bluuebunny/crossref_metadata_2025 huggingface dataset:
Building A Research Partnership Between Computer Scientists and Health Service Researchers for Access and Analysis of Population-Level Health Datasets
Authors: Schull Michael , Brudno Michael , Ghassemi Marzyeh , Gibson Garth , Goldenberg Anna , Paprica P. Alison , Rosella Laura , Stukel Thérèse , Victor J. Charles , Virtanen Carl
Published: December 2020

IntroductionThere is widespread enthusiasm to improve health through the application of artificial intelligence and machine learning (AI/ML) methods to large population-level health datasets. Achieving this may require successful collaboration between institutions as well as between computer scientists (CS), machine learning researchers (MLR) and health service researchers (HSR). The objective is to describe lessons learned in creating the Health Artificial Data and Analysis Platform (HAIDAP) in Ontario, Canada.

Objectives and ApproachA partnership between a HSR institute (ICES), an AI/ML institute (Vector) and a high-performance computing center (HPC4H) was initiated in 2017 to enable the application of AI/ML methods to population-level health data for the province of Ontario (population 14M). The HAIDAP was launched in 2019. We describe lessons learned (and being learned) following the HAIDAP’s launch.

ResultsMajor learnings include: 1)importance of institutional partnerships and alignment with institutional strategies; 2)potential of joint institutional risk-sharing models; 3)need for scientific collaborations bridging disciplines around joint research projects; 4)sensitivity to different scientific cultures (e.g., academic prestige of conference proceedings for MLR vs journal publications for HSR; traditional statistical vs. ML model assumptions); 5)differences in research timeline expectations; 6)different experience with and expectations for access to de-identified routinely collected data (e.g., need for research ethics committee project approvals and privacy impact assessments); 7)developing data access models that enable greater flexibility (e.g. importing code or using open source tools); 8) broadening data access models to allow modern high-dimensional exploratory data analysis; 9)obtaining support of information/privacy regulator; 10)hardware is (relatively) easy part compared to other success factors.

Conclusion / ImplicationsThe HAIDAP has enabled multi-disciplinary collaborations and novel AI/ML research of Ontario’s population-level health data. Collectively we have learned that additional effort is required to develop systems and processes enabling more efficient access to data and analytic tools for the analysis of administrative health data.
A National Level Case-Control Study for Determining Risk of Major Cardiovascular Events in People with Epilepsy
Authors: Torabi Fatemeh , Lee-Lane Ella , Lacey Arron , Fonferko-Shadrach Beata , Harris Daniel , Akbari Ashley , Lyons Ronan A , Rees Mark , Sawhney Inder , Halcox Julian , Powell Rob , Pickrell W Owen
Published: December 2020

IntroductionThe risk of cardiovascular events amongst people with epilepsy who are receiving enzyme-inducing anti-epileptic drugs (EIAEDs) seems to be higher than those on other medications and the general population. National-level record linkage enables development of case-control studies at a wider scope accounting for multiple factors.

Objectives and ApproachPeople with epilepsy were identified between 2003-01-01 and 2017-12-31 and were matched to a control group on: age, gender, deprivation quintile and year of diagnosis, accounting for any changes in clinical therapeutic guidelines. Primary and secondary care population records were linked to capture relevant comorbidities and major cardiovascular events. Annual district birth and death extract were used in combination with the Welsh Demographic Service (WDS) dataset to capture demographic and cardiovascular related death records. The WDS dataset was used to identify eligible control groups for each case and a linkage approach between the control and case database was developed for matching cases and controls with replacement and randomization. Survival analysis was conducted to evaluate the difference in time to first major cardiovascular event in patients receiving EIAED versus Non-EIAEDs and controls.

Results10,241 cases (mean age 49.6 years, 52.2% male) with diagnosis of epilepsy were matched to 35,145 controls. 3,180 (31.1%) cases received EIAEDs and 7,061 (68.9%) received non-EIAEDs. The risk of experiencing a major cardiovascular event was higher in cases compared to controls (adjusted hazard ratio 1.52,95%CI[1.50–1.55];p<0.001). There was no significant difference in cardiovascular events between those treated with non-EIAEDs and EIAEDs (adjusted hazard ratio 1.04,95%CI[0.95-1.12];p=0.407).

Conclusion / ImplicationsData linkage provides a unique opportunity and insight into studying disease risk factors. We have shown that individuals with epilepsy prescribed antiepileptic drugs, re at an increased risk of a major cardiovascular events regardless of treatment type (EIAED,NEIAED) compared with a matched control population.
Using the Canadian Institute for Health Information’s Information Quality Framework to Support Integration and Utilization of Complex, Multi-Jurisdictional Data
Authors: Willemse Chrissy
Published: December 2020

The Canadian Institute for Health Information (CIHI) provides essential information on Canada’s health systems and the health of Canadians. This presentation discusses information quality’s role in the integration and utilization of CIHI’s complex, multi-sector and multi-jurisdictional data.

