bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of inbreeding and sex on rabbits meat quality
Authors: Pałka Sylwia , Maj Dorota , Migdał Władysław , Bieniek Józef , Derewicka Olga
Published: April 2017

The aim of this study was to determine the effect of inbreeding and sex on meat quality traits such as: acidity, colour, chemical composition and texture in New Zealand White and Belgian Giant Grey crossebred rabbits (n=84; 50♂:34♀). Two variants of crossing were used. Variant I - crossbred (F1) unrelated rabbits (RAB = 0) - received non - inbred rabbits (Fx = 0), variant II - crossbred (F1) related rabbits (full siblings RAB = 0.5) - received inbred rabbits (Fx = 0.25). After weaning at 35 days of age, animals were fed pellets ad libitum. Slaughter and dissection at 12 weeks of age were performed. After 45 min of slaughter pH loin (m. longissimus lumborum) and leg (m. biceps femoris), and the colour (L * - lightness, a * - redness, b * - yellowness) were measured. The results indicated that inbreeding had a significant effect on inerease of meat acidity in 45 min and after 24 h. Furthermore, the meat of inbred rabbits was a lightness and had smaller values of the redness and yellowness in 45 minutes and after 24 hours. Meat inbred animals contained less protein and ash, and more fat compared to meat non-inbred animals. Inbreeding did not affect significantly dry matter and water content in the meat. Texture parameters of inbred and non-inbred rabbits were similar. The level of inbreeding equal 25% affected negatively on meat quality traits such as acidity, colour and chemical composition. Sex does not differentiate the quality parameters of meat with the exception of yellowness in the 45th minute after slaughter.
Vascular endothelial growth factor (VEGF) expression in dogs suffering from squamous cell carcinoma
Authors: Sobczyńska-Rak Aleksandra , Polkowska Izabela , Gołyńska Magdalena , Szponder Tomasz , Żylińska Beata , Łopuszyński Wojciech
Published: April 2017

The aim of the present study was to monitor VEGF expression in the blood serum of dogs suffering from squamous cell carcinoma in correlation with the speed of metastasis. The research material consisted of tumour tissue and blood samples collected from 26 dogs of various breeds, aged between 5 and 15 years, and 10 control group animals. Blood samples were centrifuged, and the serum obtained was examined by immunoenzymatic assays to determine vascular endothelial growth factor (VEGF) levels. The study group animals were observed for a period of 6 months, during which their blood was drawn twice for immunoenzymatic tests. In all study group animals, elevated blood serum VEGF levels were observed on the day of surgery compared with the control group. In 14 cases, disease relapse was observed with metastases to the bones or lungs. In all relapsing animals, significantly higher blood serum VEGF levels were observed. VEGF levels are closely related to the neoplastic process, but the exact mechanism of the factor's involvement in neoplastic progression remains unclear, as does the complexity of the angiogenic processes. Studies of the mechanisms affecting tumour proliferation and the monitoring of VEGF levels can facilitate better diagnostics and prognostics, as well as improve the effectiveness of cancer treatment and the planning of new therapeutic strategies for both human and animal patients.
Creating reproducible dynamic reports using data from the Secure Anonymised Information Linkage (SAIL) Databank
Authors: Wang Ting
Published: April 2017

ABSTRACT

Introduction/BackgroundR, an open source analytical software has gained wide popularity for its powerful statistical and graphical techniques, little known is that it also proves to be a fantastic tool for generating automated, content specific documentation using a combination of extensible packages (i.e. R markdown, Pandoc, MiKTex, Knitr). One such example of using these techniques is to create content specific PDF reports for the 300 plus general practices in Wales who are contributing data to the Secure Anonymised Information Linkage (SAIL) Databank.

Objectives1). Create large number of automated PDF reports 2). Content specific to individual practice

ApproachThis project aimed to facilitate the production of a large number of similar reports (tailored to specific recipients) by reducing the repetition and manual effort required. This was done by using a combination of packages in R to create scripts to automate the production of large numbers of tailored reports that capture the characteristics of each individual practice.

ResultsThe output of this piece of work was a set of tailored reports for more than 300 Walsh general practices contributing data to the Secure Anonymised Information Linkage (SAIL) Databank up to 2015. The production of these reports was automated using a combination of R packages; the source code is flexible and can be applied to a range of contexts.

ConclusionMethods described in this talk is highly efficient and easy to adapt to different context (e.g. automate documentation for metadata)
The impact of cycle proficiency training on cycle-related behaviours and accidents in adolescence: findings from ALSPAC, a UK longitudinal cohort
Authors: Teyhan Alison , Cornish Rosie , Boyd Andy , Sissons Joshi Mary , Macleod John
Published: April 2017

ABSTRACT

ObjectivesIn the UK, some children undertake National Cycle Proficiency Scheme [NCPS]/Bikeability training in primary school. It aims to promote cycling and safe cycling behaviours but there has been little scientific evaluation of its effectiveness. We aimed to examine the impact of cycle training on cycle-related behaviours and accidents in adolescence using self-report and hospital episode statistics (HES) data.

