bluuebunny/crossref_metadata_2025 huggingface dataset:
Chloroquine treatment against naturally occuring Giardia duodenalis infection in dogs
Authors: Ural Kerem , Gultekin Mehmet , Pasa Serdar , Aysul Nuran , Ayan Adnan
Published: April 2017

The aim of the present study was to evaluate the efficacy of chloroquine on lessening or eliminating cyst shedding in dogs naturally infected with Giardia duodenalis. A total of 26 dogs naturally infected with G. duodenalis, from various breeds, ages and of both sexes were selected and randomly assigned into two groups based on treatment (group I, n=20 dogs treated orally with 2.5 mg/kg chloroquine twice daily for 5 consecutive days) and control (group II, n=6 untreated control dogs). Diagnosis was based on microscopic faecal examination and rapid test kits. Cyst excretion was determined on days 0, 3, 7 and 10, before and after treatment. Evaluation of the percentage reduction in cyst excretion revealed 99.8% efficacy on day 3 and 99.9 % on days 7 and 10 in the treatment group. Geometric means of the number of excreted cysts did not change significantly in the control group. Chloroquine at the proposed dosage might be a practical in application, low priced and highly effective treatment option in dogs with giardiasis.
KEBIJAKAN PENGGUNAAN SANKSI PIDANA DALAM PERUNDANG--UNDANGAN HUKUM ADMINISTRASI UNDANGAN HUKUM ADMINISTRASIUNDANGAN HUKUM ADMINISTRASI UNDANGAN HUKUM ADMINISTRASI
Authors: Sulaiman Eman
Published: April 2017

Abstract

The use of criminal sanctions as the main sanction has indicated the extent to
which the level of understanding of the legislators to the problem of "crime and
punishment". At least show that the limited understanding of the use of criminal
sanctions also affect the determination of criminal sanctions in administrative
law. "Errors" in the formulation of the implications for the difficulty and
confusion in the law enforcement, because there is a gap of two disciplines,
namely the criminal law on the one hand and on the other hand administrative
law, which has its own procedural law. This confusion will lead to ambiguity in
the resolution of cases of violation of administrative law contains criminal
sanctions, whether enforcement will be carried out by law enforcement agencies
within the criminal justice sisitem or whether officials of the state administration
in the sphere of administration? Such circumstances, of course, will lead to the
existence of legal uncertainty for the community.
Kata Kunci: sanksi pidana, hukum pidana, hukum administrasi
Percepção e ação ecossanitária numa comunidade adjacente à Sanga das Charqueadas em Tapes - Rio Grande do Sul - Brasil
Authors: AMBOS Silvia Maria Hoff , RUAS NETO Antônio Leite , AMBOS Stefania Hoff
Published: April 2017

O município de Tapes localiza-se às margens da Laguna dos Patos no Rio Grande do Sul. Tapes possui três cursos d’água urbanos: Arroio Teixeira, Sanga do Meio, Sanga da Charqueadas e um rural, Sanga das Capivaras. Os cursos de água são poluídos pelo esgoto doméstico e aporte de agrotóxicos, com risco à saúde principalmente em inundações. Neste estudo objetivou-se compreender as percepções ecológicas e sanitárias da comunidade da Vila Maria, situada no início da Sanga das Charqueadas. Em períodos sem inundação, a comunidade utiliza as margens do curso para recreação e tem contato com a água durante a pesca esportiva. A mata ciliar é densa em parte e há animais silvestres na área. Avaliou-se a percepção sobre as condições ecológicas e as propostas de melhoria incluindo atividades de fitorremediação. A metodologia foi a da Educomunicação com perspectiva de ecossanitarismo e o Método Bambu de planejamento em oficinas comunitárias. O conhecimento tradicional e popular foi valorizado para a ação comunitária. Nesta parte do curso de água foi detectada contaminação por coliformes fecais anteriormente e confirmada no estudo. Foi constatado um nível proibitivo para contatos recreativos, no qual ficou próximo de 100 000 NMP/100 ml. Nas oficinas observou-se o cuidado com os recursos naturais e um interesse em desenvolver alternativas mitigadoras como a fitorremediação. Uma ação comunitária de reflorestamento nativo na mata ciliar e plantio de taiobas para fitorremediação foi indicado e praticado. Concluiu-se que o desenvolvimento de ações comunitárias ecossanitárias foi viabilizado a partir do espaço criado pelo projeto.

 

 
Implementasi pemanfaatan software penulisan laporan hasil belajar siswa SMK pada pelaksanaan Kurikulum 2013
Authors: Retnawati Heri , Hadi Samsul , Nugraha Ariyadi Chandra
Published: April 2017