IntroductionCIHI’s Data and Information Quality Program is recognized internationally for its comprehensiveness and high standards. As the need for linked data research increases, the requirements on quality continue to grow. CIHI’s multi-sector, multi-jurisdictional healthcare system and the varying health policies, care delivery models, and data collection practices that go with it pose challenges for researchers as they try to pull the data together in a comprehensive way. CIHI’s Information Quality Framework forms the foundation for addressing these challenges and ensuring data are fit for integration and are properly utilized.

Objectives and ApproachIn 2019, a connected data quality project was initiated to improve the usability of CIHI’s analytical data. Information quality framework concepts were applied across CIHI data sources to better understand data linkage challenges, measure inconsistencies across data sources, identify opportunities to improve data and standards, and develop resources to support users.

ResultsFindings from the project identified key connected data quality activities for the organization to operationalize. These focus on quality assessment and reporting; harmonization of data standards; expanded documentation and analytical resources; data classification and profiling tools to support descriptive analysis; and new source of truth and pre-linked datasets. Quality activities were prioritized based on need and complexity, and “connected data teams” were established to carry out the work.

Conclusion / ImplicationsExpansion of CIHI’s quality framework across data sources facilitates its data linkage capabilities and “connected data” use. It enables the evolution of CIHI’s analytical environments and information products from being database specific to integrated-data driven, and facilitates the use of CIHI’s analytical data for research.
Learnings from Multi-Source Enduring Linked Data Assets (MELDAS)
Authors: Neideck Geoff
Published: December 2020

IntroductionDemand continues to grow for accessible and large scale linked data assets to answer complex cross-sector, and cross-jurisdiction research questions. To meet this demand, a number of Multi-source, Enduring Linked Data Assets (MELDAs) have emerged including the National Integrated Health Service Infrastructure (NIHSI), National Disability Data Asset (NDDA) and Multi-Agency Data Integration Project (MADIP). Using these MELDAs has proven much more efficient than project-specific linkages, and provides consistent national data assets for multiple uses. However, the development of these assets raises new challenges, including complex data models, governance, and access arrangements, and new approaches to analysis.

Objectives and ApproachThrough developing the NIHSI Analytical Asset in collaboration with state/territory and Federal Government partners, the AIHW has identified challenges in traditional linkage approaches, which require innovative approaches to ensure high quality linkage. As AIHW commences scoping on new MELDAs, we are taking lessons from building the NIHSI and applying them to future design.

ResultsAIHW’s development of MELDAs across jurisdictions and portfolios provides new learnings on how to address advanced real world data integration issues. This review will focus on lessons learnt at the Australian Institute of Health and Welfare (AIHW) working with new data sharing arrangements, applications of technologies and innovative approaches to streamline MELDA processes.

Conclusion / ImplicationsThe learnings from the AIHW development of MELDAs will assist others developing enduring assets to establish effective sharing arrangements, governance and technical solutions to ensure efficient management. These learnings will save time and resources, and prompt further discussion on a gold standard for building MELDAs moving forwards.
Drug-Related Deaths Among Young People Involved in The Criminal Justice System: A Whole-Population Multi-Sectoral Data Linkage Study
Authors: Young Jesse T , Tibble Holly , Borschmann Rohan , Kinner Stuart A
Published: December 2020

IntroductionDrug-related death is substantially higher in formerly incarcerated adults compared to the general population. Despite this, remarkably little is known about the epidemiology of drug-related death among justice-involved adolescents. A richer understanding of drug-related mortality in justice-involved young people is essential for the development of effective, evidence-based interventions for this vulnerable group.

Objectives and ApproachIn a whole-population cohort of justice-involved young people in Queensland, Australia, we aimed to: 1) calculate the rate of drug-related death overall, and separately by intent and drug category; and 2) estimate the probability, and identify the predictors of, drug-related death. We probabilistically linked Youth Justice Queensland and National Death Index (NDI) records for every young person who came into contact with the youth justice system in Queensland between 1 January 1993 and 31 December 2014 (N=48,963). The NDI provided death data until 31 December 2017. Crude mortality rates (CMR) were calculatedoverall, separately by intent, and by prescribed versus illicit drug cause. Competing risk survival analysis will be conducted.

ResultsOf the 48,963 individuals, 1452 (3%) died by 31 December 2017. Of these, 204 (14%) deaths were due to drugs, yielding a CMR of 31 (95%CI:27-36) per 100,000 person-years. Most drug-related deaths were recorded as intentional (CMR=28; 95%CI:24-33 per 100,000 person-years) and deaths from prescribed medications were more common than illicit drugs (CMR=17; 95%CI:14-20 and CMR=11; 95%CI:9-14 per 100,000 person-years, respectively).

