bluuebunny/crossref_metadata_2025 huggingface dataset:
"Nachhaltigkeit" – definiert nach einem kriteriengebundenen Verfahren
Authors: Tremmel Jörg
Published: April 2017

"Sustainability" has become a guiding principle for environmental science even though consensus on the definition of the term has never been reached. That the criteria used by researchers in attempts to define scientific terms are usually not explicitly given or discussed, contributes to the flurry of definitions of sustainability. Thus, this paper suggests criteria for the definition of sustainability and, subsequently, defines sustainability according to these criteria. The result – an analytical definition of sustainability – demonstrates that a majority of scientists has stopped using a narrow concept of sustainability focusing on the ecological dimension. Rather, they more often employ a broader definition. Accordingly, today, sustainability needs to be understood as a concept that measures inter- and intra-generational justice on equal levels. The paper discusses the advantages of an analytical definition, as opposed to definition processes where the criteria used are not revealed. The shift in meaning of "sustainability" implies that this term has lost some of its value for the environmental sciences. The prognosis entails that ecologists might no longer refer to "sustainability," but use alternative terms such as "ecologisation" or "ecological carrying capacity", or amend the term with an adjective and use "ecological sustainability".
Symplectic topology of Lagrangian submanifolds of ℂPn
with intermediate minimal Maslov numbers
Authors: Iriyeh Hiroshi
Published: April 2017

We examine symplectic topological features of a certain family of monotone Lagrangian submanifolds in ℂPn
. First we give cohomological constraints on a Lagrangian submanifold in ℂPn
whose first integral homology is p-torsion. In the case where (n, p) = (5,3), (8, 3), we prove that the cohomologies with coefficients in ℤ2 of such Lagrangian submanifolds are isomorphic to that of SU(3)/(SO(3)ℤ3) and SU(3)/ℤ3, respectively. Then we calculate the Floer cohomology with coefficients in ℤ2 of a monotone Lagrangian submanifold SU(p)/ℤ
p
in

C

P

p
2

−
1

.

${\mathbb C}P^{p^2-1}.$
Condensation of refrigerant R407C in multiport minichannel section
Authors: Bohdal Tadeusz , Charun Henryk , Sikora Małgorzata
Published: April 2017

Analysis of the state of-the-art in research of refrigerant condensation in miniature heat exchangers, so-called multiports, was made. Results of refrigerant R407C condensation in a mini condenser made in the form of two bundles of tubular minichannels from stainless steel with an inside diameter 0.64 mm and length 100 mm have been presented. Two exchangers consisted of four minichannels and 8 minichannels have been investigated. The values of average heat transfer coefficient and frictional pressure drops throughout the condensation process were designated. The impact of the vapor quality of refrigerant and the mass flux density on the intensity of heat transfer and flow resistance were illustrated. A comparative analysis of test results for various refrigerants in both mini heat exchangers were made.
Three new species of Pharygodonidae (Nematoda: Oxyuridea) in Laudakia tuberculata (Squamata: Agamidae) from Dehradun, Uttarakhand, India
Authors: Rizvi Anjum N. , Maity Pallab , Bursey Charles R.
Published: April 2017

sp. nov.,
Transposition of Subclavian Artery – Is It the Appropriate Choice?
Authors: Lazovski Nikola , Jovev Sasko , Babic Dusan , Babic Srdjan , Dzemali Omer
Published: April 2017

Introduction: To present patients with symptomatic subclavian artery disease and treatment possibility.

Case report: A 53-year-old female was admitted with vertigo and left arm claudication. Duplex-scan and MSCT arteriography verified subclavian artery occlusion. After the endovascular treatment failure, the patient was switched to surgical treatment - subclavian artery transposition. After the successful surgical treatment, the patient was discharged on the second postoperative day. If the patient is a candidate for surgery, the literature review shows good initial and long-term results after the subclavian artery transposition, and emphasizes this technique as superior.

Conclusion: Subclavian carotid transposition is a safe and effective method of treatment in patients after endovascular treatment failure or other indication. Also, the surgical treatment is technically demanding because of the difficult access to the vessel origin, and it requires experienced surgeons.
Визначення чутливості виробничого штаму Bacillus anthracis UA–07 до антибіотиків
Authors: Rublenko I. , Skripnik V.
Published: April 2017

Long-term use of antibiotics leads to antibiotic resistance in pathogens. In addition, there is a possibility of permanent genetic changes in strains due to environmental influences. Therefore there is a need for periodic study vaccine strains for sensitivity to antibiotics in order to study and control of their passport characteristics. The aim of our research was necessary to determine the sensitivity of the strain of Bacillus anthracis UA-07 to antibiotics. The results of studies of sensitivity of strain Bacillus anthracis UA–07 to 50 antibiotics were determined by the size of the diameter of the zones of growth retardation. Zone growth delay of 15 mm was considered a sign of a weak antibiotic sensitivity, zone 15–24 mm – a sign of sensitivity and area of more than 24 mm - a sign of the high sensitivity of the strain to this antibiotic. Lack of stunted growth areas points to the insensitivity of the strain to this antibiotic. The research results show that the strain of Bacillus anthracis UA–07 is highly sensitive to ofloxacin (Of5), ampicillin / sulbactam (A/S10/10), linezolid (LZ30), amoxicillin (AMX30), norfloxacin (NX10), cefalotin (CEP30), tetracycline (TE30). Not affect the development of the studied microorganism antibiotics, cefepime (SPM30), nystatin (NS100U) tsefuroksyn (CXM30) tsefeksym (CFM5), sulfadiazine (SZ300), metronidazole (MT4), cefazolin (Cz30).
Динаміка лейкоцитів крові поросят у різні стресорні періоди онтогенезу при згодовуванні добавок «В-глюкан» та «Біовір»
Authors: Stoyanovskyi V.H. , Matsiuk O.I. , Kolotnyskyy V.A.
Published: April 2017