ApproachThe sample (n=5415) were participants in the Avon Longitudinal Study of Parents and Children who reported whether or not they had received NCPS training. Self-reported outcomes at 14 and 16 years included: cycling to school, ownership of cycle helmet, use of cycle helmet and high-visibility clothing on last cycle, and involvement in a cycle accident. Hospital admittance due to a cycle accident from 11-16 years was also included for a subsample (n=2222) who have been linked to HES. The association between cycle training and each of the outcomes was analysed using multilevel logistic regression (individual level 1, school level 2 [pseudo-ID of school attended obtained from linkage to National Pupil Database]), adjusted for a range of potential confounders.

ResultsApproximately 40% had received NCPS training. At 14 and 16 years, trained children were more likely to cycle to school (at 16 years: adjusted OR 1.56, 95% CI 1.20-2.02) and to own a helmet (16 years: 2.03, 1.72-2.41) than those who had not attended a course. They were also more likely to have worn a helmet on their last cycle at age 14 (1.26, 1.07-1.49), and to have worn high-visibility clothing at age 16 (1.70, 1.22-2.39). Training was not associated with self-reported involvement in a cycle accident, and only six participants with HES data had been admitted to hospital due to a cycle accident. Irrespective of training, results indicate very low use of high-visibility clothing (5%), very few girls cycling to school (<2%), and less than half of helmet owners wearing one on their last cycle. Ownership and use of helmets was particularly low in children from lower socio-economic position families.

ConclusionCycle training for children can have benefits that persist into adolescence. However, the low use of cycle helmets and high-visibility clothing indicate the further potential for interventions to encourage safe cycling behaviours in young people. Our hospital admissions outcome only captures individuals who sustained serious injuries; more minor cycle injuries would have been treated in A&E but a lack of detail in admission codes precludes analysis of such data.
Young people’s views about consenting to data linkage: Findings from the PEARL qualitative study
Authors: Audrey Suzanne , Brown Lindsey , Campbell Rona , Boyd Andrew , Macleod John
Published: April 2017

ABSTRACT

BackgroundElectronic administrative data exist in several domains which, if linked, are potentially useful for research. However, benefits from data linkage should be considered alongside risks such as the threat to privacy. Avon Longitudinal Study of Parents and Children (ALSPAC) is a birth cohort study. The Project to Enhance ALSPAC through Record Linkage (PEARL) was established to enrich the ALSPAC resource through linkage between ALSPAC participants and routine sources of health and social data. Qualitative research was incorporated in the PEARL study to examine participants’ views about data linkage and inform approaches to information. This paper focusses on issues of consent.

MethodsDigitally recorded interviews were conducted with 55 participants aged 17-19 years. Terms and processes relating to consent, anonymization and data linkage were explained to interviewees. Scenarios were used to prompt consideration of linking different sources of data, and whether consent should be requested. Interview recordings were fully transcribed. Thematic analysis was undertaken using the Framework approach.

ResultsParticipant views on data linkage appeared to be most influenced by: considerations around the social sensitivity of the research question, and; the possibility of tangible health benefits in the public interest. Some participants appeared unsure about the effectiveness of anonymization, or did not always view effective anonymization as making consent unnecessary. This was related to notions of ownership of personal information and etiquette around asking permission for secondary use. Despite different consent procedures being explained, participants tended to equate consent with ‘opt-in’ consent through which participants are ‘asked’ if their data can be used for a specific study. Participants raising similar concerns came to differing conclusions about whether consent was needed. Views changed when presented with different scenarios, and were sometimes inconsistent.

ConclusionsFindings from this study question the validity of ‘informed consent’ as a cornerstone of good governance, and the extent to which potential research participants understand different types of consent and what they are consenting, or not consenting, to. Pragmatic, imaginative and flexible approaches are needed if research using data linkage is to successfully realise its potential for public good without undermining public trust in the research process.
An Investigation into the use of Health Services in Wales by those who Self–report Disability using Linked Data
Authors: Ahern Aideen , Jones Melanie
Published: April 2017

ABSTRACT

ObjectivesDisability is strongly related to employment disadvantage (Berthoud, 2008). There is a scarcity of disability research within labour economics, therefore this project will add to the evidence gap by examining existing survey data linked to medical data. As part of a wider empirical investigation into the influence of disability on economic outcomes using survey data, we examine the additional value of linked data. This analysis of linked data is aimed to form an initial exploratory project to identify the potential benefits and limitations of data linking in this context. The work aligns closely with the WG Programme to Maximise the Use of Existing Data which seeks to explore how the Welsh Government can potentially use linked data to improve the evidence base for policymaking. The findings will feed into the evidence base relating to the Programme for Government. This project hopes to increase the understanding of the relationships between disability and employment, to further inform policy makers and to create awareness among researchers of the benefits of using linked data.