Conclusion / ImplicationsRates of drug-related deaths following contact with the youth justice system are disproportionately high and represent a major public health concern. Our findings highlight the importance of initiation of alcohol and other drug (AOD) treatment upon contact with the youth justice system and continuous engagement with community treatment after discharge from the youth justice system. Evidenced-base prevention strategies and efforts to improve the continuity of care are urgently needed.
Population-Wide Data Linkage to Reduce Premature Mortality in Women Who Use Mental Health Services In NSW
Authors: Wilson Elizabeth , Tervonen Hanna , Currow David , Sara Grant
Published: December 2020

IntroductionCancer deaths are a major contributor to premature mortality in people with mental health conditions. Some cancers occur more often in people with mental health conditions because of increased risk factors. However, most premature cancer mortality in people with mental health conditions arises from increased cancer case fatality rates due to health care related factors. While there is substantial evidence that a problem exists, further evidence is needed to support effective action and the translation of research findings into better policy, services and care.

Objectives and ApproachThe NSW Mental Health Living Longer program involves population-wide data linkage that combines records from nine NSW data collections. Our collection includes over 120 million records for more than nine million people. This presentation focuses on the use of linked data to develop indicators to support reporting on premature breast and cervical cancer mortality for women living with mental illness. These indicators will be used to identify variation in care, assess areas for targeted intervention, and evaluate the effectiveness of research translation into more effective care.

ResultsThis work is ongoing and will be finalised by August 2020. We will use regression techniques to examine predictors of participation in breast and cervical  cancer screening for women who use mental health services in NSW. These results will be used to assess geographical variation in risk-adjusted screening participation rates. We will also present methods and results for measuring incidence and stage at presentation, as well as 5 year survival for women who use mental health services in NSW.

Conclusion / ImplicationsIf cancer survival is a key measure of the effectiveness of healthcare systems, then reduced survival in people with mental health problems reflects less effective health care. Improving screening and treatment services is likely to be the most important strategy for reducing the cancer mortality gap for women with mental illness.
Identifying In-Hospital Complications Using Lookback Periods In Australian Health Administrative Datasets
Authors: Palamuthusingam Dharmenaan , Ratnayake Gishan , Hawley Carmel M , Pascoe Elaine M , Johnson David W , Fahim Magid
Published: December 2020

IntroductionThe condition onset flag (COF) variable was introduced into hospitalization coding practice in 2008 to distinguish ICD coded diagnoses as either preexisting, new or status unknown. For datasets with multiple hospitalizations per participant, the COF enables identification of diagnoses that may have arisen in between admissions thereby enriching datasets considerably. However, datasets preceding 2008 lack equivalent depth, potentially leading to data waste.

Objectives and Approach The aim of this study was to determine if a lookback period could accurately identify new onset conditions in datasets coded prior to 2008. Outcomes identified in an index admission and not present in the lookback period were classified as a new condition. Three different lookback periods entailing the preceding 3, 2, and immediately previous admission were investigated. Accuracy was determined by applying this procedure to datasets in which COF were assigned by coders and comparing agreement between the lookback procedure and the COF. Codes examined were myocardial infarction, pulmonary embolism and pneumonia. Sensitivity analyses excluded indexed admissions where a lookback period was not possible. True positives were those conditions correctly identified by the lookback periods when compared to that classified using the COF. The crude incidence rates were also determined.

Results248,042 hospital records from 12,355 patients on chronic kidney replacement therapy were analysed. Lookback Period 1 provided the highest true positive rates for all 3 complications, ranging from 83% to 92%. Sensitivity analyses excluding patients with no previous separations, demonstrated a true positive percentage from 98% to 100%. Lookback period 3 true positive rates were the lowest (77.2-78.3%). The crude incidence calculated for first-time myocardial infarction using Lookback Period 1 was 25 events per 1000 patient years, consistent with current literature. Rates calculated using the COF variable was more than 3-fold lower. This finding was similar when evaluating other clinical outcomes.

Conclusion / ImplicationsThe Lookback Period 1 method accurately identifies in-hospital complications compared with the current method using the COF variable and is a means of identifying new hospital complications in health administrative datasets predating the availability of COF, thereby enriching existing datasets and minimising data waste.
Maternal and Neonatal Outcomes Associated with Psychostimulant Use in Pregnancy
Authors: Camacho Ximena , Havard Alys , Zoega Helga , Wilson Margaret , Gomes Tara , Vigod Simone , Pearson Sallie , Henry David
Published: December 2020

IntroductionRecent evidence from the USA and Nordic countries suggests a possible association between psychostimulant use during gestation and adverse pregnancy and birth outcomes.

Objectives and ApproachWe employed a distributed cohort analysis using linked administrative data for women who gave birth in New South Wales (NSW; Australia) and Ontario (Canada), whereby a common protocol was implemented separately in each jurisdiction. The study population comprised women who were hospitalized for a singleton delivery over an 8 (NSW) and 4 (Ontario) year period, respectively, with the NSW cohort restricted to social security beneficiaries. Psychostimulant exposure was defined as at least one dispensing of methylphenidate, amphetamine, dextroamphetamine or lisdexamfetamine during pregnancy. We examined the risk of maternal and neonatal outcomes among psychostimulant exposed mothers compared with unexposed mothers.

