bluuebunny/crossref_metadata_2025 huggingface dataset:
Using Artificial Neural Network Condensation to Facilitate Adaptation of Machine Learning in Medical Settings by Reducing Computational Burden: Model Design and Evaluation Study
Authors: Liu Dianbo , Zheng Ming , Sepulveda Nestor Andres
Published: December 2020

Background

Machine learning applications in the health care domain can have a great impact on people’s lives. At the same time, medical data is usually big, requiring a significant number of computational resources. Although this might not be a problem for the wide adoption of machine learning tools in high-income countries, the availability of computational resources can be limited in low-income countries and on mobile devices. This can limit many people from benefiting from the advancement in machine learning applications in the field of health care.

Objective

In this study, we explore three methods to increase the computational efficiency and reduce model sizes of either recurrent neural networks (RNNs) or feedforward deep neural networks (DNNs) without compromising their accuracy.

Methods

We used inpatient mortality prediction as our case analysis upon review of an intensive care unit dataset. We reduced the size of RNN and DNN by applying pruning of “unused” neurons. Additionally, we modified the RNN structure by adding a hidden layer to the RNN cell but reducing the total number of recurrent layers to accomplish a reduction of the total parameters used in the network. Finally, we implemented quantization on DNN by forcing the weights to be 8 bits instead of 32 bits.

Results

We found that all methods increased implementation efficiency, including training speed, memory size, and inference speed, without reducing the accuracy of mortality prediction.

Conclusions

Our findings suggest that neural network condensation allows for the implementation of sophisticated neural network algorithms on devices with lower computational resources.
Associations Between Methods of Meeting Sexual Partners and Sexual Practices Among Heterosexuals: Cross-sectional Study in Melbourne, Australia (Preprint)
Authors: Constantinou Heidi , Fairley Christopher K , Hocking Jane S , Bradshaw Catriona S , Choi Edmond P H , Maddaford Kate , Phillips Tiffany R , Chow Eric P F
Published: December 2020

BACKGROUND

The association between meeting partners on the web and sexual practices has been understudied in heterosexuals.

OBJECTIVE

This study aims to examine the associations between the methods of meeting partners and sexual practices and HIV and sexually transmitted infections (STIs) in heterosexuals.

METHODS

We conducted a survey among heterosexuals attending the Melbourne Sexual Health Centre in 2019. This survey asked about the methods through which the participants engaged in meeting their sexual partners, sexual practices, and intravenous drug use (IVDU) over the past 3 months. The participants’ HIV and STI (chlamydia, gonorrhea, and syphilis) status was obtained from clinical testing. Multivariable logistic regression was used to examine the association between each method of meeting and the participants’ sexual practices, IVDU, and STI status.

RESULTS

A total of 698 participants (325 men and 373 women) were included in the study. Most of the participants reported using only one method to meet partners (222/325, 68.3% men; 245/373, 65.7% women; P=.05). The men met partners most commonly at social venues (eg, bar, pub, or party; 126/325, 38.8%), whereas the women met partners most commonly through friends or family (178/373, 47.7%). Paying for sex was associated with men meeting partners at sex venues (adjusted odds ratio [AOR] 145.34, 95% CI 26.13-808.51) and on the internet (AOR 10.00, 95% CI 3.61-27.55). There was no association between IVDU and methods of meeting. Social venues were associated with condomless vaginal sex among men (AOR 3.31, 95% CI 1.94-5.71) and women (AOR 2.58, 95% CI 1.61-4.13) and testing positive for STI among men (AOR 3.04, 95% CI 1.24-7.48) and women (AOR 3.75, 95% CI 1.58-8.89).

CONCLUSIONS

Heterosexuals who met partners at social venues had a more than threefold risk of testing positive for STIs, indicating that heterosexuals may benefit from health promotion campaigns that are delivered through a public setting.
Dropout From an Internet-Delivered Cognitive Behavioral Therapy Intervention for Adults With Depression and Anxiety: Qualitative Study (Preprint)
Authors: Lawler Kate , Earley Caroline , Timulak Ladislav , Enrique Angel , Richards Derek
Published: December 2020

BACKGROUND

Treatment dropout continues to be reported from internet-delivered cognitive behavioral therapy (iCBT) interventions, and lower completion rates are generally associated with lower treatment effect sizes. However, evidence is emerging to suggest that completion of a predefined number of modules is not always necessary for clinical benefit or consideration of the needs of each individual patient.

OBJECTIVE

The aim of this study is to perform a qualitative analysis of patients’ experiences with an iCBT intervention in a routine care setting to achieve a deeper insight into the phenomenon of dropout.

METHODS

A total of 15 purposively sampled participants (female: 8/15, 53%) from a larger parent randomized controlled trial were interviewed via telephone using a semistructured interview schedule that was developed based on the existing literature and research on dropout in iCBT. Data were analyzed using a descriptive-interpretive approach.

RESULTS

The experience of treatment leading to dropout can be understood in terms of 10 domains: relationship to technology, motivation to start, background knowledge and attitudes toward iCBT, perceived change in motivation, usage of the program, changes due to the intervention, engagement with content, experience interacting with the supporter, experience of web-based communication, and termination of the supported period.