ApproachThe project will involve examining the different patient pathways for those who self-report disability in the National Survey for Wales (NSW) 2012-15. The proposal therefore involves linking data (using SAIL)at the individual level from administrative data including records from the Welsh Demographic Service, GP event data, Patient Episode Database for Wales and A&E data to individual level responses in the NSW. The aim of this project is to examine differences in objective health indicators, such as number of GP activity between those who currently self-report disability (limiting long-standing illness), and those who do not. In addition, we will explore the effects that disability status has on employment status within Wales. While social and economic disadvantage associated with disability is frequently identified using self-reported information on disability in survey data, far less is known within social science about the medical history/conditions of these individuals. It will also be possible to control for/examine the interaction with a range of other demographic characteristics (age, gender etc) which are available in the NSW.

ResultsIndividuals in Wales who self-report disability use primary and secondary health services more so than non-disabled individuals.

ConclusionThis work has the potential to contribute significantly to the Employment, Education and Wellbeing Work package (RP2) of the ADRC-W.
Linking Genomic Data with Phenotypes Derived from Electronic Health Records.
Authors: Appleby Phil
Published: April 2017

ABSTRACT

ObjectivesTo build a searchable database for SNP array data from the GoDARTS data set, in which a combined view of genotype data derived from multiple assay platforms can be extracted for both candidate gene and GWA studies and to combine this with a database of phenotype descriptors which are saved as shareable, reusable database objects and which persist beyond the lifetime of any analysis script.

To build databases and software solutions which can be made readily available to laboratories and academic institutions which may not have the resources to adopt one of the larger Genotype / Phenotype integration solutions.

ApproachTwo databases were built. The first is a hybrid Genomics one in which variant and study subject data are stored in a database with variant detail data retained in Variant Call Format (VCF) files. The second database saves phenotype descriptors as shareable, modifiable database objects alongside a table of events derived from the set of available Electronic Health Records (EHRs). All detail from the EHRs is also retained in the database which is delivered on a project by project basis using virtual machines.

Both databases are accessed using web applications, allowing delivery of data to the users’ desktops.

ResultsTraditionally the process of deriving genotype and phenotype data for epidemiological studies can be a laborious one with genotype data being retrieved from large, flat data files and phenotypes being defined by codes in flat EHR records which are tested and filtered in scripts, written for analysis in a statistical package such as Stata, SPSS or R.

In our solution, genotype data can be retrieved in seconds and delivered to the users’ desktops. Similarly lists of cases and controls can be downloaded based on saved or transient phenotype descriptors. Phenotypes descriptors derived from codes in Electronic Health Records are saved as reusable, shareable and modifiable database objects objects, allowing rapid retrieval of phenotype data.

ConclusionThe ability to access Genomic data from multiple assay platforms and to use this in conjunction with shareable libraries of phenotype objects allows rapid access to data for analysis using both Genomic SNP Array data and linked Electronic Health Records. Analysis on data extracted from our linked databases should proceed more rapidly and should be more easily reproducible.
Identifying superusers of health services with mental health and addiction problems
Authors: Quail Jacqueline , Anderson Maureen , Osman Meric , De Oliveira Claire , Wodchis Walter , Muhajarine Nazeem , Pruden Nansel Kathie , McLeod Valerie , Baetz Marilyn , Teare Gary , Lafontaine Tania , Pelly Judy , Schaefer Joelle , Baker Margaret , Neudorf Cory
Published: April 2017

ABSTRACT

ObjectiveThe objective of this research is to identify people with mental health and/or addiction (MHA) problems and determine characteristics that led to them becoming a superuser of health services (i.e., the most expensive 10% of all health service users).

ApproachIn Saskatchewan, Canada, we used hospital and physician administrative data spanning 2005 to 2014 to identify the MHA cohort. We will calculate total health care costs for each individual and assign them to one of three groups: low cost users (<50th percentile), moderate cost users (50-<90th percentile), and superusers (90th percentile and above). For each group, we will describe sociodemographic characteristics, disease characteristics, and use of health services, and describe their trajectory towards becoming a superuser. Predictors of becoming a superuser will be identified. A novel aspect of this research is the inclusion of sociobehavioural risk factors by linking 4 population and public health administrative datasets obtained from the Saskatoon Health Region to the provincial administrative health services data. Sociobehavioral factors are widely accepted as strongly influencing health. Each database was selected because it captures data on a sociobehavioral factor. The Oral Health Database contains data on early childhood development, including early childhood tooth decay, dental health status, and tobacco use in elementary school-aged children. The Integrated Public Health Information System contains data on self-reported ethnicity, the occurrence of an infectious notifiable disease, and behavioural and social risk factors for the notifiable disease. The Sexually Transmitted Infection (STI) Clinic Data contains data on exposure to and contraction of STIs, as well as referrals given for mental health and/or addiction services. Finally, the Street Outreach Program provides services to individuals living a high-risk lifestyle on the street. Their database contains information on self-reported ethnicity, hypodermic needle exchange, and homelessness.