Penelitian ini bertujuan untuk mendeskripsikan implementasi penulisan laporan hasil belajar siswa SMK pada pelaksanaan Kurikulum 2013 menggunakan software penulisan rapor online. Penelitian ini merupakan studi deskriptif eksploratif, yang merupakan bagian dari penelitian pengembangan dengan menggunakan model Sharma. Data dikumpulkan dengan observasi dan angket. Partisipan kegiatan pemanfaatan software di SMK sebanyak 9 SMK baik negeri dan swasta di DI Yogyakarta, dengan melibatkan wakasek kurikulum, guru kelas, dan teknisi teknologi informasi dari tiap sekolah partisipan. Hasil penelitian menunjukkan bahwa 56% responden menyatakan bahwa software yang dikembangkan memiliki kualitas baik dan sisanya 44% responden menyatakan bahwa bahwa software yang dikembangkan memiliki kualitas sedang. Beberapa masukan responden untuk perbaikan software yaitu (1) perlu adanya sinkronisasi sistem dengan peraturan pemerintah terbaru (2) penyempurnaan kelengkapan keterangan dalam sistem; (3) perlu adanya kerjasama dengan dinas pendidikan atau instansi terkait; dan (4) pembatasan wewenang siswa. Berdasarkan masukan-masukan tersebut dilakukan perbaikan sehingga software siap digunakan untuk membantu guru SMK di Indonesia menyusun laporan hasil belajar menggunakan Kurikulum 2013.Kata kunci: software penulisan rapor online, Kurikulum 2013, siswa SMK IMPLEMENTATION OF THE USE OF THE LEARNING OUTCOMES REPORT WRITING SOFTWARE OF VOCATIONAL STUDENT ON CURRICULUM 2013AbstractThis study aimed to describe implementation of learning outcomes report writing of vocational students on Curriculum 2013 using the online report writing software. This research was descriptive exploratory study, which was part of the research development by using Sharma’s model. Data collected by observation and questionnaire. Participants in this study involved 9 both public and private vocational school in Special Region of Yogyakarta Province, involving the vice principals of curriculum, classroom teachers, and information technology technicians from each school participants. The results showed that 56% of respondents stated that the developed software has good quality and the remaining 44% of respondents stated that the software developed has medium quality. Some respondents suggestions for improvements to the software, namely (1) the need for synchronization of the system with the newest government regulations (2) improvement of the completeness of information within the system; (3) the need for cooperation with the department of education or other related institutions; and (4) limitation the authority of the students. Based on these suggestions have been conducted improving the system so that the software was ready for use to assist vocational teachers in Indonesia to prepare the learning outcomes reports on Curriculum 2013.Keywords: the online report writing software, Curriculum 2013, vocational students
Evaluasi pelaksanaan blended learning di SMK TI Udayana menggunakan model CSE-UCLA
Authors: Divayana Dewa Gede Hendra
Published: April 2017

Penelitian ini bertujuan untuk memperoleh tingkat efektivitas pelaksanaan blended learning di SMK TI Udayana ditinjau dari beberapa komponen evaluasi yaitu system assessment, program planning, program implementation, program improvement, dan program certification. Metode penelitian yang digunakan dalam penelitian ini adalah studi evaluatif, dengan menggunakan model evaluasi CSE-UCLA (Center for the Study of Evaluation- University of California in Los Angeles). Subjek penelitian terdiri dari: kepala sekolah, guru, siswa, dan tim pengelola blended learning. Hasil penelitian menunjukkan bahwa rata-rata tingkat efektivitas pada komponen system assessment sebesar 86,7% sehingga termasuk kategori tinggi, rata-rata tingkat efektivitas pada komponen program planning sebesar 85,6% sehingga termasuk kategori tinggi, rata-rata tingkat efektivitas pada komponen program implementation sebesar 87,5% sehingga termasuk kategori tinggi, rata-rata tingkat efektivitas pada komponen program improvement sebesar 88,5% sehingga termasuk kategori tinggi, dan rata-rata tingkat efektivitas pada komponen program certification sebesar 88,9% sehingga termasuk kategori tinggi.Kata kunci: evaluasi, blended learning, CSE-UCLA EVALUATION OF BLENDED LEARNING AT SMK TI UDAYANA USING CSE-UCLA MODELAbstractThis study aimed to obtain the level of effectiveness of blended learning implementation at SMK TI Udayana in terms of some of the evaluation components such as: system assessment, program planning, program implementation, program improvement, and program certification. The method used in this study is an evaluative study, using CSE-UCLA (Center for the Study of Evaluation- University of California in Los Angeles) evaluation model. The research subjects consisted of: headmaster, teachers, students and the management team of blended learning. The results showed that the average level of effectiveness on the system assessment component amounted to 86.7% that includes high category, the average level of effectiveness on the program planning component amounted to 85.6% that includes high category, the average level of effectiveness on the program implementation component amounted to 87.5% that includes high category, the average level of effectiveness on the program improvement component amounted to 88.5% that includes high category, the average level of effectiveness on the program certification component amounted to 88.9% that includes high category.Keywords: evaluation, blended learning, CSE-UCLA
On some applications of Noshiro-Warschawski’s theorem
Authors: Sokół Janusz , Nunokawa Mamoru , Cho Nak , Tang Huo
Published: April 2017

We apply Noshiro-Warschawski?s theorem to prove that if f(z)=z+a2z2+ ... is
analytic in |z| < 1 and if |Re{zf''(z)}| ? ?|z| ? in |z| < 1, for some ? > 0,
then f (z) is univalent in |z| < 1. Also, applying Ozaki?s condition, we
obtain several sufficient conditions for functions to be p-valent or
p-valently starlike function in |z| < 1.
Some properties of certain family of multiplier transforms
Authors: Wang Zhi-Gang , Li Ming-Liang
Published: April 2017

The main purpose of this paper is to derive some inequality properties,
convolution properties, subordination and superordination properties, and
sandwich-type results of a certain family of multiplier transforms.
Who Is Afraid of Transparency?
Authors: Barlev Benzion , Citron David B. , Haddad Joshua Rene
Published: April 2017