The article provides the results of the research of the number of different types of leukocytes in blood of piglets at stress periods of ontogenesis while adding to their ration probiotic feed additives «B-Glukan» and «Biovir». There was formed three groups for conducting the research – Control (K), and two research (D1, D2), with 10 piglets in each group. Starting from 5th to 45th day age, piglets of the D1 group were fed with feed additive «B-Glukan», piglets of D2 group were fed with feed additive «Biovir» with the amount of 10 mg/kg of body mass per day. At the 28th day piglets were separated from sow. The material for the research was blood, which was taken in the morning, before the process of animals feeding, using the method of puncture of cranial vena cava at the 25th day of life (period before separation), at the 29th day of life (1 day after separation), at the 35th day of life (7 days after separation), at the 58th day of life (20 days after separation), at the 88th day of life (60 days after separation). The blood was determined by the absolute content of granulocytes, lymphocytes and monocytes using hematology analyzer MITIKH-18 (Switzerland). It is proven that while adding for D1 and D2 groups of piglets feed additives «B-Glukan» and «Biovir» in amount of 10 gr/kg body mass per day during 5th–45th day age promotes oxygen-transport function of blood, normalization of physiological state of an animals' organism in the period of adaptation to the stress action due to the process of separation, that can show the increase of leukocytes content in blood in 1.9 and 2.6 times (Р < 0.01), owing to granulocytes, lymphocytes and monocytes, in comparison with the animals of K group. Better result at the analysis of experimental material was obtained in piglets of D2 group, which were fed with feed additive «Biovir».
Reflexões teóricas sobre governança nas regiões de saúde
Authors: Bretas Junior Nilo , Shimizu Helena Eri
Published: April 2017

Resumo Este artigo analisa a governança nas regiões de saúde, através das contribuições de dois estudos: um sobre modelo de governança e outro sobre funções na gestão de redes de políticas públicas. O primeiro realizou meta-análise de 137 estudos de caso na literatura sobre governança colaborativa visando elaborar um modelo explicativo e analítico. Os autores identificam variáveis críticas que irão influenciar os resultados: História prévia de conflito ou cooperação, incentivos para participação, desequilíbrios de poder, liderança e desenho institucional. Também identificaram fatores cruciais: diálogo face-a-face, construção de confiança e desenvolvimento de compromisso e visão compartilhada. O segundo examinou redes de políticas públicas na tradição analítica e na perspectiva da governança, incorporando conceitos do campo da ciência política, economia e relações interorganizacionais, com o objetivo de apoiar a gestão delas. O estudo identifica a gestão da rede como equivalente a um jogo estratégico envolvendo as funções: ativação da rede, enquadramento das relações, intermediação, facilitação e criação de consenso e mediação e arbitragem. A combinação das duas reflexões proporciona referencia conceitual para melhor compreensão da governança nas regiões de saúde.
O BOM FILHO À CASA TORNA: FORMAÇÃO HUMANISTA EUROPEIA E SENTIMENTO PÁTRIO EM JOAQUIM NABUCO E HENRY JAMES
Authors: Mello Luiza Larangeira da Silva
Published: April 2017

Resumo Este artigo propõe uma análise comparativa entre textos de caráter autobiográfico do intelectual e político brasileiro Joaquim Nabuco e do escritor norte-americano Henry James, nos quais eles modelam suas subjetividades e confrontam-se com alguns dos problemas que mobilizaram boa parte dos intelectuais, na virada do século XIX para o XX. Tanto Minha formação (1900), de Nabuco, quanto The American scene (1907), de James, representam o sentimento a que Evaldo Cabral de Mello chama "o dilema do Mazombo", ou seja, a tensão dialética, vivida por grande parte das elites sul e norte-americanas, entre o humanismo europeu e o vínculo afetivo com o país de origem.
Percepções e experiências dos homens sobre o planejamento familiar no sul de Moçambique
Authors: Pedro Vânia Manuel , Mariano Esmeralda Celeste , Roelens Kristien , Osman Nafissa M. R. Bique
Published: April 2017

