Read Codes Research Articles

Risk factors for dementia development, frailty, and mortality in older adults with epilepsy – A population-based analysis

ObjectiveAlthough the prevalence of comorbid epilepsy and dementia is expected to increase, the impact is not well understood. Our objectives were to examine risk factors associated with incident dementia and the impact of frailty and dementia on mortality in older adults with epilepsy. MethodsThe CALIBER scientific platform was used. People with incident epilepsy at or after age 65 were identified using Read codes and matched by age, sex, and general practitioner to a cohort without epilepsy (10:1). Baseline cohort characteristics were compared using conditional logistic regression models. Multivariate Cox proportional hazard regression models were used to examine the impact of frailty and dementia on mortality, and to assess risk factors for dementia development. ResultsOne thousand forty eight older adults with incident epilepsy were identified. The odds of having dementia at baseline were 7.39 [95% CI 5.21–10.50] times higher in older adults with epilepsy (n = 62, 5.92%) compared to older adults without epilepsy (n = 88, 0.86%). In the final multivariate Cox model (n = 326), age [HR: 1.20, 95% CI 1.09–1.32], Charlson comorbidity index score [HR: 1.26, 95% CI 1.10–1.44], and sleep disturbances [HR: 2.41, 95% CI 1.07–5.43] at baseline epilepsy diagnosis were significantly associated with an increased hazard of dementia development over the follow-up period. In a multivariate Cox model (n = 1047), age [HR: 1.07, 95% CI 1.03–1.11], baseline dementia [HR: 2.66, 95% CI 1.65–4.27] and baseline e-frailty index score [HR: 11.55, 95% CI 2.09–63.84] were significantly associated with a higher hazard of death among those with epilepsy. Female sex [HR: 0.77, 95% CI 0.59–0.99] was associated with a lower hazard of death. SignificanceThe odds of having dementia were higher in older adults with incident epilepsy. A higher comorbidity burden acts as a risk factor for dementia, while prevalent dementia and increasing frailty were associated with mortality.

Biologic use in psoriatic arthritis and ankylosing spondylitis patients: a descriptive epidemiological study using linked, routine data in Wales, UK.

ObjectivesPsA and AS are chronic diseases associated with significant morbidities. National and international management guidelines include treatment with biologic therapies to improve outcomes and quality of life. There are limited real-world data on the patients’ journey from symptom onset to diagnosis and treatment in the UK. We use real-life, linked health data to explore patient pathways and the impact of biologics on patient outcomes.MethodsData from the Secure Anonymised Information Linkage databank in Wales were used to assess diagnosis and treatment of patients ≥18 years of age with at least one International Classification of Diseases, Tenth Revision code present for PsA/AS in rheumatology clinic data and at least one Read code present in primary care records. We investigated the use of biologics while exploring demographics, comorbidities and surgical procedures of 641 AS patients and 1312 PsA patients.ResultsAS patients were significantly younger at diagnosis and were predominantly male. The average time from presenting symptoms to diagnosis of AS and PsA was 7.9 (s.d. 5.5) and 9.3 (s.d. 5.5) years, respectively. The proportion of patients receiving biologic treatment was significantly higher in AS (46%) compared with PsA patients (28.8%); of these, 23.1% of AS and 22.2% of PsA patients stopped/switched a biologic. There was a significant reduction in primary care involvement, sick notes and disability living allowance for both AS and PsA patients following biologic initiation.ConclusionThis real-world descriptive study confirms that patients treated with biologics have reduced disability and time off work despite being initiated ∼13 years after the first symptoms and 6 years after diagnosis.

COMPREHENSION OF LINKED LIST DIAGRAMS: THE EFFECTS ON CODE WRITING SKILLS

The use of graphics has a tendency to aid reasoning in program solving by improving novice programmers’ ability to read and write code. This study extends existing work in computer programming on the use of diagrammatic representation for students undertaking the fundamental data structure course (CS2) in Malaysia. Students were tested on comprehension of diagrams followed by the composition of code with respect to the linked list topic. The data was assessed using the inter-rater agreement test and showed a high degree of consistent ratings. Results showed a moderate correlation between students’ ability to analyze list operations in the form of notation and performance on code writing. Students assessed the diagrams differently according to the complexity level. The result can be generalized to conclude that the use of diagrams alone may not fully support reasoning and program solving. However, some types of diagrams are potentially more effective to support code composition and more emphasis should be given to evaluating the effectiveness of diagrams in organizing cues to facilitate novice programmers in program solving. Further investigation on a combination of activities related to comprehension of diagrams, including code reading and explanation prior to code writing, is recommended.

