bluuebunny/crossref_metadata_2025 huggingface dataset:
Growth Convergence and Divergence in SAARC
Authors: Khan Ghulam Yahya , Daly Vince
Published: September 2018

We test for output convergence during 1960-2017 amongst the leading member countries of the South Asian Association for Regional Cooperation (SAARC): Bangladesh, India, Nepal, Pakistan and Sri Lanka. The context is SAARC’s commitment to eventual monetary union. Existing research, using established unit root tests, finds little support for the convergence hypothesis, even when structural breaks are permitted. We use two more recently developed approaches, both of which allow greater flexibility in the depiction of convergence. The method developed by Enders and Lee (2011) allows for a smoothly evolving trend in relative per capita incomes, rather than a (possibly breaking) linear trend. The technique introduced by Phillips and Sul (2007, 2009) allows for the possibility of convergent sub-groups. Even with these more accommodating test procedures, we find minimal evidence of growth convergence within the full group of countries. We find that these countries can be allocated to two non-overlapping convergence clubs, with India and Sri Lanka enjoying the more favourable growth path. These findings raise questions regarding the current feasibility of monetary union for SAARC.
DETERMINATION OF THE WALL VARIABLES WITHIN THE ZONAL MODEL OF RADIATION INSIDE A PULVERIZED COAL-FIRED FURNACE
Authors: Crnomarković Nenad , Belošević Srđan , Nemoda Stevan , Tomanović Ivan , Milićević Aleksandar
Published: September 2018

Determination of the wall variables (wall emissivities, wall temperatures, and heat fluxes) when the zonal model of radiation is used in numerical simulations of processes inside a pulverized coal-fired furnaces is described. Two methods for determination of the wall variables, i.e., a repeated run of numerical simulation (RRNS) and a temporary correction of the total exchange areas (TCTEA) are compared. Investigation was carried out for three values of the flame total extinction coefficient and four values of the initial wall emissivities. Differences of the wall variables were determined using the arithmetic means (AMs) of the relative differences. The AMs of the relative differences of the wall variables increased with an increase in the flame total extinction coefficient and changed a little with an increase in the initial values of the wall emissivities. For the selected furnace, the smallest differences of the wall variables were obtained for Kt=0.3 m-1 and ew,in=0.7. Although both methods can be used for determination of the wall variables, the RRNS method was recommended because the manipulation with files was easier for it. mmended because the manipulation with files was easier for it.
A NUMERICAL AND EXPERIMENTAL ANALYSIS OF THE DYNAMIC STABILITY OF HYDRAULIC EXCAVATORS
Authors: Janošević Dragoslav , Pavlović Jovan , Jovanović Vesna , Petrović Goran
Published: September 2018

The paper presents the results of a numerical and experimental analysis of the dynamic stability of hydraulic excavators. The analysis has employed the software developed on the basis of a defined general dynamic mathematical model of an excavator grounded in Newton-Euler equations as well as the measured quantities of the excavator operating state in exploitation conditions. The defined model is used to model the members of the excavator kinematic chain using rigid bodies while the actuators (hydraulic cylinders and hydraulic motors) of the excavator drive mechanisms are modeled with elastically dampened elements. The elastically dampened characteristics of the actuators are defined with regard to the size of the actuator as well as to the compressibility and temperature of the hydraulic oil used in the excavator hydrostatic drive system. To illustrate the analysis, the paper provides the results of the analysis of the dynamic stability of a 16000 kg tracked excavator equipped with a manipulator digging bucket of 0.6 m3 in capacity.
Quantum repeaters with individual rare-earth ions at telecommunication wavelengths
Authors: Kimiaee Asadi F. , Lauk N. , Wein S. , Sinclair N. , O'Brien C. , Simon C.
Published: September 2018

We present a quantum repeater scheme that is based on individual erbium and europium ions. Erbium ions are attractive because they emit photons at telecommunication wavelength, while europium ions offer exceptional spin coherence for long-term storage. Entanglement between distant erbium ions is created by photon detection. The photon emission rate of each erbium ion is enhanced by a microcavity with high Purcell factor, as has recently been demonstrated. Entanglement is then transferred to nearby europium ions for storage. Gate operations between nearby ions are performed using dynamically controlled electric-dipole coupling. These gate operations allow entanglement swapping to be employed in order to extend the distance over which entanglement is distributed. The deterministic character of the gate operations allows improved entanglement distribution rates in comparison to atomic ensemble-based protocols. We also propose an approach that utilizes multiplexing in order to enhance the entanglement distribution rate.
Retrospective evaluation of patients hospitalized due to bronchial asthma during 1991-1995 at Dr. Sami Ulus Center for Pediatrics
Authors: GUCLU Yusuf Adnan
Published: September 2018