Resumo O estudo explora as percepções e experiências dos homens sobre o planejamento familiar (PF) em dois contextos do sul de Moçambique: na localidade de Macarretane (província de Gaza) e no bairro da Mafalala (cidade capital, de Maputo). Combinando métodos qualitativos, exploram-se os conhecimentos e práticas dos homens sobre o PF, bem como percebem seu papel (e envolvimento) na saúde sexual reprodutiva e as formas de diálogo e negociação com suas parceiras sobre o PF. O PF foi definido apenas como barreira às gravidezes indesejadas. Os conhecimentos dos homens sobre o PF do ponto de vista biomédico são fracos. Existe a percepção de que os contraceptivos modernos criam efeitos secundários no corpo da mulher, colocando em risco sua capacidade reprodutiva e o prazer sexual. A capacidade ou incapacidade de negociar o uso do PF pelas mulheres é influenciada pelas normas de gênero e pelas masculinidades vigentes. Os homens consideram que o seu papel no PF é de consentir que as parceiras façam planejamento. O diálogo e a articulação em torno do uso dos serviços de PF também são influenciados pelas normas de gênero e padrões de masculinidade.
Implicações da avaliação institucional na gestão universitária: a experiência da Universidade Católica do Salvador (UCSAL)
Authors: Ferreira Maurício da Silva , Freitas Antônio Alberto da Silva Monteiro de
Published: April 2017

Resumo: A literatura nacional e internacional referente à avaliação das Instituições da Educação Superior (IES) focaliza duas modalidades avaliativas presentes nos sistemas educacionais de diversos países. A primeira modalidade, de caráter externo, dá ênfase à homogeneização e padronização de critérios avaliativos e é centrada na regulação, enquanto que a segunda modalidade, de caráter interno e de matriz educativa e formativa, dá ênfase a diferenciação institucional com suas características e peculiaridades próprias e está centrada na melhoria institucional através de processos de autoavaliação. O objetivo principal deste artigo é enfatizar a segunda modalidade, a partir da pesquisa realizada na Universidade Católica do Salvador, no ano de 2014, como parte integrante do processo de autoavaliação institucional, e analisar em que medida, uma experiência dessa natureza pode, simultaneamente e de forma complementar, ser referencial básico para a regulação e, principalmente, ser um instrumento interno de reestruturação e reorganização institucional. A metodologia adotada foi o estudo de caso, a coexistência de uma abordagem quali-quantitativa e técnica de recolha de dados empíricos decorrente da aplicação de questionários e entrevistas semiestruturadas à comunidade acadêmica. Os principais resultados da pesquisa e o consequente uso desses resultados revelam que a autoavaliação institucional pode se constituir numa forte ferramenta de gestão educacional, através do planejamento participativo, alterando de forma significativa os rumos da instituição e contribuindo de forma decisiva para a melhoria da Universidade e de seus cursos.
Entre cartas e livros: a livraria real e a escrita do bibliotecário Luís Joaquim dos Santos Marrocos no período joanino (1808-1821)
Authors: Conceição Adriana Angelita da , Meirelles Juliana Gesuelli
Published: April 2017

Resumo Entre livros e cartas, a história do império luso-brasileiro passou por profundas mudanças no início d’Oitocentos. O Rio de Janeiro tornou-se a sede da monarquia com a chegada da corte em 1808. O bibliotecário Luís Joaquim dos Santos Marrocos viu sua vida transformar-se ao acompanhar a segunda leva de livros da Real Biblioteca d’Ajuda para a América. Ele atuou na estruturação da Real Biblioteca do Rio de Janeiro, pensada como um locus de saber. Nesse contexto, estudaremos a correspondência ativa de Marrocos escrita entre 1811 e 1821 pelas seguintes perspectivas: a historicidade da Real Biblioteca; a relação de Marrocos com a escrita ; as sociabilidades individuais e coletivas desse momento; as relações políticas nas quais estava inserido e a interlocução com seu pai, Francisco José dos Santos Marrocos; a conservação deste acervo epistolar. Nossa proposta é analisar tais cartas como tema e objeto de pesquisa para refletirmos sobre a escrita das relações políticas e culturais do império luso-brasileiro.
“Oh! Gegê! vem nos salvar”: propaganda política popular (1945-1953)
Authors: Queler Jefferson José
Published: April 2017

Resumo Neste artigo, procuro explorar um significado distinto para propaganda política. Esta é normalmente vislumbrada em mensagens produzidas por governos e difundidas por meios de comunicação de massa. Entretanto, pretendo mostrar que Getúlio Vargas contou com o apoio de muitos trabalhadores que o promoveram por conta própria desde o Estado Novo até sua ascensão à Presidência em 1950. Expressando seus interesses políticos, muitos deles escreveram e ecoaram versos, músicas e panfletos defendendo sua personalidade e suas propostas. Tais atividades propagandísticas parecem ter contribuído para criar uma espécie de esfera pública no Brasil naquele momento.
Janus Kinase 2 Regulates Transcription Factor EB Expression and Autophagy Completion in Glomerular Podocytes
Authors: Alghamdi Tamadher A. , Majumder Syamantak , Thieme Karina , Batchu Sri N. , White Kathryn E. , Liu Youan , Brijmohan Angela S. , Bowskill Bridgit B. , Advani Suzanne L. , Woo Minna , Advani Andrew
Published: April 2017