The Conceptual Framework issued by the IASB and the FASB in 2010 excludes the concept of transparency on the grounds that it adds nothing to the existing corpus of qualitative characteristics. This paper argues that incorporating the concept of process transparency into the Conceptual Framework would provide the necessary conceptual basis for raising the status of the Management Discussion and Analysis from a non-mandatory guideline to an accounting standard. This would further the Boards' stated public interest objectives of “fostering trust, growth and long-term financial stability” by requiring disclosure of how critical accounting estimates affect reported results and, at a broader level, how and why key strategic management decisions are made. The paper derives this recommendation from a review of notions of transparency and “black box” in the public finance and management literatures. We also analyze the viewpoints expressed in comment letters to the Boards' Discussion Paper and the Exposure Draft, which preceded the Conceptual Framework. In contrast to the Boards' stance we find that most respondents who address the issue of transparency favor its inclusion in the Conceptual Framework. Finally, based on Kuhn's (1970) The Structure of Scientific Revolutions, we seek to explain the Boards' objection to the new concept.

Data Availability: All data are available from public sources.
PROFESI CERTIFIED SUSTAINABILITY REPORTING SPECIALIST, PELAPORAN KEBERLANJUTAN, DAN TEORI ENTERPRISE (Suatu Tinjauan Mengenai Profesi CSRS dalam Pelaporan Keberlanjutan)
Authors: Kurniawan Putu Sukma
Published: April 2017

AbstrakPerubahan dalam paradigma pelaporan perusahaan menghasilkan sebuah konsep pelaporan keberlanjutan (sustainability reporting). Pelaporan keberlanjutan merupakan sebuah bentuk tanggung jawab perusahaan kepada seluruh pemangku kepentingan perusahaan. Peran profesi certified sustainability reporting specialist (CSRS) sangat penting dalam proses penyusunan sebuah laporan keberlanjutan agar penyampaian informasi dari perusahaan kepada pemangku kepentingan dapat lebih komprehensif. Peran profesi CSRS dan pelaporan keberlanjutan pada dasarnya merupakan sebuah jawaban bagi penerapan teori enterprise (entreprise theory) bahwa bisnis yang dijalankan oleh perusahaan seharusnya bermanfaat kepada semua pemangku kepentingan perusahaan.Kata kunci: certified sustainability reporting specialist, pelaporan keberlanjutan, teori enterprise AbstractChanges in corporate reporting paradigm to produce a sustainability reporting concept. Sustainability reporting is a form of corporate responsibility to all stakeholders of the company. The role of certified sustainability reporting specialist is very important in the process of preparing a sustainability report in order to deliver information to the stakeholders of the company can be more comprehensive. The role of profession of CSRS and sustainability reporting is essentially a response to the application of the enterprise theory that the business carried on by the company should have been beneficial to all stakeholders of the company.Keywords :  certified sustainability reporting specialist, sustainability reporting, enterprise theory
Combining Propensity Score and Random Coefficient Modelling as an Approach to Analyse Complex Longitudinal Data
Authors: Clos Stefan , Donnan Peter , Rauchhaus Petra
Published: April 2017

ABSTRACT

ObjectivesWe looked for an approach to analyze/visualize a set of repeated measures of renal laboratory data (eGFR [estimated Glomerular Filtration Rate] from an observational population-based data set) as safety parameters in a longitudinal design and calculate annual changes in different sub-cohorts. Previous meta-analyses had struggled to address this problem (due to poor data quality and strong heterogeneity in underlying historical studies) and previous large population-based observational studies had only looked into binary outcomes.

Particular challenges lay (1) in the complexity of the data set with irregularly spaced observation points, (2) in the observational character of the data with associated bias and confounding by indication and co-medication and (3) in the change of lab method during the observation period.

ResultsOut of a population base of 400.000 we analysed linked longitudinal data of more than 1000 eligible patients with over 1000.000 prescription records of index drug or co-prescription drugs. Data were provided by the Dundee University Health Informatics Centre (HIC).

We addressed the differences in covariates (which typically can lead to biased estimates of treatment effects in observational studies) via individual propensity scores (to reduce this bias by balancing the covariates in the two groups) and a hierarchical modelling approach.

A Random Coefficient Model (via proc mixed in SAS 9.3) proved a much more powerful statistical tool than analysis of covariance of the summary measure during follow-up, particularly as the latter approach is less efficient when applied to longitudinal data with missing data points and irregularly spaced repeated measures.Visualization was achieved with the SAS 9.3 GPLOT procedure combined with a spline function. The historical change in lab method was addressed via a conversion of lab results to an internationally recognized standard (IDMS aligned method).

We were able to achieve plausible and more precise estimates of the annual decline in eGFR in the patient group of interest than previous attempts from other research publications. This led to a publication in a high profile journal.

ConclusionOur approach of combining a Propensity Score and Random Coefficient Modelling was successful to answer a question in drug safety using repeated measurement data from a longitudinal observational population based data set. This approach may be useful for other research questions in Drug Safety or in Comparative Clinical Effectiveness Research for continuous outcome measures.
Differences in the breast cancer diagnostic process across stage groups in Ontario, Canada
Authors: Groome Patti , Whitehead Marlo , Jiang Li , Gilbert Julie , Grunfeld Eva , Langley Hugh , Lofters Aisha , Moineddin Rahim , Porter Geoff
Published: April 2017

ABSTRACT

ObjectivesEarly diagnosis leads to better cancer survival and short diagnostic intervals reduce patient anxiety. We are studying factors that prolong the breast cancer diagnostic process in Ontario, Canada.