Underrecoding of knee osteoarthritis: a population-based study with electronic health records in Dutch general practice

Purpose: Osteoarthritis (OA) has been ranked as the 10th leading contributor to global disability, with knee OA the most prevalent type. The population-based incidence and prevalence estimates are mostly based on electronic health records (EHR). EHRs consist of codified data (i.e. certain codes for diseases, such as the International Classification for Primary Care (ICPC) coding in the Netherlands and Read Codes in the United Kingdom) and narrative data (i.e. free-text notes from physicians). Current epidemiological research on knee OA is largely limited to codified data.

The incidence and prevalence of inflammatory bowel disease in UK primary care: a retrospective cohort study of the IQVIA Medical Research Database

BackgroundOur knowledge of the incidence and prevalence of inflammatory bowel disease (IBD) is uncertain. Recent studies reported an increase in prevalence. However, they excluded a high proportion of ambiguous cases from general practice. Estimates are needed to inform health care providers who plan the provision of services for IBD patients. We aimed to estimate the IBD incidence and prevalence in UK general practice.MethodsWe undertook a retrospective cohort study of routine electronic health records from the IQVIA Medical Research Database covering 14 million patients. Adult patients from 2006 to 2016 were included. IBD was defined as an IBD related Read code or record of IBD specific medication. Annual incidence and 12-month period prevalence were calculated.ResultsThe prevalence of IBD increased between 2006 and 2016 from 106.2 (95% CI 105.2–107.3) to 142.1 (95% CI 140.7–143.5) IBD cases per 10,000 patients which is a 33.8% increase. Incidence varied across the years. The incidence across the full study period was 69.5 (95% CI 68.6–70.4) per 100,000 person years.ConclusionsIn this large study we found higher estimates of IBD incidence and prevalence than previously reported. Estimates are highly dependent on definitions of disease and previously may have been underestimated.

Towards readable code in neuroscience.

Code has become central to neuroscience, and the neuroscience community must take steps to ensure its reproducibility and best coding practices. Improving code readability benefits individual researchers and the wider neuroscience community. In this Comment, Riquelme and Gjorgjieva describe why and how individual researchers and the broader neuroscientific community should aim to improve code readability in the field.

Automatically Assessing Code Understandability

Understanding software is an inherent requirement for many maintenance and evolution tasks. Without a thorough understanding of the code, developers would not be able to fix bugs or add new features timely. Measuring code understandability might be useful to guide developers in writing better code, and could also help in estimating the effort required to modify code components. Unfortunately, there are no metrics designed to assess the understandability of code snippets. In this work, we perform an extensive evaluation of 121 existing as well as new code-related, documentation-related, and developer-related metrics. We try to (i) correlate each metric with understandability and (ii) build models combining metrics to assess understandability. To do this, we use 444 human evaluations from 63 developers and we obtained a bold negative result : none of the 121 experimented metrics is able to capture code understandability, not even the ones assumed to assess quality attributes apparently related, such as code readability and complexity. While we observed some improvements while combining metrics in models, their effectiveness is still far from making them suitable for practical applications. Finally, we conducted interviews with five professional developers to understand the factors that influence their ability to understand code snippets, aiming at identifying possible new metrics.

Research on the application of binary-like coding and Hough circle detection technology in PCB traceability system

With the rapid development of smart devices, printed circuit board (PCB), as the core components of smart devices, not only proposed more and more demand for the quality and precision of their production, but also the controllability of their management and the traceability of manufacturing. The traditional processes for PCB including: acid–base corrosion, water washing, grinding and so on. Due to the traditional spray bar code, thunder engraving two-dimensional code and other methods cannot be used for PCB board identification, but the drilling method has been utilized. At present, the major methods for drilling identification and matrix drilling identification are time consuming, and low identification speed. To tackle this problem, in this paper, we combine the advantages of binary coding and the industry characteristics of PCB production, proposed a kind of binary-like code to identify the position of PCB production, in which, each digit of the binary code can be identified by four holes of a square with equal distance, and can represent the numbers from 0 to 9. Besides, fewer letters and the starting position of the code on the basis of few punching points. This method will greatly improve the efficiency of drilling identification. The system uses the photoelectric analysis module to automatically scan the hole array code on the penal (PNL) board to obtain the original image. Then, the CCD image is preprocessed, mainly including Gaussian filter for image smoothing and unsharp mask operator for image enhancement. Then, Hough detection algorithm is utilized to locate the hole, which can effectively identify the holes. Secondly, the horizontal and vertical directions of these points can be obtained according to the distance between the center points of each hole. Furthermore, the image is righted, and the starting position can be obtained. At the same time, Hough detection algorithm is used to segment the image threshold, and each character is decoded into a corresponding number. The simulation results show that the method is simple, accurate and effective. Finally, the identified digital coding sequences are compared with the database of online code reading application system, and the reliable identification and automatic identification trace-ability of PCB production are realized, and the automatic identification time is less than 1 s.