The nonreceptor kinase Janus kinase 2 (JAK2) has garnered attention as a promising therapeutic target for the treatment of CKD. However, being ubiquitously expressed in the adult, JAK2 is also likely to be necessary for normal organ function. Here, we investigated the phenotypic effects of JAK2 deficiency. Mice in which JAK2 had been deleted from podocytes exhibited an elevation in urine albumin excretion that was accompanied by increased podocyte autophagosome fractional volume and p62 aggregation, which are indicative of impaired autophagy completion. In cultured podocytes, knockdown of JAK2 similarly impaired autophagy and led to downregulation in the expression of lysosomal genes and decreased activity of the lysosomal enzyme, cathepsin D. Because transcription factor EB (TFEB) has recently emerged as a master regulator of autophagosome-lysosome function, controlling the expression of several of the genes downregulated by JAK2 knockdown, we questioned whether TFEB is regulated by JAK2. In immortalized mouse podocytes, JAK2 knockdown decreased TFEB promoter activity, expression, and nuclear localization. In silico analysis and chromatin immunoprecipitation assays revealed that the downstream mediator of JAK2 signaling STAT1 binds to the TFEB promoter. Finally, overexpression of TFEB in JAK2-deficient podocytes reversed lysosomal dysfunction and restored albumin permselectivity. Collectively, these observations highlight the homeostatic actions of JAK2 in podocytes and the importance of TFEB to autophagosome-lysosome function in these cells. These results also raise the possibility that therapeutically modulating TFEB activity may improve podocyte health in glomerular disease.
test article
Authors: Banski Erika
Published: April 2017

this is the abstract
Big Bob, Little Bob by J. Howe
Authors: Michaud Craig
Published: April 2017

Howe, James. Big Bob, Little Bob, illustrated by Lauren Ellen Anderson. Candlewick Press, 2016.Who needs binaries when we can have diversity? That’s what Bob, Bob, and Blossom might ask in Big Bob, Little Bob written by James Howe and illustrated by Lauren Ellen Anderson. This children’s picture book asks readers to question their perception of what is masculine, what is feminine, and more importantly, why we persist in imposing gender roles on children and in society. Some boys like cats, some boys like dogs, and some boys like to wear dresses. Do not make the mistake of placing stereotypes on the characters in this story! This book tackles the subject of gender roles and gender identity in a captivating, entertaining, and non-intrusive manner. Gender bending non-conforming individuals, and those who prefer to live in a gender-neutral world, will love this story. For those continuing to live in a binary-driven, gender-rigid reality this story will ask the reader to question why categorize gender, encourage embracing fluidity, and to start viewing life on a spectrum.Clean, clear fonts and simple, easy language, appropriate for all ages, permit readers the freedom to be expressive while flipping through the pages of this book. Beautifully drawn and coloured illustrations wonderfully complement the text. The illustrator makes smart colour choices and the art is stylized with thoughtfully detailed layers of images that provide deeper inferences for the viewer. Characters’ facial expressions provide insights into their thoughts, feeling, and emotions. Readers are provided the opportunity to analyse the illustrations that add clarity and detail to the author’s key message. In this book there is more than meets the eye and young readers will enjoy making connections between word and image while exploring various themes including friendship, acceptance, and inclusion - to name a few.Recommendation: 4 out of 4 starsReviewer: Craig MichaudCraig Michaud, B.Ed., M.Ed, is a graduate of the Masters of Education Studies Program at the University of Alberta, and an elementary school teacher for Edmonton Public School Board. His graduate research focused on the perspectives of gay teachers in Alberta, Canada. Contact: cmichaud@ualberta.ca
Humanitarian Needs Among Displaced and Female-Headed Households in Government-Controlled Areas of Syria
Authors: Doocy Shannon , Lyles Emily
Published: April 2017

Objectives. To identify unmet needs and assistance priorities of displaced and female-headed households in government-controlled areas of Syria.

Methods. In mid-2016, we undertook a survey of accessible areas, largely urban and government-controlled, to identify unmet needs and assistance priorities. We used a cluster design with probability sampling to attain a final sample of 2405 households from 10 of 14 governorates; 31 of 65 (47.7%) districts were included that are home to 38.1% of people in need.

Results. Displaced and female-headed households were more vulnerable than nondisplaced and male-headed households in numerous sectors. Despite approximately half of surveyed households reporting receipt of humanitarian assistance in the preceding month and apparently effective targeting of assistance by vulnerability, unmet needs were nearly ubiquitous.

Conclusions. The humanitarian situation in inaccessible areas of Syria is likely to be considerably worse; thus, findings presented here likely underestimate humanitarian needs. Efforts to expand support to Syria’s most vulnerable households are desperately needed as are innovative targeting and modalities that enable more efficient and effective assistance.
The Vector Approach to Safety Factors for Tubular Design
Authors: Liu Zhengchun , Klever Frans , Samuel Robello , Gonzales Adolfo , Kang Yongfeng
Published: April 2017

Traditionally, the collapse safety factor (SF) is the ratio of tubular-collapse resistance to collapse load. The collapse resistance is usually calculated by use of formulas suggested by API TR 5C3 (2008) or ISO/TR 10400 (2007). If the collapse load is very small, whereas the tension stress and/or internal pressure are high, the collapse SF could be very large, which is unrealistic because the load point is close to the collapse envelope. This paper presents a vector approach for the collapse-SF calculation to overcome this problem. Moreover, the application of this vector approach can be properly extended to the calculation of International Organization for Standardization (ISO) connector SF for arbitrary load combinations.