ApproachThis is a retrospective study of all patients diagnosed 2007-2011 (n=33,752). We linked data from Cancer Care Ontario and the Institute for Clinical Evaluative Sciences including: Ontario Cancer Registry, physician claims, ambulatory, ER visits, and hospital discharges. Detection method (screening versus symptomatic) was determined using Screening Program and claims data. The diagnostic interval is the time from first relevant health care encounter to the definitive diagnosis. Elements of the diagnostic interval include: use of imaging, biopsy, and the number of encounters and providers.

ResultsOverall, 30.6% were screen-diagnosed and the median diagnostic interval was 40 days (IQR 21-80). The median interval was shorter in the screened group at 32 days versus symptomatic at 45 days. The diagnostic interval was longer for stage I patients at 47 days compared to stage II (37 days), stage III (33 days) or stage IV (22 days). Stage IV patients were less likely to be diagnosed via biopsy (44% vs 61%) and the symptomatic stage IV subgroup less likely to have breast imaging (61% vs 96%). 26% of stage IV patients saw 0 or 1 providers while 8% of stage I patients saw 6 or more. 19% of stage I patients had 10 or more encounters overall versus 15% and 28% had >1 mammogram versus 14%. Effects are largely similar in screened and symptomatic groups.

ConclusionShorter diagnostic intervals in stage IV are associated with a more direct diagnostic path. We will present results quantifying the number of days attributable to the diagnostic elements. Understanding the impact of elements of the diagnostic process provide targets for improvement of its length.
Investigating the relationships between chronic ill health and educational outcomes in children
Authors: Fleming Michael , Mackay Daniel , Pell Jill , McLay James
Published: April 2017

ABSTRACT

ObjectivesThis population wide record linkage study linked Scottish education data to a number of administrative health datasets to explore the impact of childhood chronic ill health on subsequent educational and health outcomes. Chronic conditions investigated in this study were diabetes, asthma, epilepsy, ADHD and depression. Specific educational outcomes of interest were academic attainment, school leaver destination, absence levels, exclusions and record of special educational need (SEN). Children were also followed up for hospital admissions and all-cause mortality.

ApproachPupil census data and associated education records for all children attending primary and secondary schools in Scotland between 2009 and 2013 were linked to national prescribing data, hospital admissions (acute, psychiatric and cancer), death records and their mother’s maternity records to enable a range of different chronic conditions to be studied whilst controlling for various confounders. Specific drugs are prescribed for some particular chronic conditions therefore children identified from prescribing data as receiving these drugs at the time of the school census were assumed to have these conditions. Hospital admissions and death records provided information on subsequent admissions and mortality. Linking all children to their mother’s maternity records provided ability to control for a range of obstetric factors, birth outcomes and maternal antecedents.

ResultsDiabetes, asthma, epilepsy, ADHD and depression were significantly associated with increased numbers of absences at school and increased risk of SEN. All of the conditions with the exception of diabetes were significantly associated with poorer subsequent educational grade attainment. ADHD and depression were significantly associated with increased numbers of exclusions at school whilst asthma was significantly associated with less exclusion. Epilepsy, ADHD and depression were significantly associated with poorer leaver destination 6 months after leaving school.

ConclusionCompared to peers, children who had ADHD or depression were most adversely affected experiencing poorer educational outcomes in all five of the educational domains investigated. Children with epilepsy experienced poorer outcomes across four domains. Children with diabetes and asthma experienced more absence and increased SEN and asthmatic children experienced poorer attainment. Children who have these chronic illnesses at school appear to be at an educational disadvantage therefore further understanding of the intricate relationships between health and education is an on-going important area of public health.
Longditudinal Study of Type-2 Diabetics – Do the morbidly obese really have better outcomes?
Authors: Bailey Kerry , Nock Kelly , Thomas Helen , Barker Craig , Player Luke
Published: April 2017

ABSTRACT

BackgroundDiabetes continues to utilise 10% of the NHS budget and have considerable impact on people’s lives. Abertawe bro Morganwyg Health board identified diabetes and obesity as a strategic priorities. Working in collaboration with SAIL and We Predict ABM identified this as an area for which greater insights could be gained from linked data. Type-2 diabetes is not easily identified through ICD-10 and READ codes but if new diabetics can be identified through linked data and followed up over time local areas can understand the progression locally, which populations are at risk of serious outcomes and where interventions may be made.

ObjectivesTo identify newly diagnosed type-2 diabetics and matched controls in order to produce and analyse difference to the key outcomes of interest – death, retinopathy, myocardial infarction, CVD, CKD and amputation. In addition to produce sub group analysis – including by age group, gender, BMI and deprivation.

ApproachA stakeholder group of GPs, managers, NHS analysts and SAIL employees were consulted. Several approaches to define and identify newly diagnosed type 2 diabetics were considered. The final algorithm consisted of a combination of 227 linked primary and secondary care codes. All 635,552 patients in the historical data set were eligible for inclusion. Suitable matched controls (patients who did not have a Type-2 Diabetes diagnosis matched based on Gender and Age Group) were identified, and allocated a synthetic ‘date of diagnosis’ or date of entry into ‘study’. The ‘cases’ and controls were then followed up to each of the key outcomes of interest for as long as data was available (in some cases 20 years). Using ‘R’ relevant analysis including survival curves were produced. After feedback to key stakeholders different approaches to presenting (visualising) the outputs were developed. Finally all the statistics and visualisation was automated.