Introduction: Asthma is a heterogeneous disease characterized by chronic airway
inflammation. Bronchial asthma ‎is the most common chronic disease of childhood
and is among the causes of frequent hospitalization in children. ‎This study
aims to describe the demographic and clinical characteristics of the patients
hospitalized due to ‎‎"bronchial asthma" within five years. Methods: The hospital records of patients aged 0-15 years admitted with the
diagnosis of bronchial asthma to the Dr. Sami Ulus Center for Pediatrics
between 1991-1995 were examined. The sociodemographic characteristics, ‎skin,
and laboratory values of the patients and the medications they received were
examined. ‎Results: Of the total 135 patients, 58.5% (n = 79) were males. The age
distribution of the inpatients was mostly in ‎the age group of 3-5 years
(57.8%, n = 78). The mean annual hospitalization rate was 0.53%. Patients
‎hospitalized for five days composed the largest group (39.3%, n = 53). Most of
the hospitalized patients (74.1%; n = ‎‎100) were coming from urban settings.
The most common pathologic condition on chest X-ray were increased ‎aeration +
infiltration (52%, n = 70). Sinusitis was accompanied to 78.5% of the
hospitalizations. There was ‎‎50.4% (n = 68) leukocytosis in the hemograms.
Most sensitive skin tests were mixed grass pollen and house dust. ‎The primary
medication used in prophylactic treatments was Ketotifen. Salbutamol was the
most common ‎medication used in the emergency department, theophylline and
antibiotics for the bedside, and salbutamol syrup ‎was the most prescribed
medication for the discharged patients.‎

Conclusion: The greater proportion of male gender and 3-5 year-olds in the study
group indicated that these risk ‎factors were consistent with the previous
literature. The similarity of annual admission rates within the years indicates
‎that there is no change in asthma frequency in the population served over time.
Even though the number of cases ‎requiring antibiotics in bronchial asthma is
high (similar to sinusitis), we believe that the use of antibiotics should be
‎lowered. ‎
Fenomenologia, mundo-da-vida e crise das ciências: a necessidade de uma geografia fenomenológica / Phenomenology, life-world and crisis of sciences: the need for a phenomenological geography
Authors: Goto Tommy Akira
Published: September 2018

O artigo tem como proposta apresentar a constituição de uma “geografia fenomenológica” a partir da crítica fenomenológica que Edmund Husserl (1859-1938) promove à ciência moderna, exposta nos seus últimos escritos denominados “A Crise das Ciências Européias e a Fenomenologia Transcendental”. Nesses escritos Husserl denuncia a crise de sentido vivida pela filosofia e ciência moderna, evidenciando o quanto o distanciamento entre as ciências e o mundo-da-vida produziu conseqüências graves, desvinculando do interior delas questões que concernem à humanidade e à sociedade. Husserl encontra como única saída para a crise a Fenomenologia Transcendental, cuja intenção é recuperar a ordem espontânea, o sentido e a orientação da existência humana, retomando o rol da subjetividade transcendental, expostas nas evidências pré-científicas e pré-lógicas do mundo-da-vida (Lebenswelt). No caso específico da geografia como ciência moderna, como argumentaria Husserl, impõe-se também a necessidade de se constituir uma nova geografia,capaz de retomar o sentido da humanidade, a partir de um saber geográfico unificado. Essa geografia recuperada pelo ideal de ciência, refundada pela fenomenologia husserliana, pode ser chamada de Geografia Fenomenológica ou uma Geografia Eidética, cujo intuito está na re-condução da reflexão aos princípios constituíntes da realidade, ou seja, a subjetividade e o mundo em sua plena correlação.
A exteriorização da memória pessoal em Nazareth Pacheco
Authors: Jardim Hiáscara Alves Pereira
Published: September 2018

Este artigo tem como finalidade discutir a relação entre a memória pessoal e a criação artística tendo como base a produção de Nazareth Pacheco. Nesse sentido, o presente artigo aborda o tema da autobiografia evidente em alguns dos objetos artísticos produzidos pela artista nos anos 1990. Analisamos algumas de suas obras de arte em que a memória pessoal é exteriorizada nos elementos visuais que as compõem. Para tanto, adotou-se um corpus teórico diversificado do campo da arte e da psicanálise.
Comunicação e consumo nas dinâmicas culturais do mundo globalizado
Authors: Castro Gisela G S
Published: September 2018

No conjunto dos estudos multidisciplinares que caracterizam o campo da Comunicação, o consumo tornou-se um tema de destaque que tem merecido análises a partir de diferentes perspectivas teórico-metodológicas. Como denominador comum, entende-se que se trata de um vetor central na constituição da experiência contemporânea num mundo crescentemente regido por processos de globalização econômica e cultural. A principal motivação deste artigo é oferecer uma cartografia comentada das principais vertentes dos estudos do consumo nas ciências sociais. Pretende-se desse modo chamar a atenção para essa temática de investigação e dar a conhecer algumas das reflexões no campo  ao dialogar com o oportuno tema selecionado pelos editores para este dossiê de Pragmatizes, a saber: cultura e práticas de consumo.
Desculturalizar a cultura - Desafios atuais das políticas culturais
Authors: Flórez Victor Miguel Vich
Published: September 2018