CONCLUSIONS

Patients who drop out of treatment can be distinguished in terms of their change in motivation: those who felt ready to leave treatment early and those who had negative reasons for dropping out. These 2 groups of participants have different treatment experiences, revealing the potential attributes and nonattributes of dropout. The reported between-group differences should be examined further to consider those attributes that are strongly descriptive of the experience and regarded less important than those that have become loosely affiliated.

CLINICALTRIAL
Attitudes of Health Care Professionals Toward Older Adults’ Abilities to Use Digital Technology: Questionnaire Study (Preprint)
Authors: Mannheim Ittay , Wouters Eveline J M , van Boekel Leonieke C , van Zaalen Yvonne
Published: December 2020

BACKGROUND

Digital technologies (DTs) for older adults focus mainly on health care and are considered to have the potential to improve the well-being of older adults. However, adoption rates of these DTs are considered low. Although previous research has investigated possible reasons for adoption and acceptance of DT, age-based stereotypes (eg, those held by health care professionals) toward the abilities of older adults to use DTs have yet to be considered as possible barriers to adoption.

OBJECTIVE

The aim of this study was to investigate the influencing role of ageism in the context of health care professionals attitudes toward older adults’ abilities to use health care DT. A further goal was to examine if social comparison and stereotype activation affect and moderate this association.

METHODS

A new measurement to assess health care professionals’ attitudes toward older adults using technology (ATOAUT-10) was developed and used in 2 studies. Study 1 involved the development of the ATOAUT-10 scale using a principal component analysis and further examined health care professionals’ attitudes toward the use of health care DTs and correlations with ageism. Study 2 further explored the correlation between ageism and ATOAUT in an experimental design with health care professionals.

RESULTS

In study 1, physiotherapists (N=97) rated older adults as young as 50 years as less able to use health care DT compared to younger adults (P<.001). A multiple regression analysis revealed that higher levels of ageism, beyond other predictors, were predictive of more negative ATOAUT, (β=.36; t=3.73; P<.001). In study 2, the salience of age was manipulated. Health care professionals (N=93) were randomly assigned to rate the abilities of a young or old person to use health care DT. Old age salience moderated the correlation between ageism and ATOAUT (R2=0.19; F6,85=3.35; P=.005), such that higher levels of ageism correlated with more negative ATOAUT in the old age salient condition, but not the young condition. Stereotype activation accounted for health care professionals’ attitudes more than did the experience of working with older patients or the professionals’ age.

CONCLUSIONS

Negative and ageist attitudes of health care professionals can potentially affect how older adults are viewed in relation to DT and consequently might influence actual use and adoption of technology-based treatment. Future studies should broaden the validation of the ATOAUT-10 scale on more diverse samples and focus on the discriminatory aspect of ageism and self-ageism of older adults. This study calls for a focus on ageism as a determinant of adoption of DT.
Fast Healthcare Interoperability Resources (FHIR)–Based Quality Information Exchange for Clinical Next-Generation Sequencing Genomic Testing: Implementation Study (Preprint)
Authors: Seong Donghyeong , Jung Sungwon , Bae Sungchul , Chung Jongsuk , Son Dae-Soon , Yi Byoung-Kee
Published: December 2020

BACKGROUND

Next-generation sequencing (NGS) technology has been rapidly adopted in clinical practice, with the scope extended to early diagnosis, disease classification, and treatment planning. As the number of requests for NGS genomic testing increases, substantial efforts have been made to deliver the testing results clearly and unambiguously. For the legitimacy of clinical NGS genomic testing, quality information from the process of producing genomic data should be included within the results. However, most reports provide insufficient quality information to confirm the reliability of genomic testing owing to the complexity of the NGS process.

OBJECTIVE

The goal of this study was to develop a Fast Healthcare Interoperability Resources (FHIR)–based web app, NGS Quality Reporting (NGS-QR), to report and manage the quality of the information obtained from clinical NGS genomic tests.

METHODS

We defined data elements for the exchange of quality information from clinical NGS genomic tests, and profiled a FHIR genomic resource to enable information exchange in a standardized format. We then developed the FHIR-based web app and FHIR server to exchange quality information, along with statistical analysis tools implemented with the R Shiny server.

RESULTS

Approximately 1000 experimental data entries collected from the targeted sequencing pipeline CancerSCAN designed by Samsung Medical Center were used to validate implementation of the NGS-QR app using real-world data. The user can share the quality information of NGS genomic testing and verify the quality status of individual samples in the overall distribution.

CONCLUSIONS

This study successfully demonstrated how quality information of clinical NGS genomic testing can be exchanged in a standardized format. As the demand for NGS genomic testing in clinical settings increases and genomic data accumulate, quality information can be used as reference material to improve the quality of testing. This app could also motivate laboratories to perform diagnostic tests to provide high-quality genomic data.
A two-stage multiproduct EMQ-based model with delayed differentiation and overtime option for common part’s fabrication
Authors: Peter Chiu Yuan-Shyi , Wang Yunsen , Chou Chung-Li , Chiu Tiffany
Published: December 2020

