Code sets for respiratory symptoms in electronic health records (EHR) research: a systematic review protocol

Introduction Asthma and chronic obstructive pulmonary disease (COPD) are common respiratory conditions, which result in significant morbidity worldwide. These conditions are associated with a range of non-specific symptoms, which in themselves are a target for health research. Such research is increasingly being conducted using electronic health records (EHRs), but computable phenotype definitions, in the form of code sets or code lists, are required to extract structured data from these large routine databases in a systematic and reproducible way. The aim of this protocol is to specify a systematic review to identify code sets for respiratory symptoms in EHRs research. Methods and analysis MEDLINE and Embase databases will be searched using terms relating to EHRs, respiratory symptoms and use of code sets. The search will cover all English-language studies in these databases between January 1990 and December 2017. Two reviewers will independently screen identified studies for inclusion, and key data will be extracted into a uniform table, facilitating cross-comparison of codes used. Disagreements between the reviewers will be adjudicated by a third reviewer. This protocol has been produced in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol guidelines. Ethics and dissemination As a review of previously published studies, no ethical approval is required. The results of this review will be submitted to a peer-reviewed journal for publication and can be used in future research into respiratory symptoms that uses electronic healthcare databases

Health and social care costs at the end of life: a matched analysis of linked patient records in East London

Background: Care in the final year of life accounts for 10% of inpatient hospital costs in UK. However, there has been little analysis of costs in other care settings. We investigated the publicly funded costs associated with the end of life across different health and social care settings. / Method: We performed cross-sectional analysis of linked electronic health records of residents aged over 50 in a locality in East London, UK, between 2011 and 2017. Those who died during the study period were matched to survivors on age group, sex, deprivation, number of long-term conditions and time period. Mean costs were calculated by care setting, age and months to death. / Results: Across 8,720 matched patients, the final year of life was associated with £7,450 (95% confidence interval £7,086–£7,842, P < 0.001) of additional health and care costs, 57% of which related to unplanned hospital care. Whilst costs increased sharply over the final few months of life in emergency and inpatient hospital care, in non-acute settings costs were less concentrated in this period. Patients who died at older ages had higher social care costs and lower healthcare costs than younger patients in their final year of life. / Conclusions: The large proportion of costs relating to unplanned hospital care suggests that end-of-life planning could direct care towards more appropriate settings and lead to system efficiencies. Death at older ages results in an increasing proportion of care costs relating to social care than to healthcare, which has implications for an ageing society

Social gradients in health and social care costs: analysis of linked electronic health records in Kent, UK

Objectives: Research into the socio-economic patterning of health and social care costs in the UK has so far been limited to examining only particular aspects of healthcare. In this study, we explore the social gradients in overall healthcare and social care costs, as well as in the disaggregated costs by cost category. Study design: We calculated the social gradient in health and social care costs by cost category using a linked electronic health record data set for Kent, a county in South East England. We performed a cross-sectional analysis on a sample of 323,401 residents in Kent older than 55 years to assess the impact of neighbourhood deprivation on mean annual per capita costs in 2016/17. Methods: Patient-level costs were estimated from activity data for the financial year 2016/17 and were extracted alongside key patient characteristics. Mean costs were calculated for each area deprivation quintile based on the index of multiple deprivation of the neighbourhood (lower super output area) in which the patient lived. Cost subcategories were analysed across primary care, secondary care, social care, community care and mental health. Results: The mean annual per capita cost increased with deprivation across each deprivation quintile, with a cost of £1205 in the most affluent quintile, compared with £1623 in the most deprived quintile, a 35% cost increase. Social gradients were found across all cost subcategories. Conclusions: Health inequalities in the population older than 55 years in Kent are associated with health and social care costs of £109m, equivalent to 15% of the estimated total expenditure in this age group. Such significant costs suggest that appropriate interventions to reduce socio-economic inequalities have the potential to substantially improve population health and, depending on how much investment they require, may even result in cost savings

Who is more likely to use doctor-rating websites, and why? A cross-sectional study in London