O presente artigo combina a reflexão acadêmica com a proposta política. Retoma a pergunta sobre a importância das políticas culturais e tem como objetivo fundamentar uma nova resposta. Sustenta que as políticas culturais não podem concentrar-se unicamente na pura organização de eventos. Mas além do fomento à produção cultural, do estabelecimento de melhores mecanismos para sua circulação e de dirigir-se a públicos diferenciados, o ensaio aposta numa política cultural que aponte a desconstrução dos imaginários hegemônicos, vale dizer, à intenção de intervir naqueles sentidos comuns que se encontram profundamente arraigados nos hábitos sociais. Se o capitalismo contemporâneo embasa boa parte de seu poder na dominação simbólica, este ensaio entende que os símbolos da cultura em geral são igualmente um lugar de resposta.
Factors affecting social entrepreneurship intentions among agricultural university students in Taiwan
Authors: Yu Teng-Li , Wang Jiun-Hao
Published: September 2018

Taiwan’s agriculture is again generating local interest after years of decline as awareness of problems facing development and food safety grows. Agriculture-related social entrepreneurship is seen as a crucial solution to the challenges faced and has gradually become part of mainstream business in rural areas. This study examined whether empathy, social responsibility, social capital and support, and social entrepreneurial self-efficacy affect social entrepreneurial intentions. Through an online and offline survey, a sample of Taiwanese agricultural college students (n=464) were recruited for analysis. The factor analyses supported previous studies and proved that the factor structures of subscales used in this study were stable, with the exception of social entrepreneurial self-efficacy. Multiple regression analysis results indicated that management efficacy was the most prominent factor affecting social entrepreneurial conviction, followed by stakeholder perspective and communication efficacy. In addition, management efficacy was the strongest factor affecting social entrepreneurial preparation, followed by stakeholder perspective and affective empathy. Notably, cognitive empathy was revealed to be negatively associated with social entrepreneurial preparation. Social capital and support were found to have no association with social entrepreneurial intentions.
The effects of human resources in internal audit on external audit pricing decision
Authors: Cho Moon Kyung
Published: September 2018

This study presents evidence that external audit fees are negatively and significantly associated with the proportion of general internal auditors. Further, external audit hours are negatively and significantly associated with the proportion of general auditors without affecting external unit audit price. In addition, the results of the data adjusted for firm size suggest that audit fees and audit hours decrease for smaller firms as the proportion of general internal auditor increases. The result implies that both small firms and their external auditors are encouraged to utilize more general internal auditors in performing an external audit. The author finds no evidence that external audit fees are associated with internal auditor expertise or experience. This shows that external auditors are not likely to rely on internal auditors’ professional judgment in performing an external audit due to reduced auditor independence.
Control of Postprandial Hyperglycemia in Type 1 Diabetes by 24-Hour Fixed-Dose Coadministration of Pramlintide and Regular Human Insulin: A Randomized, Two-Way Crossover Study
Authors: Riddle Matthew C. , Nahra Rajaa , Han Jenny , Castle Jessica , Hanavan Kathryn , Hompesch Marcus , Huffman David , Strange Poul , Öhman Peter
Published: September 2018

OBJECTIVE

Healthy pancreatic β-cells secrete the hormones insulin and amylin in a fixed ratio. Both hormones are lacking in type 1 diabetes, and postprandial glucose control using insulin therapy alone is difficult. This study tested the pharmacodynamic effects of the amylin analog pramlintide and insulin delivered in a fixed ratio over a 24-h period.

RESEARCH DESIGN AND METHODS

Patients with type 1 diabetes were stabilized on insulin pump therapy with insulin lispro before a randomized, single-masked, two-way crossover, 24-h inpatient study in which regular human insulin was administered with pramlintide or placebo using separate infusion pumps in a fixed ratio (9 μg/unit). Meal content and timing and patient-specific insulin doses were the same with each treatment. The primary outcome measure was change in mean glucose by continuous glucose monitoring (CGM). Profiles of laboratory-measured glucose, insulin, glucagon, and triglycerides were also compared.

RESULTS

Mean 24-h glucose measured by CGM was lower with pramlintide versus placebo (8.5 vs. 9.7 mmol/L, respectively; P = 0.012) due to a marked reduction of postprandial increments. Glycemic variability was reduced, and postprandial glucagon and triglycerides were also lower with pramlintide versus placebo. Gastrointestinal side effects were more frequent during use of pramlintide; no major hypoglycemic events occurred with pramlintide or placebo.

CONCLUSIONS

Coadministration of fixed-ratio pramlintide and regular human insulin for 24 h improved postprandial hyperglycemia and glycemic variability in patients with type 1 diabetes. Longer studies including dose titration under daily conditions are needed to determine whether this regimen could provide long-term improvement of glycemic control.
Data Quality Automation: a Generic Approach for Large Linked Research Datasets
Authors: Elmessary Muhammad A , Thayer Daniel , Rees Sarah , ReesKemp Leticia , Rees Arfon
Published: September 2018

IntroductionWhen datasets are collected mainly for administrative rather than research purposes, data quality checks are necessary to ensure robust findings and to avoid biased results due to incomplete or inaccurate data.

When done manually, data quality checks are time-consuming. We introduced automation to speed up the process and save effort.