This study explores the two-stage multiproduct economic manufacturing quantity (EMQ)-based system with delayed product differentiation and overtime option for fabrication of common parts. The classic EMQ model determines optimal lot size under assumptions of steady production rate; however, managers of present-day’s manufacturing firms, operating in a highly competitive global business environment, must constantly seeks ways to strengthen their competitive forces, such strategies include: (i) to increase machine utilization through planning multiproduct fabrication; (ii) to evaluate different production schemes to reduce cost, e.g., a delayed differentiation strategy, when a common intermediate product exists in a multiproduct system, wherein all required common parts are manufactured in stage one and final multi-product are produced in the second stage; and (iii) to reduce the cycle time through implementing an overtime strategy. This study is motivated and intended to address the aforementioned real factors. We use mathematical modeling to depict the problem first, then employ the optimization technique to solve it. Our objectives are to not only decide the optimal replenishing policy, but also to explore the effect and joint influence of the postponement and overtime strategy on the optimal policy, machine utilization, system costs, and relevant cost components in the system. Without this in-depth investigation, various crucial information relating to decision making will still be inaccessible to managers in this field.
Hubungan Agama dan Budaya pada Masyarakat Gampong Kereumbok Kabupaten Pidie, Provinsi Aceh
Authors: Muhammad Muhammad
Published: December 2020

This research paper (article) aims to reveal the correlation between religion and culture of “Keureumbok village” community based on the theory proposed by Geertz. The researcher investigated the paradigm displayed through an interpretive anthropological context to pinpoint religion as a system consisting of various symbols that have meaning. According to Geertz, religion is labeled as a system of symbols that exists and constructs cultural patterns, which in turn can form a model. In other words, religion is a model for reality (truth), which can only be perfectly and precisely acquired through interpretations. An interpretative method is a way that socially presents and scrutinizes empirical data about the real truth (reality), or social fact. The more sources can be collected, the higher the trust will be earned. In the case of religion and culture in the lay community of “Keureumbok village” in Aceh, the researcher viewed that the link was more closely related.  It is found that “Keureumbok” people rely more on religious symbols, which are the manifestations of cultural elements. People, who previously value religion, instead decide to blend in religious life to avoid being shunned from the community to such an extent that religion and culture are interconnected in Aceh. Surprisingly, cultures dominantly play a role in society than in religious values. AbstrakArtikel ini bertujuan melihat kaitan agama dan budaya pada masyarakat Gampong Keureumbok berdasarkan teori yang diungkapkan oleh Geertz. Peneliti mengkaji kerangka pemikiran yang ditampilkan melalui konteks antropologis interpretatif. Untuk memahami agama sebagai suatu sistem yang terdiri atas berbagai simbol yang mempunyai makna. Menurut Geertz agama dideskripsikan sebagai suatu sistem simbol-simbol yang ada dan membuat pola-pola budaya, yang pada gilirannya dapat membentuk model. Dengan kata lain, agama adalah model untuk realitas hanya dapat diperoleh dengan baik dan tepat melalui cara-cara interpretasi. Metode interpretatif adalah sesuatu cara yang menyajikan dan menjelaskan data empiris secara sosial mengenai kenyataan yang  sesungguhnya (realitas), social fact (fakta sosial). Semakin banyak sumber laporan maka akan muncul kepercayaan yang tinggi terhadap laporan tersebut. Refleksi penulis dalam kasus agama dan budaya pada masyarakat awam di Keureumbok Aceh, lebih erat kaitannya. Penulis menemukan bahwa masyarakat Keureumbok lebih percaya pada symbol agama yang merupakan manifestasi dari unsur budaya. Masyarakat yang sudah memahami agama justru memilih melebur dalam kehidupan keagamaan, agar tidak dikucilkan dari kelompok masyarakat, sehingga di Aceh agama dan budaya saling terkait dan bahkan lebih dominan budaya yang berperan dalam masyarakat dari pada nilai-nilai agama.
El paciente con cefalea durante el ejercicio en urgencias
Authors: Ramos Romero Marta Liliana , Cavanzo Henao Paula
Published: December 2020

La cefalea relacionada con la actividad física no es infrecuente. En pacientes jóvenes suele corresponder a cefalea por esfuerzo físico primaria. Sin embargo, aun en la presencia de características típicas, el diagnóstico de cefalea primaria relacionada con el ejercicio debe hacerse luego de una investigación exhaustiva. Las causas secundarias típicas incluyen hemorragia subaracnoidea, síndrome de vasoconstricción cerebral reversible y disección arterial. Una etiología menos común es la trombosis de senos venosos durales. En esta revisión presentamos el caso de una mujer joven que experimentó cefalea durante una prueba física, en quien se documenta una trombosis de senos venosos extensa.
El adulto mayor con cefalea en urgencias
Authors: Bohórquez Valderrama Stephania , Sobrino Mejía Fidel Ernesto
Published: December 2020

Los adultos mayores conforman una población con características especiales que constituyen un reto tanto diagnóstico como terapéutico en el abordaje de las cefaleas. Si bien las cefaleas primarias son las que se presentan con mayor frecuencia en este grupo poblacional, alcanzando hasta un 66 %, también es necesario conocer acerca de las principales cefaleas secundarias que se pueden presentar y sobre todo las que representan algún riesgo o ponen en peligro la vida del paciente. Por esto, hicimos una revisión de la literatura disponible acerca del tema, con el fin de ofrecer una guía actualizada y de fácil acceso para todos. El texto inicia con un caso clínico diseñado por los autores, con su respectiva discusión, se presentan algunos datos epidemiológicos y luego se describen las cefaleas primarias y secundarias, así como las neuralgias más frecuentes en los adultos mayores. Finalmente, se mencionan algunas cefaleas no tan frecuentes pero que deben ser consideradas, además de algunos aspectos terapéuticos al respecto.
La paciente embarazada con cefalea en urgencias
Authors: Muñoz Cerón Joe Fernando , Osorio Andrea
Published: December 2020