Results 47,848 people were identified with a new a diagnosis of diabetes. Large differences in mortality were clearly evident in people with diabetes in ABM HB – for example 10 years in middle aged men when diagnosed with diabetes compared to those who were not.

There were some surprising results where people with higher BMIs appeared to have better outcomes when compared to groups of people in similar categories but with lower BMI. However this finding was not consistent - there was a difference in micro vascular and macro vascular outcomes.
Public attitudes to data linkage and sharing
Authors: Given Joanne , Nelson Elizabeth , Kane Frances , Dolk Helen , Robinson Gillian
Published: April 2017

ABSTRACTObjectiveTo capture a baseline of public attitudes in Northern Ireland towards data linkage and sharing which can then be reassessed at intervals to measure changes in public trust and understanding.

ApproachThe Life and Times Survey is an annual survey of the attitudes of the public of Northern Ireland to a wide range of social issues. Questions within the survey are grouped into modules, the range of which varies from year to year.

In the 2015 survey a module of questions and vignettes was added relating to data sharing. These questions were derived mainly from the ‘Dialogue on Data’ report from ESRC and Ipsos Mori in 2014 and related to the key theme of ‘Public understanding and views of sharing of health data, data linking, and relevant safeguards’.

Each year a systematic random sample of addresses is used to identify selected respondents. Interviews are then carried out face to face in the respondent’s home via Computer Assisted Personal Interviewing. A self-completion questionnaire is also included at the end of the interview.

It is intended that the module relating to public attitudes towards data linkage and sharing are repeated at intervals, possibly every 3 to 5 years, to assess changes in levels of public trust and understanding.

Results1200 respondents completed the NILTS between October and December 2015. The dataset is currently being cleaned and will be ready for analysis in April 2016. It is intended that the results of the survey be presented at the IPDLN conference.

ConclusionA baseline measure of public attitudes towards data linkage and sharing has been made in Northern Ireland. Repeating this assessment at intervals will make it possible to measure changes in the levels of public trust and understating over time.
Risk of mortality following discharge from Critical Care
Authors: Walters Angharad , Lyons Ronan , Berridge Damon
Published: April 2017

ABSTRACTObjectivesCritical care provides specialist treatment for patients with life-threatening illnesses and injuries. Outcomes data are fundamental to identify where resources need to be focused to provide safer care; we can determine long term survival after critical care and identify the risk factors of mortality by linking the critical care data with a mortality register, thereby building on previous survival reporting which is constrained to mortality within the admission. The objective is to identify the factors that increase the risk of mortality following discharge from critical care.ApproachAnonymised critical care data reported from 1st April 2006 are held within the Secure Anonymised Information Linkage (SAIL) databank and will be linked with ONS mortality data, inpatients data and the Welsh Demographic Service dataset. Details of patient care during the critical care admission such as duration of level 2/3 support, the organs supported and discharge details such as the time of day, along with patient demographics such as age, sex and socioeconomic factors are available for analysis. Adult Welsh patients alive at the discharge date and with a discharge date from critical care on or before 31.12.2013 will be followed up until 31.12.2014, outward migration or death.

ResultsSurvival analysis techniques will be used to determine the risk of death at certain time points after discharge from critical care and to identify the risk factors associated with mortality.

ConclusionDetermining the factors associated with mortality will allow patients at highest risk of death to be identified. If these risk factors are modifiable, then preventive interventions can be introduced to reduce the number of avoidable deaths.
Mortality rates in people with intellectual disabilities
Authors: Williams Rachael , Oyinlola Jessie , Heslop Pauline , Glover Gyles
Published: April 2017

ABSTRACTObjectivesA growing body of evidence highlights a disparity in mortality rates for people with intellectual disability (ID) compared with the general population. However, national data for England is lacking. The objective of this study was to provide evidence on mortality rates in people with ID.

ApproachPatients registered for at least a day during 01/04/10-31/03/14 at a GP practice contributing to the Clinical Practice Research Datalink (CPRD) and consenting to linkage were included. Patients with ID were identified via Read codes. Date and cause of death were identified using linked Office of National Statistics mortality data. Crude mortality rates, life expectancy and indirectly age/sex standardised mortality ratios (SMR) were calculated with 95% confidence intervals (CI), overall, by ICD10 chapter, for frequently occurring causes, and those classified as avoidable.

Results11 million person-years were included (0.5% for patients with ID) and 98,035 deaths occurred (0.7% in patients with ID). The mortality rate for patients with ID was 11.2 per 1,000 population, 1.3 times the rate for those without ID, with an associated SMR of 3.2 (95% CI 2.93.4). Life expectancy was 65.5 years (95% CI 61.969.2)for patients with ID and 85.3 years for those without (95% CI 85.285.4). Mortality rates were higher in patients with ID in all age/sex groups, with larger differences for younger ages. Patients with ID had higher cause-specific mortality rates across all ICD10 chapters, with highest SMRs for congenital malformations (72.9, 95% CI 55.194.7), nervous system diseases (9.8, 95% CI 7.812.1) and mental disorders (5.4, 95% CI 3.97.3). Circulatory deaths were the most frequent, with ischaemic heart disease (SMR 2.2, 95% CI 1.62.8) and cerebrovascular disease (SMR 3.3, 95% CI 2.34.5) most prominent. A higher proportion of deaths were classified as avoidable for patients with ID (44.7%, 95% CI 41.048.5%) compared to those without (21.0%, 95% CI 20.721.3).