Optimizing QR code readability for curved agro-food packages using response surface methodology to improve mobile phone-based traceability

Quick response (QR) codes are two-dimensional (2D) barcodes that are widely used in food packaging. Moreover, scanning QR codes with mobile phones has become a convenient method to ensure product traceability. However, attaching QR codes to curved agro-food products to improve traceability effects and increase customer satisfaction presents a significant challenge. This paper reports an optimization method developed for curved surfaces that uses response surface methodology (RSM) analysis. The value ranges of the following four factors affecting QR readability were selected and analyzed: reading distance, ball diameter, code size, and coded characters. A central composite inscribed experiment using four factors with five levels was designed using RSM to obtain the optimal reading parameters, and experimental equipment was designed in-house. The results indicate the primary factors that significantly affect QR code readability are reading distance, ball diameter, the interactions between reading distance and code size, and the interactions between ball diameter and code size. Optimal parameters were obtained with the established model by using apples and melons. For actual experimental testing, two solutions for apples and one solution for melon were selected to determine the requisite average values for the parameters. Tests were performed using different mobile phones, including both iOS and Android platforms. An analysis of the results reveals only slight differences between simulated readability and actual readability for different fruits and mobile phone platforms.

Hormonal contraception and the risk of severe asthma exacerbation: 17-year population-based cohort study

BackgroundLongitudinal studies investigating impact of exogenous sex steroids on clinical outcomes of asthma in women are lacking. We investigated the association between use of hormonal contraceptives and risk of severe...

A pilot study of a nurse-led integrated care review (the INCLUDE review) for people with inflammatory rheumatological conditions in primary care: feasibility study findings

BackgroundPeople with inflammatory rheumatological conditions such as rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, polymyalgia rheumatica and giant cell arteritis are at an increased risk of common comorbidities including cardiovascular disease, osteoporosis and mood problems, leading to increased morbidity and mortality. Identifying and treating these problems could lead to improved patient quality of life and outcomes. Despite these risks being well-established, patients currently are not systematically targeted for management interventions for these morbidities. This study aimed to assess the feasibility of conducting a randomised controlled trial (RCT) of a nurse-led integrated care review in primary care to identify and manage these morbidities.MethodsA pilot cluster RCT was delivered across four UK general practices. Patients with a diagnostic Read code for one of the inflammatory rheumatological conditions of interest were recruited by post. In intervention practices (n = 2), eligible patients were invited to attend the INCLUDE review. Outcome measures included health-related quality of life (EQ-5D-5L), patient activation, self-efficacy and treatment burden. A sample (n = 24) of INCLUDE review consultations were audio-recorded and assessed against a fidelity checklist.Results453/789 (57%) patients responded to the invitation, although 114/453 (25%) were excluded as they either did not fulfil eligibility criteria or failed to provide full written consent. In the intervention practices, uptake of the INCLUDE review was high at 72%. Retention at 3 and 6 months both reached pre-specified success criteria. Participants in intervention practices had more primary care contacts than controls (mean 29 vs 22) over the 12 months, with higher prescribing of all relevant medication classes in participants in intervention practices, particularly so for osteoporosis medication (baseline 29% vs 12 month 46%). The intervention was delivered with fidelity, although potential areas for improvement were identified.ConclusionsThe findings of this pilot study suggest it is feasible to deliver an RCT of the nurse-led integrated care (INCLUDE) review in primary care. A significant morbidity burden was identified. Early results suggest the INCLUDE review was associated with changes in practice. Lessons have been learnt around Read codes for patient identification and refining the nurse training.Trial registrationISRCTN, ISRCTN12765345

A Platform and Algorithms for Interoperability Between Clinical Coding Systems

A large number of conceptually different medical coding and classification systems are in use in medical practice, of which the most popular are ICD-9, ICD-10, and Read Codes. To achieve interoperability, a platform that enables translation between them is needed. In this paper we report on the progress of Babylon Health in developing such an interoperability platform. Based on state-of-the-art partial mapping approaches, we propose a methodology for integrating coding systems into Babylon’s medical Knowledge Graph and propose a code translation algorithm in which this Knowledge Graph acts as a mediator.