ResultsThere were 140,356 eligible deliveries in NSW and 449,499 in Ontario during the respective study periods. Fewer than 1% of these pregnancies were exposed to psychostimulants during gestation, although use was higher in Ontario (0.30% vs 0.11% in NSW). Preliminary unadjusted analyses indicated possible associations between psychostimulant use in pregnancy and higher risks of pre-term birth (relative risk [RR] 1.7, 95% confidence interval [CI] 1.4-2.0 (Ontario); RR 1.8, 95% CI 1.2-2.6 (NSW)) and pre-eclampsia (RR 2.0, 95% CI 1.5-2.6 (Ontario); RR 2.0, 95% CI 1.2-3.5 (NSW)). Similarly, psychostimulant use was associated with higher risks of low birthweight (RR 1.6, 95% CI 1.3-1.9 (Ontario); RR 2.0, 95% CI 1.3-3.0 (NSW)) and admission to neonatal intensive care (RR 2.1, 95% CI 1.9-2.3 (Ontario); RR 1.5, 95% CI 1.1-1.9 (NSW)).

Conclusion / ImplicationsUnadjusted analyses indicate an increased risk of adverse maternal and birth outcomes associated with psychostimulant exposure during pregnancy, potentially representing a placental effect. We are currently refining the analyses, employing propensity score methods to adjust for confounding.
High Rate of Fatal Overdose After Release from Prison In BC, Canada: A Data Linkage Study
Authors: Kinner Stuart A , Gan Wenqi , Slaunwhite Amanda
Published: December 2020

IntroductionThe province of BC, Canada is in the grips of a sustained overdose epidemic. People released from prison are at increased risk of fatal drug overdose, but the impact of the overdose epidemic on mortality after release from prison in BC is poorly understood. Few studies have been able to examine risk factors for overdose death in this population.

Objectives and ApproachWe aimed to (a) measure risk of overdose-related and all-cause death in different time periods after release from prison; and (b) identify risk factors for overdose-related and all-cause death. In a random 20% sample of the population of BC, Canada, we identified those released from prison 2015-2017 and examined linked health and correctional records for this cohort.

ResultsOf 6106 persons released from prison 2015-2017, 77 (1.3%) died from any cause and 48 (0.8%) died from overdose 2015-2017. The incidence of all-cause death was 16.1 (95%CI 13.7-18.8) per 1000 person years, and the incidence of overdose death was 11.2 (95%CI 9.2-13.5) per 1000 person years. Risk factors for overdose death included a history of 3 or more incarcerations (HR=3.00, 95%CI 1.67-5.39), co-occurring substance use disorder and mental illness (HR=4.73, 95%CI 2.94-7.62), chronic physical morbidity (HR=3.10, 95%CI 1.97-4.88), and being dispensed benzodiazepines (HR=3.31, 95%CI 2.27-4.84) or opioids for pain (HR=6.77, 95%CI 3.86-11.89). The incidence of fatal overdose was significantly higher in the first two weeks post-release than at any other time during follow-up.

ConclusionPeople released from prison in BC are at markedly increased risk of preventable death, mainly due to overdose. As such, people transitioning from prison to the community should be a key target population for overdose prevention efforts. To be maximally effective, these efforts must go beyond provision of methadone and naloxone on release, to consider physical and mental health comorbidities, and psychosocial disadvantage.
Is Wellbeing Associated with Time Spent in Nature?
Authors: Rodgers Sarah E , Rowney Francis , Thompson Daniel , Mizen Amy , White Mathew , Lovell Rebecca , Fry Richard , Watkins Alan , Wheeler Benedict , Akbari Ashley , Stratton Gareth , Lyons Ronan , White RonanJames , Nieuwenhuijsen Mark , Geary Rebecca , Rodgers Sarah
Published: December 2020

IntroductionGreen and blue spaces (GBS), such as parks, woodlands, rivers, and beaches, are thought to be important for mental health and wellbeing. Our longitudinal cohort contains objective household-level environment data linked at the invidual level to routinely recorded mental health data, augmented with cross sectional self-reported health behaviours, including leisure visits to the outdoors.

Objectives and ApproachOur overall approach will evaluate if residential proximity to GBS is associated with mental health and wellbeing, and if any associations aremodified by visits to outdoors spaces following individual-level data linkage. Here, we examined cross-sectional survey data on time spent visiting nature outdoors. Wellbeing outcomes were assessed using self-reported scores. Data were analysed using generalised additive models in the SAIL Databank.

ResultsUsing a sample of National Survey for Wales respondents (2016/17, n=3,481), over 40% of adults in Wales reported spending less than 30 minutes outdoors each week. Weekly time outdoors was positively associated with wellbeing (p=0.007) and life satisfaction (p=0.03) having adjusted for potential confounders including, age, rurality, loneliness, employment status. Confidence intervals varied along the fitted GAM model. Models using a second wave of survey data (n≈7,000), anonymously record-linked to residential environment and health data will explore these associations further.