El diagnóstico del dolor de cabeza en mujeres embarazadas representa un reto en la práctica clínica diaria. Si bien esta condición fisiológica se ha descrito como un factor de riesgo al momento de considerar etiologías secundarias, es adecuado plantear la utilidad de los criterios ICHD 3 como herramienta útil para diferenciar etiologías primarias de no primarias; esto especialmente cuando las banderas rojas tradicionales están ausentes.
El adolescente con cefalea en urgencias
Authors: Jiménez Jaramillo Juan Diego
Published: December 2020

Dado que la cefalea es un motivo de consulta frecuente a urgencias durante la edad pediátrica, en especial dentro del grupo de los adolescentes, es de vital importancia reconocer su etiología para poder hacer un abordaje más acertado. Por ello, es necesario conocer que la gran mayoría de las veces la cefalea se deberá a una causa primaria (migraña o cefalea de tipo tensión) o secundaria a procesos infecciosos triviales (infecciones respiratorias, urinarias o gastrointestinales) y en número reducido de casos será secundaria a procesos de mayor gravedad, los cuales tendrán que excluirse mediante un buen interrogatorio, exploración física y estudios complementarios para evitar que se ponga en riesgo la integridad del adolescente.
Branch-like gas in a commercial diver’s liver: a case report
Authors:   Dept. of Hyperbaric Medicine, No. 971 Hospital of the People’s Liberation Army Navy, Qingdao, 266071, China, Yu Tao , Liu Lina ,   Dept. of Medical Imaging, No. 971 Hospital of the People’s Liberation Army Navy, Qingdao, 266071, China, Xu Fei ,   Dept. of Neurosurgery, Shenzhen People’s Hospital, Shenzhen, 518020, China, Wu Di ,   Dept. of Hyperbaric Medicine, No. 971 Hospital of the People’s Liberation Army Navy, Qingdao, 266071, China, Su Yushun ,   Dept. of Medical Laboratory Testing, Laoshan Branch of the No.971 Hospital of the People’s Liberation Army Navy, Qingdao, 266071, China, Sun Qing ,   Dept. of Hyperbaric Medicine, No. 971 Hospital of the People’s Liberation Army Navy, Qingdao, 266071, China,   Dept. of Special Medicine, Qingdao University, Qingdao, 266071, China
Published: December 2020

We report the case of a 42-year-old commercial diver who presented with palpitations, arthralgia, tachypnea and vomiting after three hours of repetitive dives to 25-30 meters below sea level(msw). He was diagnosed with severe decompression sickness (Type II DCS) based on his dive history, his abrupt ascent to the surface within minutes, and systemic symptoms with mild hypovolemic shock. Besides remarkable cutis marmorata on the torso, the patient was also found positive for diffuse branch-like pneumatosis in the liver, mesentery and intestines on an abdominal computed tomography (CT). His vitals were relatively stable, with a soft distended abdomen and mild tenderness over the right upper quadrant. He was treated with hyperbaric oxygen (HBO2) treatment in addition to essential crystalloid resuscitation. The abdominal pneumatosis resolved completely after two HBO2 sessions. Post-diving intra-abdominal pneumatosis is a rare complication of DCS. In our case it was difficult for dive doctors to diagnose promptly because an emergency abdominal CT was not a routine for potential DCS cases. We propose that a contrast-enhanced abdominal CT, which usually involves a intravenous injection of imaging agent, should be considered in emergency management of these patients, especially when they present with gastrointestinal symptoms.
HBO2 for sudden sensorineural hearing loss
Authors: LeGros Tracy Leigh , Murphy-Lavoie Heather ,   Clinical Professors, Section of Emergency Medicine, Louisiana State University, University Medical Center, New Orleans, Louisiana
Published: December 2020

Sudden sensorineural hearing loss (SSNHL) presents as an abrupt onset of hearing loss; 88% of these presentations are idiopathic (ISSHL). Many mechanisms of injury and etiopathologies have been postulated, but they share a common result – hypoxia of the organ of Corti leading to hair cell-cilia fusion, synaptic, dendritic swelling and sustained depolarization. Of all of the various treatments tried, only corticosteroids and hyperbaric oxygen (HBO2) therapy have shown benefit in randomized controlled trials (RCTs). This paper reviews the pathophysiology of SSNHL, the variety of treatments studied, and the best evidence (both retrospective case controlled and prospective randomized controlled studies) for the use of HBO2 and corticosteroids. The best results are obtained when these two treatments are combined and initiated within 14 days of symptom onset. HBO2 is given at 2-2.5 ATA for 90 minutes for 10-20 sessions. Steroids should be dosed at 1mg/kg/day and slowly tapered over two to three weeks. If a patient is not a good candidate for or refuses systemic steroids, good results have also been obtained using intratympanic (IT) steroids in combination with HBO2. Patients should be followed by and otolaryngologist before, during and following HBO2. For severe hearing loss treatment with HBO2 improves by 37.7 dB, 19.3dB for those with moderate loss and 15.6 dB improvement overall. These recoveries, on average, improve a patient’s hearing from ranges requiring hearing aids and sign language, to levels at which normal or near-normal hearing is restored.
Physiological shear stress enhances differentiation and mucus-formation of intestinal epithelial cells in vitro.
Authors: Lindner Marcus , Laporte Anna , Block Stephan , Elomaa Laura , Weinhart Marie
Published: December 2020