Objectives and ApproachWe have devised a set of automated generic quality checks and reporting, which can be run on any dataset in a relational database without any dataset-specific knowledge or configuration.

The code is written in Python. Checks include: linkage quality, agreement with a population data source, comparison with previous data version, duplication checks, null count, value distribution and range, etc.

Where dataset metadata is available, checks for validity against lookup tables are included, and the output report includes documentation on data contents. An HTML report with dynamic datatables and interactive graphs, allowing easy exploration of the results, is produced using RMarkdown.

ResultsThe automation of the generic data quality check provides an easy and quick tool to report on data issues with minimal effort. It allows comparison with reference tables, lookups and previous versions of the same table to highlight differences. Moreover, this tool can be provided for researchers as a means to get more detailed understanding about their data.

While other research data quality tools exist, this tool is distinguished by its features specific to linked data research, as well as implementation in a relational database environment. It has been successfully tested on datasets of over two billion rows.

The tool was designed for use within the SAIL Databank, but could easily be adapted and used in other settings.

Conclusion/ImplicationsThe effort spent on automating generic testing and reporting on data quality of research datasets is more than compensated by its outputs. Benefits include quick detection and scrutiny of many sources of invalid and incomplete data. This process can easily be expanded to accommodate more standard tests.
Design and operation of a distributed health data network
Authors: Brown Jeffrey
Published: September 2018

IntroductionSeveral large health data networks such as FDA Sentinel, PCORnet, and the Canadian Network of Observational Drug Effect Studies (CNODES) facilitate multi-site research using real-world electronic health data such administrative claims data, electronic health record data and registries. Experience in operation of mutliple health data networks will described.

Objectives and ApproachOver the past 15 years substantial progress has been made in developing the optimal network operational design, governance, and technical architecture to facilitate the creation and operation of large-scale distributed health data networks. The design, architecture, and operation of a sustainable health data network requires balancing the needs of the network stakeholders such as funders, data sources, investigators, and regulatory bodies while enabling rapid and efficient use of data to support evidence generation and decision making. Important topics include protection of patient privacy, security, data autonomy, distributed analytics, data quality, and protection of confidential information.

ResultsThe design and architecture of existing distributed health data networks provides guidance regarding the potential operational model for new networks and identifies areas of research to improve network functionality and capabilities. Most health data network adopt a common data model approach to facilitate multi-site querying and data quality assessment. This approach is coupled with distributed querying in which data partners maintain physical and operational control of their data. This design maximizes protection of confidential and proprietary information and minimizes the need to share patient-level data. Privacy-preserving distributed regression approaches and methods that obviate the need to share person-level data while generating robust results help to ensure network participation. Strong security and governance structures are also necessary for effective operation of a distributed network.

Conclusion/ImplicationsDistributed health data networks offer the opportunity to use real-world data for public health surveillance and comparative safety and effectiveness research across large populations. The operational design, technical and analytic architecture, and governance models of networks drive their acceptance and success.
Coding Agreement on Identification of Main Resource Use Using ICD-10 and ICD-11
Authors: Doktorchik Chelsea , Southern Danielle , Quan Hude , Eastwood Catherine
Published: September 2018

IntroductionMain condition coding definitions in the International Classification of Disease (ICD) 10th and 11th versions are broadly defined in the current and upcoming versions of ICD, and coding health data can involve subjective coding specialist interpretation. Inconsistent coding can lead to inaccurate reporting, and lower quality data for research use.

Objectives and ApproachMain condition coding agreement was compared between ICD-10 and ICD-11. 730 hospital charts were randomly selected from Foothills Medical Centre in Calgary, Alberta. These charts were previously coded using ICD-10, and six professional coding specialists recoded them using ICD-11. To compare frequencies of ICD-10 to ICD-11, we used current WHO crosswalk tables to match codes. For any missing codes, manual comparison by done by a qualified reviewer. In Canada, the “main condition” is the clinically significant reason for the hospital visit. If multiple problems were present, the diagnosis using the greatest amount of resources is coded, “main resource use”.

ResultsOverall, 730 ICD-10 coded charts were analyzed. Of these charts, 79% (577) had matching resource coding between ICD-10 and ICD-11, and 21% (153) had mismatching coding. Matching coding was either considered an exact match between definitions (23.2%, 134), or similar but not identical (often one code has greater detail, 76.8%, 443). Mismatching codes were either due to different codes for similar conditions (13.1%, 20), different codes for not similar but related conditions (43.8%, 67), or completely different codes for unrelated conditions (43.1%, 66).

Conclusion/ImplicationsICD-10 and ICD-11 main resource codes had a high match frequency indicating consistency between coding practices and ICD definitions (577/730, 79%). Future research will aim to understand underlying causes of mismatched main resource use codes. This research will help us understand issues in coding and contribute to future ICD-11 revisions.
Understanding Patterns of Emergency Department (ED) Use over time in Ontario to plan new EDs for the future
Authors: Dvorani Erind , Graves Erin , Ishiguro Lisa , Schull Michael , Sivilotti Marco
Published: September 2018

IntroductionThe Applied Health Research Question (AHRQ) portfolio is an initiative funded by the Ontario Ministry of Health and Long-Term Care, leveraging the linked data and scientific expertise at ICES to answer questions that directly impact healthcare policy, planning or practice.