ConclusionA previous study based in England (White et al. 2019) found an upper wellbeing benefit threshold of 2 hours per week for time spent in nature. This was not apparent in our preliminary models, but may be revealed in further analyses. We will next incorporate longitudinal mental health and environmental data for 2 million adults living in Wales, UK. Linking to ambient and accessible residential GBS, while taking into account changes due to migration and actual visits, will allow us to provide valuable guidance to local government, who are often responsible for provisioning and maintaining outdoor facilities.
Creating A Validation Dataset to Test Record Linkage Algorithms in A Province-Wide South African Health Information Exchange
Authors: Mutemaringa Themba , Heekes Alexa , Smith Mariette , Tiffin Nicki , Boulle Andrew
Published: December 2020

IntroductionIncreasing use of digital medical records creates disparate data resources for the same health care client population; and harnessing the benefits of real-time health data requires effective data linkage. A South African Health Information Exchange (HIE) collates and links routine health data from multiple sources, running daily updates through an automated ETL process. Many existing deterministic and probabilistic algorithms link person-level data using demographic identifiers, and can be combined in an optimised methodological pipeline. The performance of such pipelines must be validated against known matched pairs. The HIE uses current algorithms for record linkage, but methods that rely on similar spelling, name frequency and phonetic matching have been optimised for non-African names, and are not as effective.

ObjectivesWe assessed common problems arising in the linkage process in the HIE, using this information to compile a curated representative African validation database for optimising existing and new linkage pipelines.

ResultsUsing current linkage algorithms, we have identified the proportion of duplicates in the last five years, ranging from 25% in 2015 and stabilising at 10% by 2019. Common causes of duplicates across the whole database include mismatch in first name (37%), surname (17%), date of birth (13%), sex (8%) and South African Identification Number (0.2%). Complications from new-born naming and records of twins affect >8% of all records, and temporary health identifiers assigned at birth, during emergency response, and during poor connectivity of facilities to the provincial patient master index affect 2% of records.

ConclusionsBased on these data, we have constructed a South African-specific, representative validation dataset that contains linkage pairs that represent placeholder phrases for newborns prior to naming (e.g. “baby of”), language variations; twins; character insertions, substitution and omissions in names with similar spellings; frequencies of names in the general population; and similar-sounding names.
Planting the S.E.E.D.S of Indigenous Population Health Data Linkage
Authors: Rowe Robyn K , Walker Jennifer D
Published: December 2020

IntroductionThe increasing accessibility of data through digitization and linkage has resulted in Indigenous and allied individuals, scholars, practitioners, and data users recognizing a need to advance ways that assert Indigenous sovereignty and governance within data environments. Advances are being talked about around the world for how Indigenous data is collected, used, stored, shared, linked, and analysed.

Objectives and ApproachDuring the International Population Data Linkage Network Conference in September of 2018, two sessions were hosted and led by international collaborators that focused on regional Indigenous health data linkage. Notes, discussions, and artistic contributions gathered from the conference led to collaborative efforts to highlight the common approaches to Indigenous data linkage, as discussed internationally. This presentation will share the braided culmination of these discussions and offer S.E.E.D.S as a set of guiding Indigenous data linkage principles.

ResultsS.E.E.D.S emerges as a living and expanding set of guiding principles that: 1) prioritizes Indigenous Peoples’ right to Self-determination; 2) makes space for Indigenous Peoples to Exercise sovereignty; 3) adheres to Ethical protocols; 4) acknowledges and respects Data stewardship and governance, and; 5) works to Support reconciliation between Indigenous Peoples and settler states. S.E.E.D.S aims to centre and advance Indigenous-driven population data linkage and research while weaving together common global approaches to Indigenous data linkage.

Conclusion / ImplicationsEach of the five elements of S.E.E.D.S interweave and need to be enacted together to create a positive Indigenous data linkage environment. When implemented together, the primary goals of the S.E.E.D.S Principles is to guide positive Indigenous population health data linkage in an effort to create more meaningful research approaches through improved Indigenous-based research processes. The implementation of these principles can, in turn, lead to better measurements of health progress that are critical to enhancing health care policy and improving health and wellness outcomes for Indigenous populations.
A Comparison of The Health Impacts of Individual Level and Area Based Welsh Government Fuel Poverty Schemes
Authors: Morrison-Rees Sian , Lowe Sarah
Published: December 2020

IntroductionLiving in a cold and/or damp house is known to increase the risk of morbidity, mortality and excess winter deaths. To reduce fuel poverty in Wales, the Welsh Government developed schemes to provide energy efficiency improvements to those most likely affected by fuel poverty.

We explored the relative impacts on health of an individual-level scheme, Warm Homes Nest, and an area-based scheme, Arbed.

Objectives and ApproachOverall aim: to evaluate the health impacts of Welsh Government funded schemes designed to reduce fuel poverty. Presented objective: to investigate the relative impact of the individual-level and area-based schemes on the health of recipients. A longitudinal dataset was created using the anonymised residence that received improvements linked to residents’ health measures using routine health records held in the SAIL Databank at Swansea University.

We used difference-in-difference (DID) estimations to compare any changes in recipient health before and after intervention with any concurrent change in health in those yet to receive the intervention.

ResultsAn analysis of the Warm Homes Nest Scheme, published in 2017 and presented at the IPDLN 2018 conference found a positive impact of the scheme on the health of recipients.