Objectives: To explore the extent to which doctor-rating websites are known and used among a sample of respondents from London. To understand the main predictors of what makes people willing to use doctor-rating websites. Design: A cross-sectional study. Setting: The Borough of Hammersmith and Fulham, London, England. Participants: 200 individuals from the borough. Main outcome measures: The likelihood of being aware of doctor-rating websites and the intention to use doctor-rating websites. Results: The use and awareness of doctor-rating websites are still quite limited. White British subjects, as well as respondents with higher income are less likely to use doctor-rating websites. Aspects of the doctor–patient relationship also play a key role in explaining intention to use the websites. The doctor has both a ‘complementary’ and ‘substitute’ role with respect to Internet information. Conclusions: Online rating websites can play a major role in supporting patients’ informed decisions on which healthcare providers to seek advice from, thus potentially fostering patients’ choice in healthcare. Subjects who seek and provide feedback on doctor-ranking websites, though, are unlikely to be representative of the overall patients’ pool. In particular, they tend to over-represent opinions from non-White British, medium–low-income patients who are not satisfied with their choice of the healthcare treatments and the level of information provided by their GP. Accounting for differences in the users’ characteristics is important when interpreting results from doctor-rating sites

Compensatory Base Changes Reveal Sexual Incompatibility among Members of the Anopheles subpictus Sensu Lato (Diptera: Culicidae) Species Complex in Sri Lanka

The mosquito Anopheles (Cellia) subpictus sensu lato (s.l.) is a major secondary vector of malaria in Sri Lanka. The sibling species composition in this species complex in Sri Lanka remains debatable. Compensatory base changes (CBCs) in the secondary structures of internal transcribed spacer 2 (ITS2) are reliable sources to predict sexual incompatibility among closely related species. The objective of the present study was to investigate the An. subpictus s.l. populations in Sri Lanka using the CBC analysis. Mosquito DNA was amplified and sequenced for the ITS2 region. The sequences were annotated using ITS2 Database. ITS2 secondary structures were constructed and analyzed for CBCs using various bioinformatics tools. The ITS2 regions consisted of two different lengths, 575 bp and 480 bp. The two CBCs and three hemi CBCs identified in the present study suggest that there may be at least two sexually incompatible sibling species. In conclusion, it is likely that there may be only two reproductively isolated sibling species in the An. subpictus species complex in Sri Lanka. However, due to high divergence of ITS2 in these species, it is reasonable to assume that they may be undergoing a speciation event to separate as a distinct species

Rediscovering the Derating Mechanisms for Three-Phase Induction Motors Operating under Supply Voltage Unbalance

© 2020 IEEE. This paper presents a comprehensive analysis on the operating performance of three-phase Induction Motors (IMs) driven by unbalanced supply voltages. It is a well known fact that three-phase IMs are adversely affected by the presence of unbalanced supply voltages and it is required to derate the output power wisely for efficient and safer operation of the motor. There is a certain guidance given in NEMA MG1-1993 to decide a suitable derating level, however limitations and drawbacks of such practices have been identified. Although voltage unbalance is a well-defined concept, existence of numerous voltage unbalance conditions have led to problematic prediction of IM performance in terms of temperature rise and motor derating. Thus, different study approaches, their findings, limitations and shortcomings are critically reviewed in this paper in order to develop a comprehensive derating mechanism for three-phase IMs

Prevention of phantom pain after major lower limb amputation by epidural infusion of diamorphine, clonidine and bupivacaine.

Phantom limb pain may appear in up to 85% of patients after amputation. There is no effective treatment. Perioperative epidural infusion of morphine and bupivacaine, alone or in combination, is effective in preventing phantom limb pain in patients with pre-existing limb pain. Serious side-effects, however, make them difficult to manage on a general ward. Clonidine has been shown to be an effective postoperative analgesia when applied epidurally. To mitigate the potentially serious side-effects of all these drugs, we have studied their combined efficiency in preventing phantom limb pain in a prospective controlled study of 24 patients undergoing lower limb amputation. In the study group (n = 13), an epidural infusion containing bupivacaine 75 mg, clonidine 150 micrograms and diamorphine 5 mg in 60 ml normal saline was given at 1-4 ml/h 24-48 h preoperatively and maintained for at least 3 days postoperatively. The control group (n = 11) received on-demand opioid analgesia. Pain was assessed by visual analogue scale at 7 days, 6 months and 1 year. At 1 year follow-up, one patient in the study group and eight patients in the control group had phantom pain (P < 0.002) and two patients in the study group versus eight patients in the control group had phantom limb sensation (P < 0.05). There was no significant improvement in stump pain. We conclude that perioperative epidural infusion of diamorphine, clonidine and bupivacaine is safe and effective in reducing the incidence of phantom pain after amputation

Influence of Vertebrate Excreta on Attraction, Oviposition and Development of the Asian Tiger Mosquito, Aedes albopictus (Diptera: Culicidae)