The new SF is named the vector SF. It is the multiplier that would scale the load-point vector to reach the strength envelope in stress space. It must meet the following requirement: When all the tubular loads (axial force, internal pressure, and external pressure) are scaled by this SF, the load point must fall exactly on the failure envelope. Therefore, for American Petroleum Institute (API) collapse, the new SF must simultaneously satisfy the API TR 5C3 (2008) collapse formulas and the through-load-point radial-line equation. Ridders' method (Ridders 1979) is used to solve the SF for a specific load case. The algorithm has been implemented in a casing-design computer program (Landmark 2017) and integrated with commercial software. This vector approach has been applied to both pipe body and connectors.

Example cases are used to study the effect of the vector approach on the collapse-SF values. The collapse-SF value is observed to become much smaller when the effective axial stress (actual axial stress plus internal pressure) is very high, which is expected because of the much-smaller vector collapse resistance (at the cross point of the radial line with the collapse curve). When the effective axial stress is not positive, the collapse SF slightly changes. A North Sea high-pressure/high-temperature well is also presented. The results indicate that the vector collapse SF is more realistic. In particular, it is most conservative in load cases with high effective axial stresses.

In summary, it is shown that the vector approach to calculate the SF is equivalent to the current method of comparing the von Mises equivalent stress with the material yield strength (YS). The vector SF has critical safety implications for load cases in which high effective axial stresses exist. Its software implementation can certainly assist well engineers with more-conservative and more-straightforward tubular design.
A Matric Flux Potential Approach to Assess Plant Water Availability in Two Climate Zones in Brazil
Authors: Pinheiro Everton Alves Rodrigues , de Jong van Lier Quirijn , Metselaar Klaas
Published: April 2017

Core Ideas

A multi‐layer root water uptake model is developed based on matric flux potential.

Soil hydraulic properties from two important ecological zones in Brazil are assessed.

Water supplying capacity to plants is higher in semiarid than in humid zone soils.

Reduction of root suction below −150 m does virtually not affect water availability.

Predicting soil water availability to plants is important for agricultural and ecological models. Models that explicitly take into account root water uptake and transpiration reduction describe the ability of soil to supply water to plants based on soil hydraulic properties that depend on soil water content. The objective of this study was to further develop an existing single‐layer root water uptake model based on matric flux potential to allow for multi‐layer scenarios; and to illustrate its functionality using soil hydraulic properties from layered soils from two climate zones in Brazil: a semiarid zone and a humid zone. For each soil layer, the hydraulic properties were determined by inverse modeling of laboratory evaporation experiment data available for pressure heads between −165 and −1.5 m. The water supplying capacities of soils were evaluated using the newly developed multi‐layer root water uptake model. Soils from the semiarid zone were able to supply water to plants over a wider range of pressure heads. Soils from the humid zone showed slightly stronger hydraulic restrictions for supplying transpirable water. For the analyzed soils, only a negligible increase in available water results from decreasing the root water potential below −150 m. Therefore, based on this analysis, it is reasonable to expect plant adaptation to move toward an increase of root length density rather than to a decrease of minimum root water potential.
TELAAH ILMIAH SAINS DALAM HADITS YANG BERKAITAN DENGAN KEHIDUPAN SEHARI-HARI
Authors: Anwar Edi Daenuri
Published: April 2017

Abstract

Hadits yang merupakan manifestasi perkataan (qouliy), perbuatan (" ’liy) dan dan pengakuan (taqriri) dari bagi baginda nabi Muhammad saw 14 abad yang silam mengandung kajian sainti" k yang sangat mendalam dan bermanfaat bagi kehidupan, memiliki rahasia-rahasia yang baru bisa diketahui pada abad
modern ini. Hadits yang dimaksud adalah hadits yang berkaitan erat dengan kehidupan sehari-hari (a’malul yaumiyyah) meliputi: makanan, minuman, kesehatan, dan tidur. Rahasia-rahasia tersebut coba dikaji dari baerbagai sudut, sanadnya, kitabnya, dan rahasia sains yang yang terkandung di dalammnya
meliputi " sika, kimia, biologi, dan kedokteran. Rahasia yang ditelaah meliputi: puasa, khasiat yang terkandung dalam makanan, siwak, gandum, kurma, 
larangan meniup minuman, cara yang terbaik dalam tidur.

Keywordi: hadits, sains, rahasia
Egalitarian Policies and Effective Demand: Considering Balance of Payments (Note 1)
Authors: Abe Taro
Published: April 2017

This study examines the effectiveness of redistribution policies considering balance of payments. Unlike Bowles (2012) and Abe (2015, 2016), we assume that capital movement is sluggish to consider the short-run effects. Results indicate that conventional egalitarian policies such as increasing unemployment compensation and strengthening dismissal regulations can be effective, whereas an asset-based redistribution such as a decrease in the ratio of monitoring labor cannot be. These results contradict Bowles (2012). We need to reevaluate conventional egalitarian policies if the effects of effective demand and adjustment of capital continue in the long run.
How access, appropriateness, and quality of care affect patient outcomes for time-sensitive medical emergencies in British Columbia, Canada
Authors: Panagiotoglou Dimitra
Published: April 2017

ABSTRACT

ObjectivesCox Proportional Hazards models tested the relationship between access to care for time sensitive medical events and 30-day survival while controlling for appropriateness and quality of care.