ConclusionNational English data confirm that patients with ID have higher mortality rates than those without. Mortality rates for patients with ID were higher across all age/sex groups and causes, with almost half of deaths classified as avoidable.
The healthcare costs of heart failure during the last five years of life: A retrospective cohort study
Authors: Hollingworth William , Biswas Mousumi , Maishman Rachel , Dayer Mark , McDonagh Theresa , Purdy Sarah , Reeves Barnaby , Rogers Chris , Williams Rachael , Pufulete Maria
Published: April 2017

ABSTRACTObjectivesEvidence on the economic impact of heart failure (HF) is vital in order to predict the cost-effectiveness of novel interventions. The objective was to estimate the healthcare costs of HF during the last five years of life.

MethodsAdults who died with HF in 2012/3 were identified through linked English Office of National Statistics mortality data and Clinical Practice Research Datalink (CPRD) primary care data. CPRD and linked Hospital Episode Statistics admissions data were used to estimate the cost of primary care prescriptions and primary care and hospital admission healthcare with 95% confidence intervals (CI). Generalized least squares regression was used to estimate the relationship between costs, HF diagnosis and patient characteristics.

ResultsIn the last 90 days of life of 1,555 identified patients, healthcare costs were £8,912 (95% CI £8,436-9,388)per patient, more than 90% of which were for inpatient or critical care. In the last 90 days, patients spent on average 17.8 days (95% CI 16.8-18.8) in hospital and had 8.8 (95% CI 8.4-9.1) primary care consultations. Most (59%) patients were in hospital on the day of death. Mean quarterly healthcare costs were significantly higher after diagnosis than preceding diagnosis (by £1,479, 95% CI £1,286-1,671). Younger patients and patients with higher comorbidity had higher costs.

ConclusionHealthcare costs increased sharply at the end of life and were dominated by hospital care. There is potential to save money by implementation and evaluation of interventions known to reduce HF hospitalisations, particularly at the end of life.
One for all, all for one - Establishing a corporate linkage methodology for integrated health analytics in Canada
Authors: Paton David , Kirby Lori , Poitras Philippe
Published: April 2017

ABSTRACTObjectivesTo describe the successes, challenges and trade-offs encountered when establishing a standard patient linkage methodology for linking pan-Canadian health data across the continuum of care.

ApproachHealth facilities, regional health authorities and ministries of health across Canada need access to timely, integrated health information across the continuum of care in order to make effective decisions to manage and improve their health systems. To better meet these needs, our organization has embarked on an initiative to integrate our web-based analytic tools. A requirement for this integration is the establishment of a corporate linkage standard.

The scope is to enable linkage across a dozen patient-level data holdings including data from acute care, long term care, home care, rehabilitation, mental health, pharmaceuticals and registries for joint replacements and organ transplants. In Canada, provinces and territories issue jurisdiction-specific health care numbers (HCN) to their residents.

A working group was established to review existing methodologies and to define a standard linkage. To gain support from the various groups in our organization to adopt the proposed standard, the right balance was sought between accuracy, timeliness, ease of implementation as well as availability and quality of data elements across our data holdings. In addition, an accurate patient linkage key was manually created as a benchmark to compare false positives and false negatives of the various candidate methods.

ResultsIn general, adding data elements to the linkage methodology increased false negatives, decreased false positives and reduced the number of records that could be included in the linkage. Data quality issues affecting linkages varied across the data holdings and by jurisdiction.

The final standard linkage methodology is simple and deterministic: link records by jurisdiction and HCN and exclude records where HCN is used by multiple people, for example, newborns who share their HCN with their mother.

ConclusionArriving at a methodology that balanced the need for inclusiveness, simplicity and precision required collaboration, compromise, analysis and innovation. To date, the new client linkage standard has been implemented for ad-hoc analysis as well as in the data warehouse for our new web analytics tool. The implementation of the new client linkage standard represents an important foundational step towards creating an integrated analytics tool that spans across the continuum of care.
Linking strategies and biases when matching cohorts to the National Pupil Database.
Authors: Downs Johnny , Setakis Efrosini , Mostafa Tarek , Hayes Richard , Hotopf Matthew , Ford Tamsin , Gilbert Ruth
Published: April 2017

ABSTRACT

ObjectivesTo compare sample biases when linking education data to external datasets using opt in and opt out consent models for the Millennium Cohort Study (MCS) – opt in, and the Case Register Interactive Search Child and Adolescent Mental Health sample (CRIS CAMHS) –opt out.

ApproachWe compared demographic factors in the linked and unlinked populations when two cohorts, the MCS, and CRIS CAMHS data were linked to the National Pupil Database. The MCS is a birth cohort collecting prospective data on the social, economic and health-related circumstances of children surveyed at roughly two-yearly intervals from the age of 9 months. At age 7, parents were asked to consent for information from their child’s education records (via the UK Department for Education’s National Pupil Database, NPD) to linked to the MCS. Of the 9000 adults with parental responsibility, 8448 (93.9%) consented. The CRIS CAMHS sample is the UK's largest, anonymised clinical database for children and adolescents referred to South London child and adolescent mental health services, which is collected using opt out consent. All 35, 426 children were eligible for linkage to their educational data.