The gastrointestinal (GI) mucus layer plays a pivotal role in tissue
homoeostasis and functionality of the gut. However, due to the shortage
of affordable, realistic in vitro mucus models, studies with deeper
insights into its structure and characteristics are rare. To obtain an
improved mucus model, we developed a reusable culture chamber
facilitating the application of physiologically relevant GI shear
stresses (0.002-0.08 dyn/cm) to cells in a bioreactor
system. Differentiation of a confluent monolayer of human
mucus-producing epithelial HT29-MTX cells was monitored under dynamic
and static culture conditions. Cells under flow remained highly
proliferative and analysis via confocal microscopy revealed superior
reorganization into 3-dimensional villi-like structures compared to
static culture (up to 120 vs. 80 µm in height). Additionally, the median
mucus thickness was significantly increased under dynamic conditions
compared to static culture (41±14 vs. 29±14 µm) with a simultaneous
drastic reduction of culture time from three to two weeks for sufficient
maturation into goblet-like cells. We demonstrated the impact of culture
conditions on the differentiation of HT29-MTX cells, revealing
outstanding in vivo like reorganization of cells and the production of
thick adherent mucus networks when cultured under physiological shear
stress using our newly designed culture chamber.
Designing Solar Oven Suggested Time: (90/100 minutes) 1. Overview
Authors: Esapzai Ishtiaq Ahmad
Published: December 2020

The pupils will learn what solar energy is and how it can be used for various purposes. We will discuss how sunlight heat can be doubled with the use of aluminum and black sheet. This project will open doors to many ideas in students mind regarding the use of solar energy for different purposes in different ways. Solar Oven is a simple project so this will encourage students to create more projects, using solar energy, on their own.
Determination of the residence-time distribution in industrial dryer for the production of recycled polyester
Authors: Zauli da , Bastos Izabella , Perna Rafael , Villalba Morales
Published: December 2020

The study proposes the evaluation of the residence-time distribution (RTD) in situ in an industrial dryer for the production of recycled polyester fibers (PES) from colorless polyethylene terephthalate (PET) flakes without interruption of the production. A disturbance of the pulse type was employed, in which the tracer (blue PET flakes) had previously been crystalized and its concentration was obtained according to the time at the dryer outlet. Additionally, analyses of intrinsic viscosity and crystallization percentage of the PET flakes (colorless and blue) and PES intrinsic viscosity and color force were performed. By RTD, the mean residence time (322.8 min), the variance (1305.4 min2), the standard deviation (36.1 min) and the relative error (1.5%) were obtained when compared to the theoretical residence time, indicating the absence of preferred paths or flake agglomerates in the equipment. Finally, the characterization demonstrated that there was no alteration in the parameters of product quality during RTD evaluation, confirming the potential of application of this methodology for diagnoses of continuous industrial processes.
Classification of left invariant metrics on 4-dimensional solvable Lie groups
Authors: Sukilovic Tijana
Published: December 2020

In this paper the complete classification of left invariant metrics of
arbitrary signature on solvable Lie groups is given. By identifying the Lie
algebra with the algebra of left invariant vector fields on the
corresponding Lie group ??, the inner product ??,?? on g = Lie G extends
uniquely to a left invariant metric ?? on the Lie group. Therefore, the
classification problem is reduced to the problem of classification of pairs
(g, ??,??) known as the metric Lie algebras. Although two metric algebras
may be isometric even if the corresponding Lie algebras are non-isomorphic,
this paper will show that in the 4-dimensional solvable case isometric means
isomorphic. Finally, the curvature properties of the obtained metric
algebras are considered and, as a corollary, the classification of flat,
locally symmetric, Ricciflat, Ricci-parallel and Einstein metrics is also
given.
Interpretable Machine Learning Framework Reveals Robust Gut Microbiome Features Associated With Type 2 Diabetes
Authors: Gou Wanglong , Ling Chu-wen , He Yan , Jiang Zengliang , Fu Yuanqing , Xu Fengzhe , Miao Zelei , Sun Ting-yu , Lin Jie-sheng , Zhu Hui-lian , Zhou Hongwei , Chen Yu-ming , Zheng Ju-Sheng
Published: December 2020

OBJECTIVE

To identify the core gut microbial features associated with type 2 diabetes risk and potential demographic, adiposity, and dietary factors associated with these features.

RESEARCH DESIGN AND METHODS

We used an interpretable machine learning framework to identify the type 2 diabetes–related gut microbiome features in the cross-sectional analyses of three Chinese cohorts: one discovery cohort (n = 1,832, 270 cases of type 2 diabetes) and two validation cohorts (cohort 1: n = 203, 48 cases; cohort 2: n = 7,009, 608 cases). We constructed a microbiome risk score (MRS) with the identified features. We examined the prospective association of the MRS with glucose increment in 249 participants without type 2 diabetes and assessed the correlation between the MRS and host blood metabolites (n = 1,016). We transferred human fecal samples with different MRS levels to germ-free mice to confirm the MRS–type 2 diabetes relationship. We then examined the prospective association of demographic, adiposity, and dietary factors with the MRS (n = 1,832).