ApproachA population study of all acute myocardial infarction (AMI), trauma, and stroke events treated within British Columbia between April 1st 1999 and March 31st 2013. Data sources included: the Discharge Abstract Database (DAD); a registry file; the Vital Statistics Mortality data; and the Medical Services Plan (MSP) Payment Information.

Access to care was estimated with a de-identified residential postal code to hospital distance matrix developed using origin-destination network analysis in ArcGIS 10.2. Appropriateness of care compared national protocols with treatment received. Care that was contraindicated, outdated, or at an inexperienced facility was inappropriate. Quality of care was an outcome measure that used risk-standardized mortality ratios and funnel plots to identify hospitals that offered poor care.

ResultsThere were 106,409 AMI, 220,602 trauma, and 88,136 stroke events that occurred during the study period and used in condition specific hierarchical hazards models. Adjusted hazards ratios (aHR) found access to care were not associated with 30-day mortality after controlling for appropriateness and quality of care along with patient (i.e. age, sex, income, rurality, frailty) and system specific (i.e. method of transport, transfer patterns, facility volume, rurality, peer group) characteristics. Appropriate care reduced the hazard of mortality for all three conditions: AMI aHR=0.860 (95% CI=0.792-0.993, p-value=0.0003); stroke aHR=0.448 (95% CI=0.324-0.619, p-value<0.0001) and trauma aHR=0.824 (95% CI=0.703-0.967, p-value=0.0176). Quality of care reduced hazards of mortality for trauma (aHR=0.689, 95% CI=0.586-0.808, p-value<0.0001) and stroke (aHR=0.762, 95% CI=0.689-0.842, p-value<0.0001). Inter-hospital transfers were protective for AMI (aHR=0.513, 95% CI=0.406-0.649, p-value<0.0001) and stroke (aHR=0.768, 95% CI=0.630-0.936, p-value=0.0089) but detrimental for trauma (aHR=1.583, 95%CI=1.310-1.913, p-value<0.0001). Method of transport was also significant. Self-transport was protective for trauma (aHR=0.462, 95% CI=0.417-0.513, p-value<0.0001) and stroke (aHR=0.330, 95% CI=0.301-0.363, p-value<0.0001). Older age was associated with higher mortality rates across all three conditions (p-value<0.0001) and being female increased the hazard of death for AMI (aHR=1.049, 95% CI=1.010-1.088, p-value=0.0125) but was protective for trauma (aHR=0.583, 95% CI=0.551-0.617, p-value<0.0001) events.

ConclusionAs health systems evolve to meet the needs of their patients and work to provide equitable care under economic pressure for efficiency, it is important to understand how access, appropriateness and quality of care affect patient outcomes and distribute services accordingly.
Data-driven drug safety signal detection methods in pharmacovigilance using electronic primary care records: A population based study
Authors: Zhou Shang-Ming , Muhammad Rahman , Lyons Ronan , Brophy Sinead
Published: April 2017

ABSTRACT

ObjectivesThough an effective drug to treat heart failure and heart rhythm abnormalities, digoxin has side effects, such as confusion. Adverse drug events (ADEs) are major public health issues, but signal detection of ADEs is challenging for healthcare professionals. The objectives of this study is to evaluate if data-driven techniques can be used to detect ADEs, specifically examine the best method to detect the known event of confusion in patients prescribed digoxin from electronic primary care records and generate evidence for unknown ADEs.

ApproachIn this study, we analysed 195,454 patients from a general practitioner (GP) database Wales, UK held in the SAIL (Secured Anonymised Information Linkage) databank with 51,920 patients prescribed digoxin and the rest acted as controls. All diagnostic events within 1 year after taking digoxin were considered. We used different data-driven analytic techniques - the proportional reporting ratio (PRR), the reporting odds ratio (ROR), the information component (IC), and the Yule’s Q (YULE) to detect signal of a statistical association between digoxin and associated adverse events.

ResultsThe YULE detected the highest number of 544 signals, the IC the lowest number of 117 signals, and they commonly identified 83 same signals. All ROR based signals were included in the YULE based signals. It detected that 8.09 people per 10,000 who took digoxin suffered from the side effect of confusion including acute confusional state of cerebrovascular origin and others. All 4 methods can detect the confusion event with the values of IC =5.35 (standard deviation =0.312), PRR=1407.2 (95% confidence interval=[993.72, 1992.71]), ROR== 2813.39 (95% confidence interval=[1692.443, 4676.776]), and YULE=0.99 (95% confidence interval=[0.9992892, , 0.9992895]) respectively. Also some unknown signals, such as “carcinoma in situ of rectum”, were identified by the 4 methods. One common signal detected which was not clearly mentioned in clinical guideline is “digoxin poisoning” with the values of IC =1.87 (standard deviation =0.0946), PRR=214.71 (95% confidence interval=[68.75, 670.56]), ROR=215.67(95% confidence interval=[69.05, 673.63]), and YULE=0.99 (95% confidence interval=[0.9907,0.9908]) respectively. This finding is consistent with the previous study that digoxin can sometimes have toxic effects, particularly at high blood concentrations, because it normally takes a long time to be broken down by the body.

