denaxas Spiros , Eggo Rosalind , Patel Riyaz , Zhang Qiuli , Woodfield Rebecca , Flaig Robin , Hemingway Harry , Sudlow Cathie
Published: April 2017

ABSTRACT

AimsWe aimed (i) to create algorithms for identifying stroke and acute myocardial infarction (MI) cases in a large prospective population-based study (UK Biobank), using linked data from national hospital admissions data and death registers, combined with self-report data from the baseline assessment; and (ii) to assess validity by examining associations with risk factors and mortality.MethodsUK Biobank is a prospective study of 503,000 participants, aged 40-69 years when recruited in 2006-2010 from centres across England, Scotland and Wales. Participants provided extensive questionnaire data on lifestyle, environment and medical history (with confirmation of self-reported medical conditions during a brief interview with a trained research nurse), had physical measures, and provided biological samples. Follow-up is principally through linkages to national health-related datasets, integrated from different data providers for each country and including cohort-wide data for ICD-coded hospital admissions and registered deaths, with follow-up to 2011 for this report. We used expert opinion and systematic reviews to identify baseline self-report items and ICD codes maximising positive predictive value for identification of stroke, MI and their subtypes. We classified participants with at least one relevant code as being first affected either before (prevalent cases) or after recruitment (incident cases). We compared cases with non-cases (controls) using logistic regression (prevalent cases) and survival analysis (incident cases) to examine associations with vascular risk factors, defined using data from the baseline assessment. We used survival analysis to compare vascular, non-vascular and all-cause mortality for cases versus controls post recruitment (prevalent cases) and post hospitalization (incident cases).ResultsWe identified 8654 stroke cases and 13,479 MI cases. 90% of both were prevalent at recruitment, of which 29% (stroke) and 54% (MI) were identified through both research nurse-confirmed self-report and hospital admission records. During ≈1 million person years of follow-up in those without a prevalent record, we identified 871 incident strokes and 1387 incident MIs, of which 8% (stroke) and 2.9% (MI) were identified in both hospital and death records. Male sex, low socio-economic status, smoking and increased body mass index were all positively associated with both stroke and MI. Compared with age and sex-matched controls, mortality for stroke and MI cases was increased both after recruitment (prevalent cases) and after hospitalization (incident cases).ConclusionInformation from linked coded datasets from different data providers can be combined with information collected at recruitment to identify and validate prevalent and incident acute MI and stroke.
Linking education and health data to examine the characteristics of children prescribed antipsychotic medication.
Authors: Brophy Sinead , Kennedy Jonathan , Fernandez-Gutierrez Fabiola , John Ann , Potter Robert , Christine Linehan , Kerr Michael
Published: April 2017

ABSTRACTObjectivesTo examine the characteristics of children who are prescribed antipsychotic medication.

ApproachA cohort study using routine data from general practitioner and hospital records linked with education records. All children in Wales between the years 1999 to 2014 were included in the analysis, demographic characteristics and outcomes of children were stratified by intellectual disability/autism (identified using education records and GP records) and antipsychotic use. All data were linked and held in the Secure Anonymised Information Linkage (SAIL) Databank in Wales

ResultsOf children with intellectual disability 2.4 % (360/14428) have been prescribed an antipsychotic and 75 % of these have a diagnosis of autism. This compares with 0.19% (1126/602320) of children without intellectual disability who are prescribed an antipsychotic. Children, predominantly boys (78.1% (281/360) of those with intellectual disability prescribed an antipsychotic were boys compared to 67.12% (9442/14068) of those not prescribed antipsychotics), with aggression codes (17.5% of those on an antipsychotic had aggression codes compared to 1.36% of those without antipsychotic) were more likely to be prescribed antipsychotics. Those with intellectual disabilities were prescribed antipsychotics at a younger age (58 % of those with intellectual disability started the drug before the age of 14 compared to 29 % of those without intellectual disability) but were less likely to be from a deprived area compared to those prescribed antipsychotics but without intellectual disability/autism (22.5 % and 28.4 %, were in the lowest fifth of deprivation, intellectual disability and non- intellectual disability, respectively). Antipsychotic use was associated with more visits to the GP for epilepsy, diabetes and injury (post drug compared to prior to drug) and higher deaths in childhood (compared to those not give antipsychotics).

ConclusionsThe linkage of the education records allowed intellectual disability to be used as an explanatory factor in analysis looking at drug prescriptions. The majority of children prescribed antipsychotics do not have psychotic or mental disorder diagnosis codes but have a diagnosis of behavioural problems, attend special schools and have intellectual difficulties. In the group with intellectual disability/autism there is evidence that the use of antipsychotics may be associated with more visits to the GP for epilepsy, diabetes, injury (post drug compared to prior to drug) and is associated with more deaths in childhood. These findings support concerns that antipsychotics may be over used for managing predominately behavioural problems.
ICD-11: towards better capture of quality and safety events in hospital
Authors: Southern Danielle , Quan Hude , Ghali William
Published: April 2017

ABSTRACT

BackgroundThe Quality and Patient Safety TAG (Q&S TAG) is charged with reviewing ICD-10, ICD-10CM and progressive drafts of ICD-11 to inform the development of the ICD-11, focusing on identifying practical modifications for ICD 11 drafts that would enable better measurement of quality and safety. ApproachThe tasks of the Q&S TAG include: Horizontally crossing all ICD-11 chapters to advise on optimizing the entire classification’s content, structure and coding rules for enhanced application in both existing; Developing an inventory of existing quality of care and patient safety indicators and potentially novel quality and safety indicators; Assessing potential uses of ICD-11 for health services, quality and patient-centered outcomes research; Reviewing and critiquing the ICD-11 beta draft from the perspective of the quality and safety use case; Reviewing and critiquing Volume II work from the perspective of quality and safety use case and Designing field trials for the beta version of ICD-11. The Q&S TAG has held meetings in both New York, NY and Washington, D.C. where members have reviewed the status of discussions around coding rules (main condition, diagnosis timing, coding field), Chapter 19&20 content and associated clustering mechanisms and presented these concepts in emails to WHO and prepared to undertake a granular review of the content in chapters 1-20 and devised a committee work plan to do this. ResultsSix manuscripts have come from meetings. The QS-TAG has also devised a matrix model for considering potential ICD-11 field trials. The matrix categorizes cross-tabulates topic areas (e.g., validity of coded concepts, completeness of capture of critical patient safety and quality concepts, reliability and feasibility of various coding rules, opinions of stakeholders on various issues) against the methodologies that would be used for the field trials (i.e., code-recode studies using real medical records, coding studies assessing completeness of capture of key safety/quality concepts, surveys of stakeholders, heuristic evaluations of ICD-11 on various user interfaces, etc). Q&S TAG has completed 2 field trials, with 2 more in development phases. ConclusionUltimately, an enhanced classification system will permit expanded use of coded health data for large-scale quality and safety surveillance in health care systems internationally.