RESULTS

The MRS (including 14 microbial features) consistently associated with type 2 diabetes, with risk ratio for per 1-unit change in MRS 1.28 (95% CI 1.23–1.33), 1.23 (1.13–1.34), and 1.12 (1.06–1.18) across three cohorts. The MRS was positively associated with future glucose increment (P < 0.05) and was correlated with a variety of gut microbiota–derived blood metabolites. Animal study further confirmed the MRS–type 2 diabetes relationship. Body fat distribution was found to be a key factor modulating the gut microbiome–type 2 diabetes relationship.

CONCLUSIONS

Our results reveal a core set of gut microbiome features associated with type 2 diabetes risk and future glucose increment.
Independent Observational Analysis of Ulcer Outcomes for SINBAD and University of Texas Ulcer Scoring Systems
Authors: Leese Graham P. , Soto-Pedre Enrique , Schofield Christopher
Published: December 2020

OBJECTIVE

The aim of this study was to compare the University of Texas (UT) and Site, Ischemia, Neuropathy, Bacterial Infection, and Depth (SINBAD) foot ulcer scores in predicting ulcer outcome within a routine diabetes foot clinic.

RESEARCH DESIGN AND METHODS

From 2006 to 2018, data were collected from all patients attending an outpatient diabetes foot clinic with an active ulcer not healed within 4 weeks. UT and SINBAD were compared in predicting ulcer outcome. A unified numerical score for UT was constructed and compared with UT grade (depth) and stage scores. Outcomes included death, a healed ulcer, or a nonhealed ulcer, which included major or minor amputation and nonhealing chronic ulcers.

RESULTS

Outcomes were available from 1,645 ulcer outcomes in 1,068 patients (mean [SD] age 65.4 [4] years, 72% male), of which 1,108 (67%) healed. With exclusion of death as an adverse outcome, the c-statistic (area under operator curve) was 0.67 (95% CI 0.65–0.71) for UT grade/depth and 0.64 (0.61–0.67) for UT stage. The new unified UT score had an improved c-statistic of 0.71 (0.68–0.74). The c-statistic was 0.72 (0.69–0.75) for SINBAD. There was a stepwise decrease in the proportion of ulcers healed for each increased score on ulcer grading for both grading schemes.

CONCLUSIONS

This large and independent observational comparison, in a real-world clinical setting, demonstrated that the UT and SINBAD diabetes foot ulcer grading schemes had similar prognostic ability for predicting foot ulcer outcomes. We have devised and validated a unified numerical scoring system for UT.
Participation in Boys & Girls Clubs Of Winnipeg is Associated With Health, Social and Education Outcomes Among Metis Children
Authors: Enns Jennifer , Brownell Marni , Nickel Nathan , Sanguins Julianne , Sarkar Joykrishna , Burland Elaine , Chartier Mariette , Chateau Dan , Katz Alan
Published: December 2020

IntroductionThe Boys & Girls Clubs of Winnipeg (BGCW) provide out-of-school programs to children and youth living in low-income neighbourhoods in Winnipeg, Canada. These programs aim to set participants on a path to success by supporting healthy behaviours, academic achievement and social skills. Metis children and youth make up a substantial proportion of BGCW participants, but there are few empirical data available on how the programs influence health, social and education outcomes in this population.

Objectives and ApproachWe linked BGCW attendance records for all Manitoba children born 1987-2010 to the individual-level administrative health, social and education data in the population-based Data Repository at the Manitoba Centre for Health Policy in Winnipeg. The comparison group of non-participants was matched on age and neighbourhood of residence. We narrowed the cohort to Metis participants by linking to datasets containing Metis identifiers. Education outcomes were examined using a generalized additive model, and health and justice system outcomes with a time-to-event model, adjusted for socioeconomic status, mother's mental health and age at first birth, and involvement in the child welfare system.

Results1,664 Metis children and youth participated in BGCW from 2005-2016. The comparison group comprised 9,248 Metis children and youth. Greater BGCW participation was associated with higher likelihood of performing well in grade 3 numeracy (boys and girls) and grade 7 student engagement (boys only), but not other education outcomes (grade 3 reading, grade 7 mathematics, grade 7/8 reading/writing, or graduating high school). Greater BGCW participation was also associated with lower risk of becoming involved with the justice system (i.e., lower risk of being charged with a crime) and with lower risk of teen pregnancy.

Conclusion / ImplicationsParticipation in BGCW programs may contribute to improved health, justice and education outcomes for Metis children and youth in Winnipeg.
Maternal Depression in Early Childhood and Developmental Vulnerability at School Entry
Authors: Wall-Wieler Elizabeth , Roos Leslie L. , Gotlib Ian
Published: December 2020

IntroductionStudies on the relationship between exposure to maternal depression in early childhood and childhood development have been limited by small samples, lack of information on timing of maternal depression, and use of a composite measure of childhood development.