ResultsIn a province of approximately 1.1 million people, we identified 417,724 people as having at least 1 MHA diagnosis, of which two-thirds were depression and/or anxiety. Substance abuse was found in 9.4%, and schizotypal and psychotic disorders were found in 7.9%, of the MHA cohort,

ConclusionIndividuals with severe MHA problems account for a disproportionate amount of health care costs. Identifying predictors of becoming an MHA superuser may afford an opportunity to intervene, possibly years in the future, to prevent a person from becoming a superuser. If true, this has significant implications for health care costs, wait times to access health services, and quality of life for this vulnerable population.
A population-based study examining injury among older adults with and without dementia
Authors: Meuleners Lynn , Hobday Michelle
Published: April 2017

ABSTRACTObjectiveTo estimate the incidence and risk factors for injuries among older adults with and without dementia.MethodsA retrospective, population-based cohort study was undertaken using the Western Australian Data Linkage System (WADLS). Cases included 29,671 (47.9%) older adults with an index hospital admission for dementia, aged 50+ years between 2001 and 2011. Comparison participants without dementia included a random sample of 32,277 (52.1%) older adults aged 50+ years from the State Electoral Roll. The outcome of interest was a hospital admission to a metropolitan tertiary hospital in Perth Western Australia for at least 24 hours with an injury as the principal diagnosis. Descriptive statistics were used to compare participants with and without dementia in terms of socio-demographic characteristics, co-morbid conditions, injury severity, cause of injury and length of stay in hospital. Population rates were calculated based on the relevant WA population data from the Australian Bureau of Statistics. Poisson regression with robust standard errors was used to examine risk factors for injuries in those with and without dementia, after adjusting for relevant confounders. ResultsThe age-standardised injury rates for older adults (60+ years) were 117 per 1,000 population with dementia and 24 per 1,000 population without dementia. The majority of injuries were caused by falls for both the dementia (94%) and non-dementia (87%) groups followed by transport-related injuries and burns. The results of the multivariable modelling found that older adults with a diagnosis of dementia had over double the risk of hospital admission for an injury compared to those without dementia (IRR=2.05; 95% CI=1.96-2.15). Other significant predictors of an admission for all-cause injury were older adults aged 85+ years (IRR=1.43; 95% CI=1.13-1.81), being unmarried (IRR=1.07; 95% CI=1.03-1.12) and a history of falls (IRR=1.03; 95% CI=1.01-1.06). Females were at reduced risk of injury (IRR=0.92; 95% CI=0.87-0.97).ConclusionsOlder adults with dementia were at increased risk of an admission for an injury compared to those without dementia. Multifactorial injury prevention programs should target older people with dementia, those over 85 years, living alone and with a history of previous falls.
Abuse and neglect in children with disabilities: risk varies by type of disability
Authors: Maclean Miriam , Sims Scott , Hansen Melanie , Leonard Helen , Bourke Jenny , Bower Carol , O'Donnell Melissa
Published: April 2017

ABSTRACT

ObjectivesTo examine the risk of abuse and neglect for children with different types of disabilities taking into account other existing adversities, including socioeconomic disadvantage, parental mental health issues, etc.

ApproachPopulation based record linkage study of all children born between 1990-2010 utilising the Western Australian Register of Developmental Anomalies, the Intellectual Disabilities Exploring Answers database, Health data and Child Protection data.

ResultsAfter taking into account existing adversities intellectual disability was associated with the highest risk of a child maltreatment allegation and entering out-of-home care. Further results include risk by level of intellectual disability and causes of disability.

ConclusionDifferent disabilities are associated with differing risk of child maltreatment and child protection involvement. Groups that are considered at higher risk require services to identify and address the support needs of this group and determine how prevention and early intervention can lower the risk for child abuse and neglect in this vulnerable group.
Are There Long-term Academic Benefits of Full-Day Kindergarten? A Population-Based Analysis
Authors: Brownell Marni , Nickel Nathan , Chateau Dan , Taylor Carole , Crockett Leah , Katz Alan , Sarkar Joykrishna , Burland Elaine
Published: April 2017

ABSTRACT

ObjectiveDespite the implementation of full-day kindergarten (FDK) in several Canadian provinces, there is little evidence on the long-term outcomes associated with this program. Our objective was to use population-level linked data sources from Manitoba, Canada, to determine whether FDK results in better long-term academic outcomes and reduced inequities in outcomes.