Aedes albopictus is an important vector of dengue worldwide. Eliminating dengue in Sri Lanka depends entirely on controlling the vector and human-vector contact. Thus, studying the bionomics and behavior of Ae. albopictus is paramount. The objective of this study was to evaluate the effect of the excreta of cow, goat and pig on the attraction, oviposition and development of Ae. albopictus. Bioassay chambers determined the mosquito stimulatory response. Ovitraps determined Ae. albopictus oviposition preference to excreta singly, in combination and on fermentation. The excreta effect on larval development was also determined. The results revealed that Ae. albopictus gravid females were significantly attracted to goat excreta but were repelled by pig excreta. The oviposition preference was highest for cow excreta and lowest for pig excreta. For excreta combinations, the Cow+Goat combination increased the oviposition while the Pig+Goat combination reduced the oviposition. The oviposition preference of Ae. albopictus increased with the rate of fermentation. The pig excreta increased the Ae. albopictus larval mortality, larval and pupal duration and reduced adult fecundity, whereas the cow excreta positively affected all these aspects. Our findings additionally suggest that a high abundance of Ae. albopictus in rural areas of Sri Lanka may be due to its oviposition attraction and growth performance for vertebrate excreta

Premature mortality attributable to socioeconomic inequality in England between 2003 and 2018: an observational study

Background: Low socioeconomic position is consistently associated with increased risk of premature death. The aim of this study is to measure the aggregate scale of inequality in premature mortality for the whole population of England. Methods: We used mortality records from the UK Office for National Statistics to study all 2 465 285 premature deaths (defined as those before age 75 years) in England between Jan 1, 2003, and Dec 31, 2018. Socioeconomic position was defined using deciles of the Index of Multiple Deprivation: a measure of neighbourhood income, employment, education levels, crime, health, availability of services, and local environment. We calculated the number of expected deaths by applying mortality in the least deprived decile to other deciles, within the strata of age, sex, and time. The mortality attributable to socioeconomic inequality was defined as the difference between the observed and expected deaths. We also used life table modelling to estimate years-of-life lost attributable to socioeconomic inequality. Findings: 35·6% (95% CI 35·3–35·9) of premature deaths were attributable to socioeconomic inequality, equating to 877 082 deaths, or one every 10 min. The biggest contributors were ischaemic heart disease (152 171 excess deaths), respiratory cancers (111 083) and chronic obstructive pulmonary disease (83 593). The most unequal causes of death were tuberculosis, opioid use, HIV, psychoactive drugs use, viral hepatitis, and obesity, each with more than two-thirds attributable to inequality. Inequality was greater among men and peaked in early childhood and at age 40–49 years. The proportion of deaths attributable to inequality increased during the study period, particularly for women, because mortality rates among the most deprived women (excluding cardiovascular diseases) plateaued, and for some diseases increased. A mean of 14·4 months of life before age 75 years are lost due to socioeconomic inequality. Interpretation: One in three premature deaths are attributable to socioeconomic inequality, making this our most important public health challenge. Interventions that address upstream determinants of health should be prioritised. Funding: National Institute of Health Research; Wellcome Trust

Who is more likely to use doctor-rating websites, and why? A cross-sectional study in London

Objectives: To explore the extent to which doctor-rating websites are known and used among a sample of respondents from London. To understand the main predictors of what makes people willing to use doctor-rating websites. Design: A cross-sectional study. Setting: The Borough of Hammersmith and Fulham, London, England. Participants: 200 individuals from the borough. Main outcome measures: The likelihood of being aware of doctor-rating websites and the intention to use doctor-rating websites. Results: The use and awareness of doctor-rating websites are still quite limited. White British subjects, as well as respondents with higher income are less likely to use doctor-rating websites. Aspects of the doctor-patient relationship also play a key role in explaining intention to use the websites. The doctor has both a 'complementary' and 'substitute' role with respect to Internet information. Conclusions: Online rating websites can play a major role in supporting patients' informed decisions on which healthcare providers to seek advice from, thus potentially fostering patients' choice in healthcare. Subjects who seek and provide feedback on doctor-ranking websites, though, are unlikely to be representative of the overall patients' pool. In particular, they tend to over-represent opinions from non-White British, medium-low-income patients who are not satisfied with their choice of the healthcare treatments and the level of information provided by their GP. Accounting for differences in the users' characteristics is important when interpreting results from doctor-rating sites