This presentation will describe the further analysis comparing the area-based Arbed scheme with both the recipients of the individual-level Nest scheme and groups in comparable need that had not yet received the intervention. We will present results focussing on the relative impacts of the two schemes on respiratory health, infection prescribing and mental health.

Conclusion / ImplicationsProviding home energy efficiency interventions has the potential to benefit population health, however there is a scarcity of evidence comparing different methods of implementing schemes. Our findings will inform more effectively focussed home energy efficiency schemes and potentially thus improve the health and wellbeing of people living in Wales.
Evaluating Machine-Learning Models for Predicting Hospital Transfers in Administrative Data: A Study of Admissions for Myocardial Infarction
Authors: Lopez Derrick , Lu Juan , Sanfilippo Frank , Briffa Tom , Hung Joe , Nedkoff Lee
Published: December 2020

IntroductionHospital administrative data is a valuable source to measure myocardial infarction (MI) rates. However, admission counts are susceptible to over-inflation if the patient is transferred multiple times during a single episode of care, and variables denoting transfers may not be reliable. To obtain an accurate number of events, hospital transfers need to be correctly identified.

Objectives and ApproachWe assessed multivariable logistic regression and various machine-learning models to predict transfers in hospital administrative data. Using Western Australian linked hospital data, we identified records from 2000-2016 with a principal discharge diagnosis of MI. Our standard method to compare against was a 24-hour look-back to identify a transfer using just admission and separation dates from the current and previous records for the same patient. Multivariable logistic regression and decision trees with various boosting algorithms were used to predict if a single record was a transfer, using variables recorded in the admission (e.g. age, sex, type of hospital, admitted from, emergency/elective admission). The performance of each model was calculated using metrics including area under the curve (AUC).

ResultsRecords in the training, validation and testing samples had similar characteristics: mean age=68.9 years, 66% were male and 58% admitted to tertiary hospitals. Gradient Boosting Decision Tree (AUC=0.887, 95%CI: 0.886-0.887) outperformed multivariable logistic regression (AUC=0.875; 95% CI: 0.869-0.881) and random forest models (AUC=0.859; 95% CI: 0.853-0.865).

Conclusion / ImplicationsMultivariable logistic regression and machine-learning models are able to identify transfers in a single record from existing variables. They can be used in unlinked hospital administrative data where records belonging to the same patient cannot be identified.
Academic Achievement Among Children with Congenital Heart Defects in Arkansas
Authors: Maity Suman , El-hassan Nahed , Goudie Anthony , Kaiser Jeffrey R , Nembhard Wendy N
Published: December 2020

Children with congenital heart defects (CHD) have impaired cognitive development.

The objective was to determine if children with CHDs differed in academic performance during elementary and middle school years from children without CHDs. Data from the state birth defects registry, Arkansas Reproductive Health Monitoring System (ARHMS), birth certificate records, and achievement test-scores (grades 3-8) from the Arkansas Department of Education were linked using unique identifiers for children born between 2000-2011 in Arkansas. Cases were identified using 6-digit British Paediatric Association codes and matched controls were assigned from birth certificate data. Proficiency (yes/no) on achievement tests was determined using standard thresholds per grade. Data were stratified based on sex, gestational age, and birth weight. Odds ratios (OR) and 95% confidence intervals (CI) were calculated from multivariate logistic regression adjusting for maternal education level and age, race/ethnicity, and infant sex.

A total of 3,730 children with CHDs and 7,385 children without CHDs were evaluated. Children with CHD were less likely to be proficient in early elementary school grades for mathematics (3rd: OR=0.72, 95% CI: 0.59, 0.87; 4th: OR=0.77, 95% CI: 0.62, 0.95) and literacy (3rd: OR=0.75, 95% CI: 0.63, 0.89; 4th: OR=0.72, 95% CI: 0.58, 0.90). The trend of being less proficient associated with CHD remained mostly consistent with sex, gestational age, and birth weight. In multivariate analysis, CHD was negatively associated with being proficient in mathematics and literacy. Maternal education (1-3 years beyond high school) was positively associated with test proficiency. Additionally, non-Hispanic (NH) black children had lower odds of being proficient compared to NH white children.

Educational performance was negatively associated with CHD in early elementary grades; there was no difference in later grades. However, larger sample sizes in later grades are necessary for reliable estimates. Maternal education and race/ethnicity were significant factors associated with childhood educational performance.
Changing Practice Patterns Among Canadian Primary Care Physicians: Cross-Provincial Analysis of Linked Health Data
Authors: Lavergne M. Ruth , Peterson Sandra , Ahuja Megan , Rudoler David , Goldsmith Laurie J , Grudniewicz Agnes , Marshall Emily Gard
Published: December 2020

IntroductionCanadians report persistent problems accessing primary care despite an increasing per-capita supply of primary care physicians (PCPs). There is speculation that PCPs, especially those early in their careers, may be working less and/or choosing to practice in focused clinical areas rather than comprehensive family medicine.