ResultsFor MCS, 7446 (82.7% of the population) eligible children were successfully linked to NPD following opt in consent. After stratification into distinct geographical regions, London children in the most deprived quartile of neighbourhood deprivation were over twice as likely (O.R 2.5, C.I 1.18-5.3) not to have their educational records linked. For the opt out CRIS CAMHS cohort, 30,178 (85.1%) were linked, with no significant differences in linkage rates between children in the highest and lowest quartiles of deprivation (O.R 1.05, C.I 0.93-1.18). Relative to children of White ethnicity, Asian, Black African and Mixed ethnic groups were significantly less likely to be matched in both studies. Black Caribbean ethnicity was significantly associated with non-linkage in the MCS cohort (O.R 3.0, C.I 1.49-6.01), but not in CRIS CAMHS (0.96, C.I 0.83-1.12).

ConclusionRecord linkages are a valuable enhancement to child-based longitudinal studies and clinical registries, allowing evaluation of questions relevant to public health and social care policy. Opt out consent approaches improve representation of more socially disadvantaged populations. Nevertheless, whether using opt in and opt out consent process, possible biases due to linkage error can be important and need to be addressed when analysing and interpreting results.
Impacts of Alternative Billing Claims on Hypertension Prevalence and Mortality Estimates in Alberta, Canada
Authors: Cunningham Ceara Tess , Quan Hude , Jette Nathalie , Chen Guanmin
Published: April 2017

ABSTRACT

ObjectivesIn Canada, secondary sources of health information such as physician billing claims are used for surveillance of chronic conditions such as hypertension. The value of this data may be affected by different types of physician payment models. Fee-for-service (FFS) physicians submit billing claims in order to be remunerated whereas physicians on salary or capitation also called alternative payment plans (APP) are remunerated regardless of whether claims are submitted. Thus there are concerns nationally that APPs may be associated with decreased frequency of billing submission, thereby eroding data quality and leading to underestimates of disease burdens and outcomes. We assessed the impact of APPs on hypertension prevalence, mortality and cardiovascular (CVD) hospitalization in Alberta.

ApproachThe following health administrative databases from Alberta, Canada were used in this study: 1) Alberta Health Care Insurance Plan registry; 2) Hospital Discharge Abstract database (DAD); 3) Physician claims data and; 4) Vital Statistics database. We defined patients with hypertension aged 20 years and older between April 1, 2004 and March 31, 2009 (fiscal years 2004 to 2009) based on previously validated algorithm. Cases were then sorted into FFS and non-FFS billing status. Descriptive statistics for age group, sex, income quintile, rural/urban geographical location, death status and comorbidities were reported between the shadow billing and non-shadow billing groups in regards to prevalence, all-cause mortality and CVD hospitalizations.

ResultsA total of 613, 844 adult hypertensive cases were captured during the 5 year study period. The majority of hypertension cases (99.6%, n=610,167) were identified through FFS claims. The effect of non-FFS billing estimates represented a small proportion of hypertension cases (0.40%, n=3677) identified during the study period. Among the FFS claims, overall hypertension prevalence was 22.2% (n=610167) and the effect of non-FFS billing estimates (0.13%, n=3677) on prevalence estimates was relatively minor. All-cause mortality 33.8 (95% CI 33.6-34) and CVD 40.6 (40.4-40.9) were higher for FFS cases than non-FFS cases 19.0 (16.6-21.8) and CVD: 8.0 (6.4-9.8).

ConclusionDuring the study time period, the impact of non-FFS (i.e. shadow billings) on physician claims may not have impacted hypertension prevalence estimates greatly. Since Alberta uses shadow billing incentive programs, future research is needed to determine whether incentive programs should be considered in other provinces or nationally in order to preserve the overall quality of physician claims data.
Incidence, risk factors, and adverse short term perinatal and maternal outcomes associated with singleton breech presentation at delivery in Northern Tanzania
Authors: Mahande Michael Johnson , Mchaki Uyonyimoo M. , Obure Joseph J.
Published: April 2017