Objectives and ApproachThe objective of this project was to evaluate historical patterns of emergency department (ED) use to better plan for a new emergency Department in Kingston and to better understand the factors contributing to increasing ED utilization.

Emergency departments across Ontario continue to see consistent increases in volume at rates exceeding expected volume growth due to population growth alone. Some hospitals across the province observe significantly higher volume increases compared to the provincial average.

ResultsFrom 2006/07 to 2016/17, rate and volume of emergency department visits in Ontario increased 8.82% and 19.87% respectively. Throughout the same period, emergency department visit rate and volume at Kingston General Hospital increased 20.70%, and 27.2%. Using historical data and projected population growth by age and sex, we were able to estimate that emergency department volume would increase at least 11.94% by 2025 due to estimated shifts in population size and distribution (by age and sex) alone. From 2006/07 to 2016/17, the greatest rate of increase in reason for ED visits was mental/behavioral problems. Throughout this period the increase in volume and rate of ED visits due to mental/behavioural problems was 274.46% and 259.59% respectively.

Conclusion/ImplicationsPopulation-specific volume projections and historical trends in ED use can be utilized for planning ED operations to improve efficiency and patient care quality. This has been used to inform the redesign of the ED at the Kingston Health Sciences Centre to ensure it will meet the needs of the community.
Identifying Knowledge Gaps with Administrative Health Data: A Cohort Study of Traumatic and Non-Traumatic Spinal Cord Injury in Alberta
Authors: Bakal Jeff , Ho Chester , McKenzie Nicole , Yeung Jack Man Shun
Published: September 2018

IntroductionThe Spinal Cord Injury (SCI) population consists of two main sub-groups: traumatic (TSCI) and non-traumatic (NTSCI). TSCI has been studied; however less attention has been given to NTSCI. It is important to understand both SCI sub-groups for identification of knowledge gaps and subsequent health service planning.

Objectives and ApproachThe goal is to study the SCI population (both TSCI and NTSCI) in Alberta, Canada, leveraging recent administrative health data. It is difficult to identify NTSCI patients for their heterogeneous conditions, and relatively low prevalence. Consequently, we followed a validated algorithm using particular ICD-10-CA codes, to identify (and index) adult SCI patients from Ambulatory and Inpatient records between April 1, 2006 and March 31, 2016.

Indexed patients were linked to various databases (inpatient, ambulatory, physician claims, provincial insurance registry), and analyzed in multiple perspectives such as demographics patterns, deaths, resource and cost utilization, geographic distribution, and care equity between groups.

ResultsThrough 10 years of data we have identified 5217 SCI patients (3309 TSCI; 1908 NTSCI). 68.7% TSCI and 58.6% NTSCI are male. NTSCI patients are approximately 10 years older (46.3 TSCI; 54.5 NTSCI), and have a 3-point higher Charlson score. 1-year mortality in NTSCI is approximately 2.4 times the TSCI group.

Hospitalizations, ER visits, critical care time have also been examined. Patients with NTSCI had a higher median index LOS (14 days IQR (4-51)) compared to the traumatic group who had much higher variability (11 days IQR (11-65.5)). Noted 13.7% NTSCI patients and 19.5% TSCI do not have hospitalizations after index (a diverse characteristic of SCI). Resource Intensity Weights, physician billing, rural-urban area utilization have also been compared between the sub-groups.

Conclusion/ImplicationsWith the use of administrative databases and a validated algorithm, we described a diverse patient cohort with two main sub-groups (TSCI/NTSCI). Both groups were analyzed upon multiple topics and showed variations. Our results have provided updated knowledge of a comprehensive SCI population in Alberta, Canada, and may lead to improvements on care-giving model.
Integrating Local Government, Non-Profit and Social Service Agency Data to Understand Systems and Outcomes in a Large, Southeasten U.S. City
Authors: Lane Justin , Hill David
Published: September 2018

IntroductionA central undercurrent between policymakers not being able to make totally informed decsions and non-profit leaders lacking knowledge to most effectively craft their services is the lack of data integration among organizations and across sectors.

Objectives and ApproachWe have 40+ data sharing agreements with local governmental agencies (school district, sheriff's office, DSS, Veteran Services, homeless services) and many local non-profit agencies. On an individual project basis, we integrate historical and longitudinally deposited data across datasets in order to research the effects of community initiatives and non-profts to understand the population they are serving and the outcomes assoicated with their services.

Many agencies lack the capacity for data cleanliness and structure, so we scrub and deposit their data on relational database on a secure server for future integration and investigation.

ResultsWe highlight two projects:

We completed a project for a local non-governmental, non-profit housing organization integrating data from 20+ data sharing agreements to investigate familial, individual, and childhood outcomes pre- and post- obtaining homeownership through this organization. This allowed the organization an in-depth, historical view of the effects that stable housing had on the recipients and their families, as well as how to tailor services for new families.