Objectives and ApproachOur objectives were to compare practice patterns among early-career (<10 years in practice) and established (10+ years) PCPs and to determine if any changes over time reflect cohort effects (attributes unique to recent cohorts of PCPs), or period effects (changes over time across all PCPs). We accessed linked population and physician registry data, physician billing data, hospital discharge records, and vital statistics in each of three Canadian provinces from 1996/7 to 2017/8. Physician fee schedules are negotiated separately by province which means that while fields capturing service dates, dollars billed, and diagnosis codes are directly comparable, other fields capture similar, but not identical information across provinces (e.g. specific fee codes and service location codes). We developed measures of services volume, continuity, and comprehensiveness of primary care that could be applied across provinces and used these to describe practice patterns over two decades and explore cohort and period effects.

ResultsMeasures of service volume (total patient contacts, number of unique patients seen) and continuity are lower among early-career physicians but the gap between early-career and established physicians has not changed. Measures of comprehensiveness of care, including provision of services in home, long-term care, hospital, and emergency department, as well as indicators of focused practice, hospitalist and locum care show more varied patterns, with declines in comprehensiveness across all physicians, but more evidence of focused practice among early-career physicians.

Conclusion / ImplicationsFindings have implications both for health workforce planning and organizational reforms to support access to comprehensive primary care.
Uso de propulsor mandibular fixo Flex Developer como recurso no tratamento da Classe II em paciente não colaborador
Authors: Rédua Renato Barcellos
Published: December 2020

Class II malocclusion has a high incidence in the population, which may compromise smile aesthetics, occlusion function and stability. Skeletal Class II may affect facial aesthetics and upper airway volume. Class II malocclusion is routinely associated with skeletal Class II condition, having as treatment alternatives the use of Extra Buccal Appliance (EBA) or removable or fixed propulsor appliance. This article describes a case of a patient who did not accept the use of EBA and so it was fitted a Flex Developer propulsor for Class II correction and discussed the advantages and disadvantages of therapeutic alternatives for Class II correction.
Rinomodelação: uma nova abordagem
Authors: Fontanari Roberta , Luiz Julia Jéssika de Freitas , Valarelli Fabricio Pinelli , de Freitas Karina Maria Salvatore
Published: December 2020

Non-invasive aesthetic procedures are growing in the natonal scene. Minimally invasive techniques performed in a short time, in a clinic environment, and with a more comfortable postoperative are alternatives very well-accepted by patients who need to improve some face features. One of the most sought procedures in orofacial harmonizaton is rhinomodeling. The professional who works associating eﬀective techniques of this specialty manages to restructure face regions what a short time ago was only possible with more invasive surgeries.
Abordagem Full Face para Harmonização Orofacial – relato de caso
Authors: de Oliveira Ane Micheline , Romano Andrea Puppin , Biazzeto Juliane Amaral Sprenger , Crivellaro Viviane Rozeira
Published: December 2020

The aging process involves physical, social, and psychological changes. With the increase in life expectancy, the demand for aesthetic treatments is increasingly noticed in the search for harmonious and slower aging. This article reports a clinical case of a 42-year-old female patent complaining of onset of skin ﬂaccidity and fall of the labial commissure, in additon to a tired and saddened appearance - known as “Sad Look”. A combination of common procedures in Orofacial Harmonization such as application of botulinium toxin, filling with plasma gel and filling with hyaluronic acid were used as a rejuvenation objective. The main results obtained were the reestablishment of the balance of muscular strength, the stimulation of collagen production and consequently the improvement of skin quality and lessen ﬂaccidity, as well as the the return of volume and lost facial contours.
Formation of the structure of gas-liquid, food dispersion non-equilibrium liquid systems in conditions of hydrodynamic and acoustic cavitation
Authors: Taleysnik Mikhail , Shcherbakova Natalia , Pesterev Mikhail , Savenkova Tatiana , Gerasimov Timofey
Published: December 2020

The present article illustrates the principles of the transition from macro static equilibrium to the equilibrium of micro static volume of liquid dispersion systems under conditions of the combination of two types of cavitation actions. In the process of food dispersion systems production, a non-equilibrium state is created. Properties of disperse systems are explained on the example of invert syrup. In static conditions were determined the principles of formation of aggregates: from sucrose molecules at the stage of sugar dissolution to formation of voids and gas-phase bubbles. Conditions of creation of the dynamic non-equilibrium state of syrup by combining hydrodynamic and acoustic cavitation are taken into consideration. The character of bubble state transformation in conditions of geometry flow in gas-liquid systems and sound oscillations excitation in them is shown. After the collapse of bubbles in the gas phase the nature of the conversion of highly concentrated gas-liquid systems is also represented. That was the determining factor in the formation of materials of new types. The practical output of the present work was the production of products in the conditions of combined cavitation effects.
Risk assessment tools available to inform a nurse practitioner’s determination of tolerable risk
Authors:   , Smith Ricki
Published: December 2020