ApproachUsing data held in the Manitoba Centre for Health Policy Data Repository we examined provincial reading and numeracy assessments in grades 3, 7, and 8 and a performance index in grade 9 for students in two Manitoba school divisions between 1999-2012. In School Division A (SDA), FDK is targeted in the lowest SES schools; in School Division B (SDB) FDK was gradually introduced universally. SDA FDK students were matched using propensity scores to students in an adjacent school division with similar socioeconomic status (SES) but no FDK; in SDB a stepped-wedge design was used. Logistic regressions accounted for confounders including classroom effects and sex. Gamma sensitivity analyses were used to assess sensitivity of results to unmeasured confounding. The Kakwani Progressivity Index (KPI) determined how FDK affected equity.

ResultsThere were 224-544 children in FDK and 869-1923 non-FDK matches in SDA, depending on the outcome examined; numbers in SDB ranged from 335-707 (FDK) and 222-475 (non-FDK). Including interactions, 35 comparisons were examined in SDA and 24 in SDB. None of the outcomes examined in SDB showed statistically significant effects of FDK that were robust to unmeasured confounding. In SDA there were only 3 statistically significant and robust findings of benefits of FDK, all related to math. Comparisons of KPIs for FDK and non-FDK children in both school divisions demonstrated inequities in outcomes associated with SES, however there were no significant differences in equity between the FDK and non-FDK children for any of the outcomes.

ConclusionsOur findings indicate no apparent benefits of universal FDK, and limited benefits from targeted FDK, specifically long-term improvements in numeracy for low-income girls. No reductions in inequity were found. Decisions regarding FDK implementation should weigh the costs of this program against the limited long-term academic benefits.
Algorithms for assessing person-based consistency among linked records for the investigation of maternal use of medications and safety
Authors: Tran Duong , Havard Alys , Jorm Louisa
Published: April 2017

ABSTRACTObjectivesPerinatal records linked to pharmaceutical claims and other administrative data provide a powerful resource to investigate maternal use of medications and safety. In this population-based project, data quality assessment was performed on the consistency of linked records brought together from several data collections to ensure reliable links for data analysis.

ApproachPerinatal data for the Australian states of New South Wales (NSW) and Western Australia (WA) were linked to pharmaceutical claims by a Commonwealth integrating authority, while linkage to hospital admission, emergency department (ED), mortality and congenital notification data was performed by respective State-based data linkage units. All de-identified records belonging to a unique person ID were sorted chronologically. To assess the consistency of unique persons, both within and across States, algorithms were developed based on pregnancy plurality and birth order, gestation, parity, maternal age and sex, date of delivery, dates of health service use, and State where the claim was made.

ResultsThe dataset included 595,456 NSW and 188,014 WA mothers with respectively 937,344 and 295,095 pregnancies delivered between 2003 and 2012. The information brought together through linkage was highly consistent for the majority of mothers and infants. Inconsistencies are identified in 742 cases, including negative inter-pregnancy period, highly illogical parity, highly inconsistent maternal age, maternal gender being systematically recorded as male, use of health services after date of death, and different infants sharing a common ID. These cases will be excluded from analyses. Date of delivery was corrected for 667 pregnancies, using date of birth recorded in the infant’s admission and ED records, and date of the mother’s admissions. Among admission and ED records, over 8000 needed correction in infant age due to typographical errors, 1820 were duplicates, while 1000 had discrepancies between dates of birth, date of admission and separation. There were 455 deaths, mostly neonates, identified by status of admission or ED discharge but not recorded in mortality data. The majority of these deaths were confirmed by the status of neonatal discharge at birth. There were 3404 women who had a single unique ID according to Commonwealth linkage but more than one unique IDs according to State-based linkage. 2827 mothers had births recorded in both NSW and WA.

ConclusionQuality assessment indicated high consistency among linked records. The set of algorithms developed in this project can be applied to similar linked perinatal datasets to promote a consistent approach and comparability across studies.
#BritainBreathing: Codesigned citizen science to map seasonal allergy symptoms across the UK
Authors: Hassan Lamiece , Cruikshank Sheena , Vigo Markel , Jay Caroline , McClean Indira , Brass Andy
Published: April 2017

ABSTRACTObjectivesSeasonal allergies, hay fever and asthma affect approximately one in four people and the incidence is increasing. Whilst the causes are unknown, hypotheses propose associations with environmental changes, exposure to pollutants and decreased exposure to childhood infections. High resolution datasets on pollen count and pollution are available; however there is no equivalent for incidence of seasonal allergy symptoms. We planned a national citizen science project using smartphones to gather data from the general population on seasonal allergy symptoms, and where and when they occur. The resulting dataset will be linked with other publicly available data, enabling better understanding of allergy triggers. This is a joint project between the Royal Society of Biology, the British Society for Immunology, and The University of Manchester.