We integrate data from the school system, homeless information management systems, and non-proft services providers to understand the effects that family homelessness has on educational outcomes. This endeavor provided the community a report of the scope of local family homelessness as well educational outcomes of the students.

Conclusion/ImplicationsThrough the integration of seemingly disparate local governmental and social service provider datasets, we equip researchers, non-profit leaders, and policymakers to understand the effects of initiatives and redesign systems and/or reallocate resources.
Trends in Socioeconomic Inequalities in Hypertension in Ontario, Canada, 2000-2012
Authors: Shokar Simran , Rosella Laura , Smith Peter , Chen Hong , ChenManson Heather , Tu Jack , Smith Brendan
Published: September 2018

IntroductionHypertension is leading risk factor for cardiovascular disease and mortality. Low socioeconomic position (e.g., income or high material deprivation) is an important risk factor for hypertension. However, there is limited evidence monitoring the extent to which socioeconomic inequalities in hypertension exist and are changing over time in Ontario.

Objectives and ApproachThe study objective was to estimate socioeconomic trends in prevalent hypertension by household income and material deprivation in Ontario from 2000 to 2012. A pooled cross-sectional study was conducted using data from 6 Canadian Community Health Surveys linked to the Discharge Abstract Database and Ontario Health Insurance Plan data (n=121,390 over 35 years, 54\% female). Relative-weighted Poisson regression models were used to estimate hypertension rates (adjusted for age, sex, ethnicity and immigration) across quintiles of equivalized household income and area-level material deprivation. Socioeconomic inequalities were estimated using the slope index of inequality (SII) and relative index of inequality (RII).

ResultsSocioeconomic inequalities in hypertension were observed across income quintiles on both absolute (SII: 1428 per 10,000, 95\%CI:1126,1730) and relative (RII:1.74, 95\%CI:1.53,1.94) scales in 2000, decreasing by 2012 (SII:297 per 10,000, 95%CI: -82,676; RII:1.19, 95%CI:0.93,1.45). A similar pattern was observed across material deprivation quintiles, however with smaller inequalities in 2000 (SII:595 per 10,000, 95%CI:306,884; RII:1.25, 95%CI:1.11,1.39) and 2012 (SII:389 per 10,000, 95%CI:17,761; RII:1.24, 95%CI:0.99,1.49).

Conclusion/ImplicationsSocioeconomic inequalities in hypertension were observed in Ontario, with decreasing trends between 2000 and 2012. Area-level material deprivation underestimated individual-level socioeconomic inequalities in hypertension.
Alberta's Data Mobilization Strategy: Leveraging Linked Data for Innovation
Authors: Svenson Larry , Simmonds Kimberley , Perry Alexa , Riemer Justin
Published: September 2018

IntroductionThe Province of Alberta maintains a mature data ecosystem with linkable data dating back over 30 years. The population-based nature of the data makes this a valuable asset for driving analytics to support health system innovation, with a focus on improving health outcomes and quality of life.

Objectives and ApproachAlberta Health has created the Secondary Use Data Access (SUDA) initiative to leverage its administrative health data. SUDA envisions strengthening partnerships between the public and private sectors with two main access approaches. The first is direct access to de-identified data held within the Alberta Health data warehouse by key health system stakeholders (e.g. academic instituions, Health Quality Council of Alberta, regulatory colleges). The second is indirect access to private and not-for-profit stakeholders, using a safe haven approach. Indirect access is achieved through private sector investments to a trusted third party that hires analysts to be placed within Alberta Health.

ResultsStaffing agreements and privacy impact assessments have been drafted to support the work. The indirect access route includes a multiple stakeholder steering committee to vette and prioritize projects. Private and not-for-profit stakeholders do not have access to the data, but rather receive access to aggregate data and statitstical models. All disclosures are done by Alberta Health staff to ensure compliance with Alberta's Health Information Act. Direct access has been established for the Alberta Medical Association as part of a long standing data sharing agreement, with access restricted to de-identified data only. To date, seven industry proposals for analytics have been received and are currently being actioned.

Conclusion/ImplicationsThe Secondary Use Data Access initiative uses a safe haven approach to leveraging data. It reduces the need to provision data outside of the data warehouse and allows for better monitoring of access and use of data. The approach provides assurances that people's health information is secure.
Linking Provincial and Prospective Cohort Study Data to Estimate the Incidence and Healthcare Burden of Viral Gastroenteritis
Authors: Tarr Gillian AM , Freedman Stephen
Published: September 2018

IntroductionAcute gastroenteritis (AGE) is a major cause of morbidity in children. While viruses are known to cause the largest proportion of illnesses, slow adoption of new technology and recommendations against routine testing have blunted our ability to estimate the impact of viral AGE on the health system.

Objectives and ApproachOur objective was to quantify the incidence of medically-attended norovirus and other viral AGE etiologic agents as a baseline for future norovirus vaccination programs. AGE cases were identified through the Alberta Provincial Pediatric EnTeric Infection TEam (APPETITE) study, December 2014-December 2017, which tested participants for five viruses: rotavirus, norovirus, adenovirus, astrovirus, and sapovirus. Study data was linked to provincial health registry data to identify visits associated with the AGE episode. Comparable visits for children throughout the province were identified, and a comprehensive set of potential confounders was evaluated and used to standardize APPETITE rates to the Alberta population.