Linguistic Economy Applied to Programming Language Identifiers

Though many different readability metrics have been created, there still is no universal agreement defining readability of software source code. The lack of a clear agreement of source code readability has ramifications in many areas of the software development life-cycle, not least of which being software maintainability. We propose a measurement based on Linguistic Economy to bridge the gap between mathematical and behavioral aspects. Linguistic Economy describes efficiencies of speech and is generally applied to natural languages. In our study, we create a large corpus of words that are likely to be found in a programmer’s vocabulary, and a corpus of existing identifiers found in a collection of open-source projects. We perform a usage analysis to create a database from both of these corpora. Linguistic Economy suggests that words requiring less effort to speak are used more often than words requiring more effort. This concept is applied to measure how difficult program identifiers are to understand by extracting them from the program source and comparing their usage to the database. Through this process, we can identify source code that programmers find difficult to review. We validate our work using data from a survey where programmers identified unpleasant to review source files. The results indicate that source files identified as unpleasant to review source code have more linguistically complicated identifiers than pleasant programs.

Relationship between Code Reading Speed and Programmers' Age

Relationship between Code Reading Speed and Programmers' Age

Redundant and Flexible Pseudorandom Optical Rotary Encoder

Optical encoders are mainly used in modern motion servo systems for high-resolution and reliable position and velocity feedback. Pseudorandom optical rotary encoders are single-track and use a serial pseudorandom binary code to measure absolute position. The realization and analysis of such a rotary encoder with advanced code scanning and error detection techniques, as well as an improved redundancy in operation, are presented. A presented serial code reading solution uses two phase-shifted code tracks and two optical encoder modules. So, the realized encoder, hybrid in nature, provides “output on demand” and more or less reliable position information using very efficient error checking. Compared to a standard absolute encoder, this encoder requires a smaller code disc, facilitates installation, has greater flexibility in operation, and is less sensitive to external influences.

Primary care consultations after hospitalisation for pneumonia: a large population-based cohort study.

Up to 70% of patients report ongoing symptoms 4 weeks after hospitalisation for pneumonia; the impact on primary care is poorly understood. To investigate the frequency of primary care consultations after hospitalisation for pneumonia, and the reasons for consultation. A population-based cohort study in England using a UK primary care database of anonymised medical records (Clinical Practice Research Datalink [CPRD]) linked to Hospital Episode Statistics (HES). Adults with the first International Classification of Diseases, 10th Revision (ICD-10) code for pneumonia (J12-J18) recorded in HES between July 2002 and June 2017 were included. Primary care consultation within 30 days of discharge was identified as the recording of any medical Read code (excluding administration-related codes) in CPRD. Competing-risks regression analyses were conducted to determine the predictors of consultation and antibiotic use at consultation; death and readmission were competing events. Reasons for consultation were examined. Of 56 396 adults, 55.9% (n = 31 542) consulted primary care within 30 days of hospital discharge. The rate of consultation was highest within 7 days (4.7 per 100 person-days). The strongest predictor for consultation was a higher number of primary care consultations in the year before index admission (adjusted subhazard ratio [sHR] 8.98, 95% confidence interval [CI] = 6.42 to 12.55). The most common reason for consultation was for a respiratory disorder (40.7%, n = 12 840), 11.8% for pneumonia specifically. At consultation, 31.1% (n = 9823) received further antibiotics. Penicillins (41.6%, n = 5753/13 829) and macrolides (21.9%, n = 3029/13 829) were the most common antibiotics prescribed. Following hospitalisation for pneumonia, a significant proportion of patients consulted primary care within 30 days, highlighting the morbidity experienced by patients during recovery from pneumonia.