ApproachIn spring 2015, two codesign workshops were held for members of the public with seasonal allergies and/or asthma (n=33). Guided by researchers, attendees used paper prototyping techniques to illustrate the functionalities of a mobile application. They also prioritised functions for inclusion within the app, discussed data sharing options and suggested material for the accompanying project website (www.britainbreathing.org). Following codesign workshops, designs and requirements were collated, refined and used to build the first version of the application in Android.

ResultsWorkshop feedback indicated that potential users prioritised simple, personal tracking. They also valued the ability to access information about symptom frequencies among other users locally. Support for academic research was high, although most wanted some control over data sharing. People were comfortable with GPS data being collected, provided it did not impinge on privacy. We agreed to make data openly available via an interactive widget on the project website. The resulting first version of the application enables personal symptom tracking and will be released in March 2016 via the Google Play store (free of charge). A national media campaign will drive recruitment, alongside inclusion in the European City of Science 2016 programme in Manchester. Emerging data on the incidence of allergy symptoms by location will be presented.

ConclusionCitizen science can be more than simply crowdsourcing data. We demonstrated that paper prototyping was a feasible and useful technique for codesigning an application with members of the public. Furthermore, workshop feedback indicated a high level of support for citizen science, provided users gained simple, personalised feedback. Further research is required to determine how codesign processes influence subsequent participant recruitment and engagement in citizen science projects.
Introducing the PRIDAL model for linking routine health and identifiable patient reported questionnaire data
Authors: Kingston Mark , Heaven Martin , Snooks Helen , Hutchings Hayley
Published: April 2017

ABSTRACTObjectives

To present an efficient privacy-protecting model (PRIDAL) for linking routine and identifiable patient-reported research data.

To describe the application of the PRIDAL model with within a major portfolio trial linking a range of health and demographic datasets pertaining to >230,000 patients, alongside >2,300 questionnaires.

To summarise the lessons learned from the application of the PRIDAL model.

ApproachThe rise in availability, quality and use of routine health data has resulted in well-developed methods for anonymised linkage of data from multiple sources. However methods for combining identifiable data (e.g. patient-reported questionnaires) with routine anonymised data are not yet tried and tested. Linking these data presents opportunities to improve the feasibility and effectiveness of observational and experimental studies, but emerging data linkage processes must address the appropriate balance between data security and usability. The Process for Routine and Identifiable Data Linkage (PRIDAL) was devised to efficiently link routine hospital data and patient-reported quality of life and quality of care questionnaire data as part of the PRISMATIC trial (http://www.trialsjournal.com/content/14/1/301). This is a mixed methods progressive cluster randomised trial of the efficacy of an emergency admission risk prediction tool in primary care, funded by the NIHR HS&DR programme. PRIDAL was conceived by a group of specialists in e-trials, health informatics, information governance and process mapping who reviewed data sources, flows, owners, and security to develop a practical and intuitive process model.

ResultsWe will present the PRIDAL process model and describe its application in relation to the PRISMATIC study. We will demonstrate that the model achieves high data matching rates (>99%), and consider the lessons learnt from its application.

ConclusionsThe linking of routine health and patient self-reported data presents a valuable opportunity in health research, but clear, replicable models, are needed to support ethical and practical data linkage. We present the fully tested PRIDAL model as a potential solution.
Low-density lipoprotein cholesterol and atrial fibrillation; A Mendelian randomization study using UK-Biobank data
Authors: Katsoulis Michail , Denaxas Spiros , Patel Riyaz , Hemingway Harry
Published: April 2017

ABSTRACTObjectivesWe used data from UK-Biobank that were linked with Hospital Episode Statistics and Office for National Statistics to assess the relationship between low-density lipoprotein cholesterol (LDL-C) and atrial fibrillation (AF). In this study, we applied Mendelian randomization in order to find out whether there is a causal effect of LDL-C to AF.

ApproachWe used data from the UK Biobank (~500,000 subjects) which is linked with electronic health records. At baseline (2006-2010), participants from across the UK took part in this project. They have undergone measures, provided blood, urine and saliva samples for future analysis, detailed information about themselves and agreed to have their health followed. Information in relation to the development of atrial fibrillation was derived from a) the enrollment of the participants (self-reported events), b) their hospitalization before and after their recruitment to UK-Biobank (confirmed events from Hospital Episode Statistics) and c) the death certificates [confirmed events from Office for National Statistics]. We also used genetic data from the analyses of the participants’ blood sample that have been stored. We used Mendelian randomization to capture the effect of LDL-C to AF. As instruments, we used a genetic predisposition risk score (GPRs) for LDL-C, which was created as a weighted sum of the 18 most significant SNPs related to LDL-C, as there were documented in Global Lipid Consortium, in 18 out of 22 chromosomes. We ran a logistic regression model, using AF as outcome and GPRs as exposure.