Risk in health care, often discussed in terms of its tolerability, is an abstract term that is patient- and context-specific. An older adult living at risk can be someone falling frequently at home risking a fractured hip, to someone self-neglecting. Family Nurse Practitioners working in Primary Care are well-situated to support patients over time and to mitigate risk. A better understanding of the risk assessment tools available to inform a level of risk tolerability for Nurse Practitioners working in Primary Care may enhance clinical reasoning and enhance their comfort with the concept of risk, resulting in consistent care delivery for patients. Evidencebased literature highlights the complexity of both defining and assessing risk, which is further reflected within the assessment tools. For these reasons, the purpose of this integrative literature review is to provide recommendations, founded in current literature findings, regarding the comprehensive risk assessment tools used to inform a Nurse Practitioner’s determination of tolerable risk for community-dwelling older adults. A search of three databases, as well as hand searches, resulted in nine tools for analysis. The interpretation of the findings suggested that risk assessment tools varied in their approach to risk, with some focused preventatively on risk mitigation while others could be applied in real-time to assess the severity of a perceived risk. Each tool included elements of risk which together, comprise a comprehensive, holistic risk assessment to be considered in the ongoing assessment of tolerable risk. A positive risk-based approach is also a shift in risk perception that Nurse Practitioners are encouraged to consider. The implications for practice include how the described approaches guide decision-making and the definitions of tolerable and intolerable risk can steer the Nurse Practitioner’s care, as well as to inform future research and the development of new risk assessment tools.
A Speech Act Analysis of the Prime Minister's Speech Pertaining to the Movement Control Order (MCO) to Address the COVID-19 Pandemic in Malaysia
Authors: Ahmad Kamil Maisarah binti , Shamshul Bahrn Fatin Fatinah
Published: December 2020

Crisis management is a competency that needs to be possessed by all leaders of today to address the challenges and volatility of the world today. The COVID-19 pandemic is one of the most crucial examples of such volatility which has impacted the world today. Malaysia is one of the countries that was initially badly affected by the pandemic, and matters were made worse with the political turmoil in the country when there was a change in the prime minister as the COVID-19 cases rose in the country. This study analyses the direct and indirect speech acts in the text of the Malaysian prime minister’s speech on the first day the Movement Control Order (MCO) was implemented country-wide to curb the spread of the COVID-19 virus using the speech act theory by Searle (1969). From the direct speech act, the five classes of the illocutionary act (declaratives, representatives, expressives, directives, and commissives) were further identified and examined. The study found that expressives and directives were used the most in the direct speech acts, while the indirect speech acts carried the purpose to direct or persuade the audience. This study carries significance to the field of speech analysis and crisis management, as it depicts a strategy in which a country leader addresses its citizens during a time of political and worldwide crisis.
Dolomite surface modification with titanium and silicon precursors and its morphostructural and thermal characterisation
Authors: Sonmez Maria , Juganaru Mircea , Ficai Anton , Ficai Denisa , Oprea Ovidiu , Gurau Dana , Alexandrescu Laurentia , Stelescu Maria Daniela , Georgescu Mihai , Nituica Mihaela , Melinescu Alina , Marin Minodora
Published: December 2020

The aim of the paper is to modify the surface of dolomite with titania (TiO2) and silica (SiO2) precursors, in order to use it as a potential reinforcement material in a polymeric matrix or for environmental applications (photocatalyst for the degradation of organic pollutants based on TiO2). The dolomite surface modification was performed by 2 methods. The first method consisted in modifying the direct dolomite surface with SiO2 and TiO2. The second method consisted in the initial treatment of dolomite with TEOS, in order to form silanol bonds, followed by the addition of SiO2 and TiO2 precursors. The obtained powders were characterized by FTIR, SEM-EDS and DSC-TG. The FTIR spectra prove the formation of the silica network while the samples modified with PDMS exhibit the characteristic peaks of methyl groups from PDMS. In EDS, the presence of the characteristic elements of dolomite (calcium, magnesium, oxygen and carbon) can be observed. When analyzing the modified dolomite powders the presence of titanium and silicon can be observed. The characteristic morphology of the dolomite is preserved in all the samples but, the surface of the larger particles is decorated with smaller particles proving the functionalization of the dolomite, according to the two routes. The thermal analysis is characteristic for dolomite-based materials, the main difference between the samples appearing as a consequence of the burning of the organic part of PDMS, which occur between 400 and 600°C.
Comparative study of the surface properties for some different types of leather finishes
Authors: Chelaru Ciprian , Ignat Madalina-Camelia , Constantinescu Rodica Roxana
Published: December 2020

A surface characteristic of leather is an important parameter in shoe industry. During the usage, the surface of shoes is the main barrier against the environment (mostly water). The macroscopic and microscopic evaluation is useful to see the surface aspect (surface defects, continuity of finish, cracks). Test for hydrophilic/hydrophobic activity is important for the leather. In this way we can estimate if the finishing touches absorb or repel the water. Microbiological test is also important, because during an intense usage, inside the shoes are released a lot of chemicals through foot perspiration that can provide a perfect environment for development of mold and bacteria in the main structure of the shoe. The samples for this study will be five bovine leathers with different finishes.