ResultsAPPETITE received and tested specimens from 2,358 children with AGE presenting to the emergency department (ED) for care and 513 children with AGE whose parent or guardian called the provincial health advice line Health Link (HL). Norovirus was the most commonly detected pathogen, associated with 579 (24%) ED cases and 177 (19%) HL cases. After norovirus, the most common viruses were, in descending order: adenovirus (441 ED, 97 HL), rotavirus (408 ED, 88 HL), sapovirus (211 ED, 68 HL), and astrovirus (75 ED, 21 HL). Results for the incidence of viral AGE by etiologic agent, with the associated number of hospitalizations, ED visits, and primary care visits, will be available by the date of the IPDLN conference.

Conclusion/ImplicationsBy linking data from APPETITE with the visit data available because of Alberta’s single-payer system, we are able to provide population-based estimates of disease incidence for viral AGE, as well as the burden on the health care system in terms of the number of visits associated with these viral illnesses.
Using Linked Data and Advanced Analytics to Prioritize Health Concerns within Regions
Authors: Powell Guido Antonio , Lavigne Maxime , Yuan Mengru , Okhmatovskaia Anya , Boston-Fisher Nikita , Buckeridge David
Published: September 2018

IntroductionLinked population health data have the potential to inform evidence-based actions targeting serious public health concerns. However, large-scale data integration efforts can produce hundreds of population health indicators, which can overwhelm the ability of decision-makers to synthesize and interpret the information.

Objectives and ApproachOur research uses an existing semantic web application for population health surveillance, the Population Health Record (PopHR). PopHR automates a computational pipeline for linking data sources, building timely population health indicators, and uses artificial intelligence to organize indicators along a determinants of health framework. To assist users in interpreting the thousands of indicators, we developed computational algorithms combining values of multiple indicators across chronic diseases, to prioritize conditions within each region. This analytic approach can assist regional decision-makers in identifying their region’s priority conditions by facilitating the integration and analysis of multiple types of indicators (e.g. disease burden, temporal patterns).

ResultsA pilot implementation of the regional prioritization algorithm focused on indicators defined in the Public Health Agency of Canada’s Chronic Disease Indicators Framework. Within this subset of diseases, we developed a computational algorithm to integrate into a priority index regional estimates of incidence, mortality, and prevalence taking into account the relative importance of each indicators’ outlier status and statistical significance of temporal trends. Our results allowed for the development of region-specific data visualizations dashboards, emphasizing the different factors driving the rankings of indicators within and across regions. For example, regions with higher socioeconomic status having generally lower disease burden are presented with visualizations emphasizing temporal trends and other statistically compelling patterns rather than simple indicators of magnitude.

Conclusion/ImplicationsThis ranking approach represents initial stages ongoing research, expanding our methods to use machine learning strategies and additional expert knowledge. Current and future prioritization analyses within the PopHR platform offer the potential for public health to gain insights from an otherwise challenging complexity and richness of linked data.
Applications of Big Data Analytics within a Dynamic Simulation Modeling Platform to Inform Osteoarthritis Care in Alberta
Authors: Sharif Behnam , Vik Shelly , Marshall-Catlin Deborah A
Published: September 2018

IntroductionOsteoarthritis (OA) is a leading cause of chronic disability. There is need to leverage administrative data to support OA policy analysis. Our objective was to develop and apply a multidimensional data cube as an input parameter repository using health administrative data to populate an OA simulation model.

Objectives and ApproachHealth administrative data including practitioner claims, inpatient and ambulatory visits from 1994 to 2013 were integrated into a multidimensional data cube. OA cases were identified using validated algorithms, and followed through stages of care (primary, specialist, acute and post-operative). The cube provided rate calculations, duration and average cost for each stage of care across the model dimensions (age categories, sex, comorbidity status and geographic zones). The rates were then linked to the model as input parameters to simulate patient flow across the continuum of care. We used the model to predict direct costs across all dimensions from 2010 to 2035.

ResultsUsing the model, total number of patients with OA in Alberta will increase from 312,000 in 2010 to 1.4 million in 2035. The average annual cost per OA patient also increases from $2,800 to $4,900, and the total cost increases from $450 million in 2010 to 2.2 billion in 2035. The majority of the patients were at earlier stages (non-surgical 78%, surgical 22%), with lower average cost (non-surgical $3,300 vs. surgical $16,400) in 2010. As new administrative data are being provided routinely, the data cube is capable of providing real-time updates for the input parameters of the model, which will aid in validation of the model results and improving the precision of projections.

Conclusion/ImplicationsThe data cube has significantly improved our ability to manage and analyze administrative data within a simulation model to project the burden of OA in Alberta. The integrated model can be used as a real time decision-support tool to inform osteoarthritis service planning and variations in resource utilization.
Understanding the social determinants of opioid related hospitalizations
Authors: Sanmartin Claudia , Carriere Gisele
Published: September 2018

IntroductionThe current opioid crisis is recognized by governments at many levels as an urgent priority. While there is basic demographic information on who experiences opioid related adverse events, there is little information to provide a more fulsome profile of those experiencing these events for targeted intervention and forward projection estimation.