ConclusionData-driven analytic methods are a valuable aid to signal detection of ADEs from large electronic health records for drug safety monitoring. This study finds the methods can detect known ADE and so could potentially be used to detect unknown ADE.
Child Health Clinical Outcome Review Programme: Health Care Utilisation, Care Pathways and Educational Status in Children and Young People with Adolescent Mental Health problems with a focus on Self harm, Eating Disorders and Anxiety and Depression
Authors: Wood Sophie , John Ann , Kemp Alison , Carter Bethan , Wright Melissa
Published: April 2017

ABSTRACT

ObjectivesTo use routinely collected datasets and data linkage to identify patterns of healthcare utilisation by children and young people (CYP) with adolescent mental health (AMH) disorders across the four UK Nations, with a particular focus on self-harm, anxiety and depression and eating disorders. The analysis will focus on healthcare utilisation during transition from child to adult services and, where possible, on the interface between different care settings e.g. primary and secondary care and health and social care.

In addition we will determine the extent to which routinely collected datasets can contribute to an assessment of the health needs and the quality of care that CYP with AMH disorders receive.

ApproachData has been requested from the national data providers in each country:

The Health and Social Care Information Centre - England

The Secure Anonymised Information Linkage (SAIL) databank - Wales

Information Services Division – Scotland 

The Honest Broker Service- Northern Ireland

As well as other sources:

The Clinical Practice Research Datalink 

The Paediatric Intensive Care Audit Network.

A number of restrictions and information governance regulations have had to be negotiated and put in place in order to access and store the data in the SAIL Databank, Swansea University. Descriptive cross sectional analysis is underway to address the key questions.

RationalThe project has arisen from the report ‘Overview of Child Deaths in Four UK Countries’ which found that 30-40% of 13-18 year olds were affected by mental health, learning difficulties or behavioural conditions. The diagnosis, management and services available for mental disorders in CYP are of growing concern and a source of controversy in the UK. Transitional care between child and adult services and the interface between primary and secondary/ specialist services, as well as, that between the NHS and other sectors is often disjointed. Thresholds for referral to Child and Adolescent Mental Health Services (CAMHS) are high and many adolescents are treated, at least initially, in primary health care systems.

ImplicationsAnalysis of routinely collected health datasets has the potential to describe the nature and extent of health needs and health care utilisation for CYP with AMH disorders (self-harm, depression/anxiety, eating disorders). Furthermore the knowledge obtained from using routinely collected healthcare data, will inform future routine data collection across the UK for CYP with AMH disorders.
Variations in antibiotic use for respiratory tract infections
Authors: Mckay Rachel , Law Michael , McGrail Kimberlyn , Patrick David
Published: April 2017

ABSTRACT

ObjectivesAntibiotic resistance is a significant public health issue, driven in large part by selection pressure induced by antibiotic use. Despite knowledge that a reduction in inappropriate antibiotic use is important, significant and sustained behaviour change has remained difficult to achieve. Previous studies have suggested that prescribing decisions vary with patient comorbidities and age, as well as the physician’s age, claim volume, specialty, and continuity of care with the particular patient. Regional level variation has also been reported. The goal of this study is to explore variations in antibiotic prescribing for respiratory tract infections (RTIs) at the levels of patients, physicians, and regions.

ApproachWe used data on fee-for-service physician visits from the universal Medical Services Plan (MSP) for all residents of British Columbia, Canada from 2002 to 2012. We identified a cohort of patient visits for RTI (ICD-9 codes 460-466, 480, or 487). We derived measures of healthcare use and comorbidities at the patient level, and measures of physician claim volume and frequency of respiratory tract infection management, at the level of the physician. We used data on antibiotics filled by individuals, the number of all medications filled by individuals each year, and counts of prescriptions written by physicians (and filled) by month, from the provincial drug insurance database. We linked antibiotic prescriptions to physician visits by patient and prescriber as antibiotics dispensed within 5 days after the RTI visit. We calculated measures of regional population distributions. We used data on meteorological temperature readings assigned to each region, for each day, and calculated 28-day moving averages. We linked data on patient demographics, physician demographics, and hospitalizations to our dataset. Our analysis will use hierarchical generalized linear mixed models (GLMMs) with logit link to account for the clustering effects of patients among physicians and regions, to model the odds of an antibiotic prescription being dispensed. Measures of variation will be discussed.

ResultsBetween April 1, 2005 and March 31, 2012, there were over 10.5 million visits by nearly 3 million individuals, served by over 8000 physicians in 88 regions. Antibiotics were prescribed in 37% of all visits.

ConclusionThese are preliminary results, with full analytic results available in the coming months. These results will have implications for better understanding the extent of variations in antibiotic prescribing, and some of the drivers of these variations, as well as the potential to inform ongoing efforts to improve the appropriateness of antibiotic use.
Bringing more science to the art of linkage: Using positive predictive value of weight and outcome sets to reduce subjectivity in probabilistic linkage
Authors: Hills Brent
Published: April 2017

ABSTRACT

ObjectiveCurrently, a probabilistic linkage is performed by our organization with final linkage classification established by users with expert knowledge applying rules referencing weight and comparison outcome sets. The particular classification results in a perceived comprehensive linkage. Acknowledged weaknesses are variation in expert knowledge and its application. Also, consideration of expert rules is often time-consuming.

We piloted a new approach, involving a file level summary of “positive predictive value” for weights and outcome sets. We contrast the new approach with the previous one and identify strengths and weaknesses.