Objectives and ApproachWe linked multiple Manitoba datasets to examine the relationship between exposure to maternal depression in early childhood and childhood development at school entry across five domains, and age at exposure to maternal depression on developmental outcomes using a population-based cohort (n = 52,103). Maternal depression was defined using physician visits, hospitalizations, and pharmaceutical data, while developmental vulnerability was assessed using the well-validated Early Development Instrument. Relative risk of developmental vulnerability was assessed using log-binomial regression models, adjusted for maternal and childhood characteristics at the birth of the child.

ResultsChildren exposed to maternal depression before age 5 had a 17% higher risk of having at least one developmental vulnerability at school entry than children not exposed to such depression before age 5. Exposure to maternal depression before age 5 was most strongly associated with social competence (aRR = 1.28, 95% CI 1.20, 1.38), physical health and well-being (aRR = 1.28, 95% CI 1.20, 1.36), and emotional maturity (aRR = 1.27, 95% CI 1.18, 1.37). For most developmental domains, exposure to maternal depression before age 1 and between ages 4 and 5 had the greatest association with developmental vulnerability.

Conclusion / ImplicationsOur findings that children exposed to maternal depression were at higher risk of developmental vulnerability at school entry is consistent with previous studies. However, we found that the association between exposure to maternal depression and development varied across developmental domains, and the relationship varied depending on the age of exposure to maternal depression. Ongoing analyses of discordant cousins will shed more light on the causal nature of this relationship.
Challenges in Data Linkage – Experiences from An Upper Gastrointestinal Cancer Data Linkage Study
Authors: Khan Nadia N , Ioannou Liane , Pilgrim Charles , Earnest Arul , Maharaj Ashika , Croagh Daniel , Liew Danny , Atwood David , Holland Jennifer , Philip Jennifer , Emery Jon , Ijzerman Maarten , Brown Wendy , Zalcberg John , Evans Sue
Published: December 2020

IntroductionNearly one quarter of a million Australian workers experience a work injury annually and make a benefit claim through one of the nation’s eleven workers’ compensation (WC) systems. The total cost to Australian society has most recently been estimated at $61.8 billion or 4.1% of GDP. The disaggregation of legislative responsibility between jurisdictions has contributed to a lack of common data standards, and thus minimal understanding of the efficiency or effectiveness of service provision in the Australian WC sector.

Objectives and ApproachThis project developed a new multi-jurisdictional work disability database including detailed information on work disability duration, health and social care service provision. Service level payment data contained in structured WC insurance claims datasets held by five large WC jurisdictions with >60% coverage of the Australian labour force was collected for all cases of work-related low back pain, fractures and limb soft tissue disease over between 2010 and 2015. Database development involved creation and coding of harmonised service-level indicators for individual episodes of healthcare provision and weekly periods of wage replacement.

ResultsA total of 253,000 cases and 10.7 million service episodes are included in the database. Initial exploratory analyses focused on the frequency, prevalence, timing, intensity and continuity of General Practitioner (GP) services to each of the injury groups. Regression modelling examined occupational, injury, demographic and jurisdictional factors affecting GP service use outcomes. As anticipated, service patterns varied by injury type, age, gender and occupational group. Significant differences in service use between WC jurisdictions were observed.

Conclusion / ImplicationsThis exploratory study demonstrates the feasibility of developing a population-based service level database for monitoring health service delivery to injured Australian workers. Future studies will examine the impact of jurisdictional policy differences on service delivery, and the relationship between service delivery and outcomes such as disability duration.
Tracking the Development of Multimorbidity In the Australian Longitudinal Study on Women’s Health
Authors: Dobson Annette , Anderson Amy , Cavenagh Dominic , Egan Nick , Fitzgerald David , Forder Peta , Hockey Richard , Loos Colleen , Loxton Deborah , Waller Michael , Xu Zhiwei , Mishra Gita , Byles Julie
Published: December 2020

IntroductionWith population ageing the prevalence of multi-morbidity (the co-occurrence of two or more chronic medical conditions) is increasing.

Objectives and ApproachOur goal was to use data linkage to obtain clinically validated data on the incidence of a range of common chronic conditions developed by participants in the Australian Longitudinal Study on Women’s Health (57,000 women) and hence to track the cumulative incidence of multi-morbidity over time.

ResultsThe major data sources differed for different conditions, e.g. the Pharmaceutical Benefits Scheme was important for identifying musculoskeletal conditions, whereas hospital admission data was crucial for identifying stroke. The most common combinations of conditions differed for women at different ages, e.g., mental health, musculoskeletal and respiratory conditions were most common for women born in 1989-95, whereas heart disease was a prominent part of multi-morbidity for women born in 1921-26. Among these older women about 50% had 3 or more chronic conditions in 2002 (when they were aged 76-81) and this increased to over 80% by 2015 (when they were 89-93). For comparison, among women born in 1973-78 fewer than 5% had 2 or more chronic conditions in 2002 (when they were aged 24-29) and this increased to about 15% in 2016 (when they were 38-43).

Conclusion / ImplicationsRecord linkage from multiple data sources, repeated over a long time span, is a powerful method for studying the development of multi-morbidity patterns in cohorts.
Identifying Incident Cancer Cases in Medicine Dispensing Claims: A Validation Study Using Australia’s Pharmaceutical Scheme (PBS) Data
Authors: Daniels Benjamin , Tervonen Hanna E , Pearson Sallie-Anne
Published: December 2020

IntroductionDispensing claims are used commonly as proxy measures in pharmacoepidemiological studies, however, their validity is often untested.