Objectives and ApproachThis study is the first to use a nationally-representative Census of Population linked with health administrative data to examine opioid-related hospitalization patterns across income and Aboriginal status.

ResultsPreliminary analyses using 2006 Census-hospital linked database found cohort rates of opioid-related hospitalizations are up to 7 times higher among Aboriginal youth, and also for young adults (12-19/ 20-24) compared with non-Aboriginal youth or young adults. Rates among these youth living on reserves were 8.4 times higher; among those off reserve 8.7 times higher. Rate among all youth living in lower income households was 5 times higher compared with those living in highest income households, For Aboriginal persons in lowest income quintile, the rate was 3 times higher relative to non-Aboriginal persons in same quintille.

Conclusion/ImplicationsNew linked health data reveal new information regarding the profile of those who experienced opioid-related adverse events. This information will serve to inform targeted intervention strategies, models for forward estimation of events.
UK and Canadian Gulf War Veteran Mortality: Using A Fellow Military Cohort as a Comparison Population
Authors: Rolland-Harris Elizabeth , Harrison Kate , Simkus Kristen , Baird Lisa , Palmer Kate , Sandra Dear , VanTil Linda
Published: September 2018

IntroductionTo compare 1990-91 Gulf War Veterans (GWV) survival outcomes with a comparable cohort, UK’s Ministry of Defence and Canada’s Department of National Defence combined data from their respective cohorts. The survival estimates/comparisons emanating from this collaboration will be novel as they will control for healthy worker/soldier effect (HW/SE).

Objectives and ApproachGWV cohort building and record linkage methods used by Canada and the UK are described in more detail elsewhere. To ensure comparability in mortality outcomes between cohorts, the following steps will be conducted prior to analysis:

ICD-9 causes of death (COD) will be recoded to ICD-10; recoding by each country will be cross-validated by the other, to ensure high inter-coder reliability;

CODs will be analysed at the ICD-chapter level;

Calculated age- and sex-specific rates will be directly standardized using the WHO 2012-2022 Standard Population. Cox proportional hazards will be used to compare survival between cohorts.

ResultsWe are currently in the process of completing this exciting cross-sectoral linkage study and expect to have preliminary results to present. To our knowledge, this will be the first time that mortality outcomes for two discrete Gulf War veteran cohorts (ascertained by record linkage) will be analytically compared, rather than comparing to the general population. These findings will not only provide a more recent evaluation of the health status of GWV in Canada, but will also be a rare opportunity to control for the HW/SE, using comparisons with non-equivalent cohorts (e.g., general population, other deployment) cannot achieve.

Conclusion/ImplicationsBeyond evidence of a strong inter-sectoral research relationship between military nations, these findings also represent a feasible solution to controlling for the HW/SE. The ability to control for this will mean more accurate UK and Canada GWV mortality/survival estimates than either country can generate on their own.
Enhancing Environmental data Resources in Cohort Studies: ALSPAC exemplar (ERICA)
Authors: Boyd Andy
Published: September 2018

IntroductionNovel data platforms are needed to expedite the linkage of geospatial and natural environment data with longitudinal population study(ies) (LPS) data. However, the intrinsic relationship between geospatial data and participant identities raises confidentiality concerns amongst participants which need to be accommodated within platform designs to ensure acceptable data use.

Objectives and ApproachWe aimed to establish generalisable mechanisms for linking spatial records into a cohort study LPS databank. Using ‘Data Safe Haven’ (Burton et al. 2015) approaches we developed a pipeline of technical processes (e.g. geocoding participants’ residential and school address records, developing an ‘engine’ for linking exposure data to LPS data), which we tested for participant acceptability (through a focus group testing acceptable use of personal identifiers in this context) and tuned to meet regulatory requirements (e.g. privacy impact assessments, information security accreditation). We demonstrated our approach through an exemplar investigation assessing in utero NO2 exposure with later childhood respiratory outcomes.

ResultsParticipants’ expressed clear expectations that the research use of location data should be restricted to trusted study staff (as distinct from the wider research community), although this expectation is context specific and does not represent a carte blanche for using granular information (e.g. GPS tracing data). This necessitated a ‘split stage’ protocol, where personal identifiers are handled separately from data/analysis. Daily NO2 exposure was modeled using road, other local and regional records; with validation exposure data collected from city-based sensors. Participants’ location information was geocoded and linked to NO2 using the ALGAE (ALorithms for Generating address histories and Exposures) privacy-preserving geocoding engine. We will summarise participant views, our exemplar findings, and describe the linkage engine we have developed and its availability via an open-source repository.

Conclusion/ImplicationsParticipants’ expect that studies control for confidentiality risks introduced by research using spatial identifiers. It is not realistic to expect that all LPS have the capacity to undertake specialist spatial linkages. Our generalisable approaches and open-source software could provide the basis for geospatial and natural environment epidemiology platforms in LPS.