ResultsOur final sample consisted of 144,092 individuals, for which we have valid information for their genetic data. The AF cases in this sample were 3207, most of which were identified from Hospital Episode Statistics (hospitalization of the participants). From the Mendelian randomization study, from our preliminary results, we found a weak positive relationship between GPRs and AF, when we did not adjust for any covariate [OR per one unit increase of GPRs=1.08, 95% CI= (0.95-1.22)] and results remained practically the same when we adjusted for age and sex [OR=1.09, 95% CI= (0.96-1.24 )].

ConclusionWe observed a weak positive association between LDL-C and AF in this study. This is the first Mendelian randomization approach that focuses on this relationship. More Mendelian randomization studies should be performed in order to identify the causal effect of LDL-C to AF. The use of electronic health records will facilitate the conduction of similar studies.
Supporting Multidisciplinary Analytic Skills: An Innovative Training Platform for Capacity Building
Authors: Greenwood Ann , Reitsma Maxine
Published: April 2017

ABSTRACTObjectivesTo serve the emerging multidisciplinary skills and capacity building needs of Population Health Researchers within a rapidly diversifying field.

Population Health Research is inherently interdisciplinary, multifaceted and firmly rooted in the evolving connections between place, time and related socioeconomic processes. To excel in this rapidly diversifying field, individuals require a broad range of multidisciplinary skills. Supporting the development of these skills through innovative training platforms is one key way to build capacity for emerging 21 Century researchers and health professionals.

ApproachEstablishment of an innovative research training platform that supports skill development in a timely, collaborative and practiced based environment.

The growing importance of data analytics and spatial thinking as it pertains to the worlds growing health concerns, be they social, physical or environmental – demands approaches that serve real time and remotely accessed, exploratory and highly collaborative research environments. A case example will be provided concerning a tri-party training platform that is serving the multidisciplinary skill requirements of new and mid-career population health professionals. Designed in collaboration with a tri-university research platform, the innovative, practice-based training environment both mirrors and supports many of the day to day skill development needs of health and social science researchers.

ResultsThe multidisciplinary focus of this specialized training platform is successfully addressing the skill development needs of a diverse cross section of health research professionals.

Trainees are bringing a wealth of experience and knowledge to share with their online colleagues, supporting a rich, practice based education and skills development environment. Those enrolled in the program possess backgrounds ranging from Population and Public Health, Epidemiology, Statistics and Sociology to Medicine to Psychology, Geography, Biostatistics and International Health.

ConclusionProviding timely, practical, hands-on analytic skills training is critical to building the capacity of new and mid-career researchers and health professionals.

Direct application of these new skills is an essential outcome and best measure of success. We are listening to our trainees and learning as we grow.Read what trainees are saying about our certificate courses.https://www.popdata.bc.ca/etu/testimonials/PHDA
Increasing research capacity with ICES Data & Analytic Services (DAS)
Authors: Ishiguro Lisa , Saskin Refik , Victor J. Charles
Published: April 2017

ABSTRACTBackgroundThe Institute for Clinical Evaluative Sciences (ICES) is a not-for-profit organization that conducts research to evaluate health care delivery and outcomes. Established in 1992, ICES houses a vast and secure array of linkable, coded health-related data on more than 13 million Ontarians, including health services data, health care provider data, registries and population-based health surveys. ICES has a reputation for generating strong evidence-based knowledge to inform policy and practice, however the use of the data was restricted to ICES’ purposes. In March 2014, ICES launched the Data & Analytic Services (DAS) platform with the primary objective of increasing access to its data to publicly-funded researchers, health care providers and administrators, policymakers and students.

MethodDAS provides access to highly de-identified, risk-reduced datasets created from ICES’ data holdings; analytic support; and complete data analysis and report writing services. DAS also enables the importation of external data for linkage to ICES’ data holdings. Research objectives and methodology are led by the requestor and ICES analysts rely on their subject matter expertise to direct the deliverables.

ResultsSince launch, over 200 requests from Canada, United States and United Kingdom have been adjudicated, of which 187 have been deemed feasible and eligible. Over the same period of time, ICES as an organization had over 700 active projects of which 348 were initiated, an increase in capacity of 26%. Though Toronto-based researchers represent the majority of the requests (62%), there have been requests from outside Ontario interested in comparing aspects of Ontario’s healthcare to their home province. Research topics have varied and include assessments of health care provision by sector, disease prevalence and treatment, and statistical methods. An unexpected outcome of increasing access has been the large interest from small physician groups and knowledge users who are not typically involved in research for academic purposes. Access to ICES’ data holdings provides an opportunity to examine a larger cohort of patients who share the same characteristics as their clinic patients or group. Furthermore, by enabling remote access to the data, DAS is able to leverage the capabilities of ICES’ data holdings and increase research capacity in a short period of time.