Objectives and ApproachWe quantified the level of ascertainment and potential biases arising when using dispensing claims to identify incident cancer cases in cohort studies. We used Department of Veterans’ Affairs client data linked with the New South Wales (NSW) Cancer Registry and Repatriation and Pharmaceutical Benefits Scheme data. We included clients aged ≥65 residing in NSW between July 2004 and December 2012. We matched clients with a cancer diagnosis to clients without a diagnosis based on demographic characteristics and available observation time. We used dispensing claims for anticancer medicines dispensed between July 2004 and December 2013 as a proxy for cancer diagnosis and calculated sensitivity, specificity, positive predictive values and negative predictive values compared with cancer registry data (gold standard), overall and by cancer site. We illustrated the potential for misclassification by the proxy in a cohort of people initiating opioid therapy.

ResultsWe identified 15,679 incident cancer diagnoses in 14,112 clients from the cancer registry and 62,663 clients without a diagnosis. The proxy’s sensitivity was 30% for all cancers and ranged from 10-67% for specific cancers. Specificity was >90% for all cancers. The proxy correctly identified 26% of people with a cancer diagnosis who initiated opioid therapy, failed to identify 74% those with a cancer diagnosis, and was most robust for clients with breast cancer (61% were correctly identified).

Conclusion / ImplicationsUse of anticancer medicine dispensings for identifying people with incident cancer diagnosis is a poor proxy. Excluding people with evidence of anticancer medicine dispensing from cohort studies may remove a disproportionate number of women with breast cancer. Researchers excluding or otherwise using anticancer medicine dispensing to identify people with cancer in pharmacoepidemiological studies should acknowledge the potential biases introduced to their findings.
Predicting Care Homes with Limited Residential Information
Authors: Hollinghurst Joe , Akbari Ashley , Rodgers Sarah E , Lyons Ronan A , Watkins Alan , Fry Richard
Published: December 2020

IntroductionResearch involving care homes is often difficult due to a lack of data and ethical issues. Wales (United Kingdom) contains approximately 1.3million residences, of these 717 are officially recorded as care homes for older people.

Objectives and ApproachOur objective was to develop a predictive methodology for identifying care homes in administrative data.

We used two data sources within the Secure Anonymised Information Linkage Databank to conduct our study. The Welsh Demographic Service Dataset (WDSD) contains all residences in Wales and demographic details of their occupants. An anonymised dataset of deterministically matched care home addresses was used to determine which of the residences in the WDSD were care homes.

We used details in the WDSD to determine the average age of the occupants, the number of people who moved into the residence in a year, and the number of people who died in a year. We were interested in care homes for older people and restricted all the residences in the WDSD to only those with an average age of 50+ years. We applied logistic regression to determine a probabilistic match for care homes based on the above characteristics. We determined an optimal cut-point for the probability of a residence being a care home based on the sensitivity and specificity.

ResultsRestricting the WDSD to have an average age of occupants of 50+ created a dataset of 3,939 residences, containing 562 care homes. After applying the logistic model to predict the care homes, we found an optimal probability cut-point which resulted in 548 true positives, 105 false positives, 14 false negatives, and 3,272 true negatives.

ImplicationsIdentification of care homes in an anonymised databank using only demographic data allows research into healthcare pathways for this hard to reach and under-researched population.
Provincial Overdose Cohort: Population Data Linkage During an Overdose Crisis
Authors: Xavier Chloé , Zhao Bin , Gan Wen Qi , Slaunwhite Amanda
Published: December 2020

IntroductionIn 2016, the Provincial Overdose Cohort (ODC) was created following the declaration of the public health emergency in British Columbia (BC), Canada. The ODC is a set of longitudinal and linked administrative data which identifies illicit drug-related overdose events, including death, ambulance, emergency room, hospital, physician, and prescription drug records.

Objectives and ApproachThe ODC was developed to better understand factors associated with overdose in order to support response activities, prevent overdose deaths, and identify trends and opportunities for interventions. Person-level linkages were conducted using provincial health insurance and health history data; socio-economic information, mental and physical illness diagnoses, and corrections history were also appended. The ODC currently includes people who have had a drug-related overdose between January 1 st 2015 and December 31 st 2017 as well as a 20% random sample of the general population.

ResultsThe ODC contains 36,576 overdose episodes and 23,161 people who have a drug-related overdose between January 1 st , 2015 and December 31 st 2017. Of the 23,161 people, 3,604 (15.6%) had a fatal overdose and 19,557 (84.4%) had a non-fatal overdose. 49.9% of people in BC who had an overdose were 20-39 years of age and 67.4% were males. From 2015 to 2017, the proportion of people experiencing 3 or more overdoses a year increased from 3.6% to 8.7%, respectively. There were an increasing number of fatal and non-fatal drug-related overdoses in BC during this time period.

Conclusion / ImplicationsLarge population data linkages can be invaluable tools during a public health emergency. Collaborative partnerships and a shared data governance across jurisdictions was central in building the ODC and understanding how various social determinants of health impact risk of overdose among people who use drugs.