ABSTRACTBackgroundBreech presentation has been associated with adverse perinatal and maternal outcomes. However, the incidence and associated perinatal and maternal outcomes has not been fully explored in Tanzania. This study aimed to determine the incidence, risk factors and adverse short term perinatal and maternal outcomes associated with singleton breech presentation at delivery at Kilimanjaro Christian Medical Centre (KCMC) hospital.MethodsThis was a retrospective study involving 47,626 singletons deliveries between 2000 and 2014, using maternally-linked KCMC Medical Birth Registry. Adjusted odds ratios (ORs) with 95% CI for risk factors and adverse short term perinatal and maternal outcomes were estimated using multiple logistic regression models. ResultsThere were a total 8761 women who had subsequent singleton deliveries during this study period. The incidence of breech delivery was 0.8%. Advanced maternal age (>30 years) (AOR 1.3 95% CI 1.1-1.6), delivery of low birth weight infant (AOR 3.4, 95% CI 2.8-4.1) and malformed child (AOR 8.0, 95% CI 3.6- 17.8) were associated with increased risk of breech delivery. Breech presentation was associated with an increased risk of delivering an infants with Apgar score of less than 7 at 5 minutes (AOR 4.6, 95% CI 3.7-5.6), low birth weight (AOR 3.5, 95% CI 2.9-4.3), congenital malformation (AOR 9.3, 95% CI 4.2-20.3) and perinatal death (AOR 6.3, 95% CI 5.1-7.9). Breech presentation was also associated with high risk of preeclampsia/eclampsia (AOR 1.6 95% CI 1.2-2.3) as compared to cephalic presentation. In addition, vaginal breech delivery increase women’s likelihood of delivering infant with Apgar score of less than 7 at 5 minutes (AOR 4.4, 95% CI 2.5-6.6), low birth weight (AOR 3.4, 95% CI 2.3-5.0) and perinatal death (AOR 5.1, 95% CI 3.1-8.4). ConclusionsBreech delivery was associated with adverse perinatal and maternal outcomes as compared to cephalic presentation. Vaginal breech delivery was associated with unfavorable perinatal and maternal outcomes as compared to cesarean breech delivery. Early identification of these risk factors and provision of appropriate management during delivery such as caesarian-section when needed may reduce the poor perinatal and maternal outcomes.
Methods of defining hypertension in electronic medical records: validation against national survey data
Authors: Peng Mingkai , Chen Guanmin , Kaplan Gilaad , Lix Lisa , Drummond Neil , Lucyk Kelsey , Garies Stephanie , Lowerison Mark , Weibe Samuel , Quan Hude
Published: April 2017

ABSTRACTObjectivesElectronic medical records (EMR) can be a cost-effective source for hypertension surveillance. However, diagnosis of hypertension in EMR is commonly under-coded and warrants the needs to review blood pressure and antihypertensive drugs for hypertension case identification. To advocate for the use of EMR data for research, we developed methods for defining hypertension using diagnosis codes, blood pressure measurements and antihypertensive drug prescriptionApproachWe included all the patients actively registered in The Health Improvement Network (THIN) database, UK, on 31 December 2011. Three case definitions using diagnosis code, antihypertensive drug prescriptions and abnormal blood pressure, respectively, were used to identify hypertension patients. We compared the prevalence and treatment rate of hypertension in THIN with results from Health Survey for England (HSE) in 2011. ResultsCompared with prevalence reported by HSE (29.7%), the use of diagnosis code alone (14.0%) underestimated hypertension prevalence. The use of any of the definitions (38.4%) or the combination of antihypertensive drug prescriptions and abnormal blood pressure (38.4%) had the higher prevalence than HSE. The use of diagnosis code or two abnormal blood pressure records within a 2-year period (31.1%) had similar prevalence and treatment rate of hypertension with HSE. ConclusionsDifferent definitions should be used for different study purposes. The definition of ‘diagnosis code or two abnormal blood pressure records with a 2-year period’ could be used for hypertension surveillance in THIN.
Evaluating the impact of dose reduction software on Computed Tomography radiation dosimetry using radiology information systems meta data: An example of the use of novel linkable data.
Authors: Moorin Rachael , Forsyth Rene , Fox Richard
Published: April 2017

ABSTRACTObjectivesRecently concerns have been expressed regarding the cancer risk to patients undergoing CT scanning prompting the development of dose-reducing software. Experimental studies using phantoms, have shown the potential to significantly reduce radiation dose without compromising diagnostic accuracy. However since dose reduction requires acceptance of more noise in the image the findings from these studies may not be representative of the impact in routine clinical practice. The aim of this study was to evaluate the effect of introduction of iterative reconstruction software on radiation dosimetry in routine clinical practice over a range of CT examinationsApproachRandom samples of CT scans pertaining to 10 commonly performed CT examination types undertaken at two hospitals in Western Australia (WA), before and after the introduction of iterative reconstruction software were extracted from the WA centralised Picture Archiving Communication System. Technical information about the scanning parameters used and radiation dose metrics were extracted from the Digital Imaging and Communications in Medicine (DICOM) information contained in the meta-data for each examination. Changes in the mean dose length product and effective dose were evaluated along with estimations of associated changes to annual cancer incidence using established radiation dosimetry techniques.ResultsWe observed statistically significant reductions in the effective radiation dose for head CT (22-27%) consistent with those reported in the literature. In contrast the reductions observed for non-contrast chest (37-47%); chest pulmonary embolism study (28%), chest/abdominal/pelvic study (16%) and thoracic spine (39%) CT were lower than expected based on experimental studies. Statistically significant reductions in radiation dose were not identified in angiographic CT. Dose reductions translated to substantial lowering of the lifetime attributable risk, especially for younger females, and estimated numbers of incident cancers. ConclusionsOur study has demonstrated a reduction in radiation dose for some scanning protocols, but not to the extent experimental studies had previously shown or in all protocols expected, raising questions about the extent to which iterative reconstruction achieves dose reduction in real world clinical practice. In addition, our study showcases a practical application of the use of technical meta-data from CT scanning examinations to monitor radiation dose and evaluate the impact of dose reduction initiatives. These readily available data provide the ability to routinely monitor CT radiation dose (within and between providers) and, when linked to other administrative data, the opportunity to conduct large scale whole-of-population epidemiological studies evaluating the effect policies and practice on population radiation dose and cancer risk.