ConclusionIn making one of the most comprehensively linked health administrative data repositories in the world widely available to the broader research and healthcare community, DAS engages investigators involved in front-line care, stimulates new avenues of research and fosters collaboration that was previously unachievable.
Real world persistence, adherence and switch-over across anticoagulants in atrial fibrillation-a national population-based study.
Authors: Banerjee Amitava , Burnell Jane , Sutton Chris
Published: April 2017

ABSTRACTBackgroundThe choice of oral anticoagulant(OAC) for stroke prevention in patients with atrial fibrillation(AF) is now between warfarin and four non-vitamin K anticoagulants(NOACs):dabigatran, rivaroxaban, apixaban and edoxaban. Although discontinuation rates were reported in clinical trials of the NOACs, real-world persistence, adherence and cross-over between therapies are unknown.

MethodsPrescription data for OACs in adults with AF between April 2011 and December 2015 were analysed from a representative national primary care database in England(The Health Improvement Network, THIN). Edoxaban was approved for use in the UK in September 2015 and therefore insufficient numbers of prescriptions were available for analysis. Persistence(estimated by gap between prescriptions) and adherence(proportion of days covered, PDC) for OACs were assessed in individuals with AF newly treated with dabigatran, rivaroxaban, apixaban or warfarin with at least 365 days follow-up after the prescription date. For each NOAC, the proportion of cross-over to another OAC was analysed.

ResultsAmong 4,354,740 individuals, 118,056 with AF were identified, of which 82,795 had available prescription data for OACs. Of these patients, 78,447 had at least 12 months data: warfarin (n=67781), dabigatran (n=2540), rivaroxaban (n=5666) and apixaban (n=2460). At 1 year, the crude persistence rates were 88.7% (95% CI 88.4-88.9) for warfarin, 59.1% (57.2-61.0) for dabigatran, 64.7% (63.4-65.9) for rivaroxaban and 67.0% (65.1-68.9) for apixaban. Persistence was significantly lower than in the clinical trials and was lower for NOACs than warfarin.

The adherence rates (PDC>80%) were 87.5% (CI 87.3,87.6) for warfarin, 83.5% (CI 82.3,84.8) for dabigatran, 84.1% (CI 83.1,85.1) for rivaroxaban and 83.6% (CI 81.6,85.5) for apixaban. The proportion of NOAC users crossing over to another NOAC and to warfarin were 12.1% and 7.3% for dabigatran, 3.4% and 3.4% for rivaroxaban, and 1.9% and 1.5% for apixaban respectively.

ConclusionsIn a large English population, NOACs exhibited lower persistence rates than in clinical trials, warranting further analyses of side effect profile and acceptability of OACs. Routinely collected data can be used to measure real-world persistence and adherence which are important in future studies of comparative effectiveness.
Is Cancer Diagnosis Following Emergency Admission Due to Patient Delay or Systems Failure: New Insights from a Comprehensive Primary Care Dataset
Authors: Yule Michael , Adam Rosalind , Murchie Peter
Published: April 2017

ABSTRACT

ObjectivesA significant proportion (13.9-21.8%) of cancers are diagnosed during emergency admissions to hospital. Patients who are diagnosed in this way have poorer outcomes. Cancer type, increasing age, and deprivation have shown to be associated with cancer diagnosis as an emergency. The role of primary care consulting behaviour prior to emergency presentation with a new cancer diagnosis is unclear and therefore the principle aim of the present study was to investigate this.

ApproachAll GP practices in the North East of Scotland were invited to participate. 2015 patients with a diagnosis of either colorectal, upper GI, prostate, lung, breast and melanoma were randomly selected from participating practices. A dataset was created that contained routinely collected data from primary care records from these patients. This information was consolidated with information from the NHS Grampian Cancer Care pathway database. Those diagnosed by screening were removed, leaving 1803 patients. The main characteristic examined was whether or not the patient had seen a GP with relevant symptoms in the 2 years before the consultation that resulted in their diagnosis or referral. Chi squared analysis and univariate linear regression analysis was performed on each characteristic to examine the association of independent variables with each outcome. Multivariate linear regression was then carried out across the characteristics.

Results362 (20.1%) of new cancer diagnosis were by emergency. Only 16.2% (n=260) of patients who saw their GP prior to their admission were diagnosed by emergency. 54.5% (n=97) of patients who had not seen their GP prior to diagnosis were emergency diagnoses. 20.7% (n=75) of patients diagnosed by emergency admission had been referred by their GP at the time of diagnosis and were awaiting their appointment with secondary care. Patients who had been seen in primary care before their cancer diagnosis were significantly less likely to have their cancer diagnosed by emergency admission (p<0.0001).

ConclusionPatients who present to their GP with symptoms of cancer are much less likely to be diagnosed as a result of an emergency admission. It is therefore postulated that GPs are adequately referring patients with cancer for further investigation and diagnosis. However around a fifth of patients overall are still being diagnosed through emergency admission to hospital, and in the majority of cases this is because they are not presenting themselves to primary care. In order to rectify this we suggest that greater awareness about cancer symptoms amongst the public is necessary.