ApproachWe resolve linkages using two different approaches, the existing method that expert users apply rules to weight and comparison outcomes, and a recent one using positive predictive values (PPV) that reduce resolution subjectivity.

The new method produces summary true positive, false positive and positive predictive values for each weight and outcome set within a file of candidate pairs above the cutoff. The top-weighted pair increments the true positive (TP) for the weight and outcome set on the record. All other candidate pairs increment false positive counts (FP). At the end of the file, PPV is calculated for each weight and outcome as TP/(TP+FP). Additionally, a .9 PPV weight threshold is established from the summary excluding weights with less than N occurrences. The approach presumes successful link

Accepted links include top-ranked records whose weight is greater than the .9 PPV threshold and top candidates with an outcome summary PPV >= .9, excluding outcome sets with less than N occurrences.

ResultsIn the pilot, the new method produced linkage results near par with the previously employed methods. Importantly, they establish accepted links by a consistent methodology, allowing for increased standardization. The method eases identification of a threshold weight and referencing summary comparison outcome PPVs identifies additional confident links in larger population-based linkages which a single weight threshold may exclude. Components require minimal tuning to data characteristics, error tolerance, and result expectations. The new method is unable to identify links established in the legacy method by additional processing or manual review. Further review of the approach as applied to other datasets is needed.
Multi-Agency Data Integration Project - Linking Data – Improving Lives
Authors: Kindermann Bindi , Hinde Sarah , Abbondante Michael
Published: April 2017

ABSTRACTObjectivesThe Australian Government’s new public sector data management agenda is initiating a national system for integrating public data and opening up access for policy makers and researchers. The Multi-agency Data Integration Project (‘the project’) is central to achieving these goals by bringing together nationally significant population datasets with the aim of streamlining the safe sharing of integrated government data. The project provides policy makers and researchers with safe access to linked, longitudinal information about the delivery of the Australian tax and transfer system, health services, along with rich demographic information. The project has been an essential step towards better enabling the Australian Government and research community to develop evidence-based policy and target services effectively, within a tight fiscal environment. The project has prompted government agencies to find new and more streamlined ways to work collaboratively to share and make best use of public data.

ApproachThe first step of the project was to link a 2011 snapshot of four national administrative datasets with the 2011 Census. A cross-agency team of data analysts from five government agencies collaborated to evaluate the datasets and test whether the linked data could be used to answer policy questions. The linkage project included experimentation with different linking methodologies, linking strategies and information models for structuring the linkage. The evaluation tested whether the linked data was representative of key population groups of interest, and explored the validity of the content variables for measuring outcomes of interest.

ResultsHigh linkage rates (between 80-95%) were achieved for the two-way linkages, and many population groups of interest were well represented. The work is confirming the value of the linkage for answering policy questions that had been difficult to address using existing approaches. The project developed ways of describing linkage quality to policy users and approaches to addressing linkage bias for different policy uses.

ConclusionPublic sector data held by government has the power to improve life course outcomes for Australian people, households and businesses. The project has generated confidence and support for continued development of a central and streamlined integrated data system. It has also generated valuable insights about governance and how to scale up the linkage and dissemination system to support additional datasets and longitudinal data. This will maximise the value and utility of public data to support policy and research, in order to achieve a better understanding of, and deliver better outcomes for, the Australian community.
Real-time linkage: when is near enough good enough?
Authors: Irvine Katrina , Williamson Jennifer , Pye Victoria
Published: April 2017

ABSTRACTObjectivesTimely data on the health and vital status of study participants is important for cohort management and patient recruitment processes in addition to traditional observational research. We have investigated the potential to modify data sourcing and linkage processes so that data is linked daily, in near real-time. Such modifications will improve the currency of linked data for end users but impact on the quality of the data for recent periods. This work aims to provide a conceptual framework for understanding drivers of quality and empirical evidence on the type and extent of quality impacts associated with linking death and recent hospitalisation data in near real-time for a large population.

ApproachWe compared different linkage strategies including real-time linkage to study the type and extent of quality impacts observed using a large population cohort linked to jurisdictional level hospitalisation and death data.

Results Changes in data quality arise from several sources: incomplete enumeration of the most recently occurring events (known as delayed notifications), differences in the availability of up-to-date personal information to assist in data linkage, and the adoption of faster probabilistic linkage techniques that skip some computational and/or manual steps (e.g. clustering and clerical review) that are performed in conventional gold-standard probabilistic linkage processes.

Compared to a gold standard process faster linkage techniques with reduced personal information produced quality metrics of precision, recall and F measure in excess of 98.0 for linkage of a population cohort with death registrations. While precision was maintained at 98.0 for linkage to hospitalisation data recall was reduced to 91.1.

Delayed notifications have a pronounced effect on quality. If incomplete enumeration is factored into quality metrics, the effective recall for the last quarter of data drops to 0.82 and 0.33 for deaths and most recent hospitalisation respectively.

ConclusionsHigh quality and current information about health and vital status can be obtained through data linkage, but there are tradeoffs between timeliness and ascertainment. Delayed notifications in jurisdictional level administrative data systems appear more problematic than subtle changes in linkage technique. The quality impacts of near-real time linkage vary significantly by data collection and so its usefulness is highly dependent on its desired purpose and quality requirements.