PSY17 The Prevalence and Clinical Profile of Atopic Dermatitis (AD) in England: A Population Based Linked Cohort Study Using Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES)

To describe the prevalence and clinical profile of Atopic Dermatitis in England by severity. A descriptive population-based database analysis was conducted using CPRD and HES linked data between 2008-2018. Adults (≥18y) and adolescents (12-17y) with a diagnosis of AD were identified using read codes, ICD-10 codes and the receipt of AD therapies. Comorbidities and symptoms were defined using read codes or ICD-10 codes. AD severity is not routinely recorded therefore severe disease was defined as receipt of ≥1 systemic immunosuppressant, phototherapy or referral for AD, moderate as ≥2 potent topical corticosteroid prescriptions in 1 year or ≥1 topical calcineurin inhibitor, and mild as any patient not meeting moderate or severe criteria. Patients may move across age groups and severity categories. There were 252,589 patients with AD, with a mean of 2,065 days follow-up. Period prevalence of AD was 2.01%, (4.99% adolescent, 1.86% adults) of which 52.23% was mild, 46.56% moderate and 3.11% severe. The most common comorbidities recorded were asthma (23.95%) depression (22.67%) and conjunctivitis (22.38%); all of which increased with AD severity (34.21%, 25.28% and 27.09% in severe AD respectively). Notably, 1.17% had inflammatory bowel disease recorded (0.71% in mild to 7.99% in severe AD). Over the cohort 31.27% had a skin infection recorded. There was a mean of 0.32 (Standard deviation ±1.13) skin infections per patient, increasing from 0.20 (SD± 0.80) in mild AD, to 0.44 (SD± 1.47) in severe AD. Recorded symptoms included pruritus (21.45%), xerosis (17.13%) and sleep disturbance (13.03%). This analysis of linked national datasets provides an initial overview of the epidemiology and clinical burden of AD indicating an increased clinical burden, including symptoms and comorbidities, with increasing severity. The limitations associated with the analysis mean that the results presented are likely an underestimate of the true burden of AD.

Maternal iodine status in a multi-ethnic UK birth cohort: associations with autism spectrum disorder

BackgroundMaternal iodine requirements increase during pregnancy to supply thyroid hormones essential for fetal brain development. Maternal iodine deficiency can lead to hypothyroxinemia, a reduced fetal supply of thyroid hormones which, in the first trimester, has been linked to an increased risk of autism spectrum disorder (ASD) in the child. No study to date has explored the direct link between maternal iodine deficiency and diagnosis of ASD in offspring.MethodsUrinary iodine concentrations (UIC) and iodine/creatinine ratios (I:Cr) were measured in 6955 mothers at 26–28 weeks gestation participating in the Born in Bradford (BiB) cohort. Maternal iodine status was examined in relation to the probability of a Read (CTV3) code for autism being present in a child’s primary care records through a series of logistic regression models with restricted cubic splines.ResultsMedian (inter-quartile range) UIC was 76 μg/L (46, 120) and I:Cr was 83 μg/g (59, 121) indicating a deficient population according to WHO guidelines. Ninety two children (1·3%) in our cohort had received a diagnosis of ASD by the census date. Overall, there was no evidence to support an association between I:Cr or UIC and ASD risk in children aged 8–12 years (p = 0·3).ConclusionsThere was no evidence of an increased clinical ASD risk in children born to mothers with mild-to-moderate iodine deficiency at 26 weeks gestation. Alternative functional biomarkers of exposure and a wider range of conditions may provide further insight.

Epidemiology of systemic sclerosis in the UK: an analysis of the Clinical Practice Research Datalink.

We developed and tested a robust case ascertainment strategy within the Clinical Practice Research Datalink (CPRD), with the aim of assessing the incidence, prevalence, mortality and delay in diagnosis of SSc in the UK. A two-stage case ascertainment strategy was devised and tested to establish a valid cohort of SSc cases within the CPRD. Incidence, prevalence and mortality statistics were analysed, alongside evaluation of the relationship between primary care codes for RP and SSc to examine diagnostic delay. SSc Read codes were identified in 3123 patients (from a study cohort of >10.1 million individuals). Of these, 1757 cases of SSc were identified using our case ascertainment approach. The overall incidence rate of SSc over the period between 1999 and 2017 was 10.7/million/year (95% CI: 9.9-11.4), being higher in females [17.69/million/year (95% CI: 16.32-19.07)] than in males [3.59/million/year (95% CI: 2.97-4.21)]. The overall prevalence of SSc in adults was 235.5/million (95% CI: 207.2-245.7). The mean rate of mortality was 32/1000 person-years, with an overall standardized mortality ratio of 3.51 (95% CI: 3.19-3.84). Of those with an initial code of RP prior to a Read code of SSc, 191/854 (22.4%) had a lag period of >10 years. We have developed and tested a robust case ascertainment strategy to examine the incidence, prevalence, mortality and diagnostic delay of SSc using primary care records of over 10 million UK residents. A significant lag between coding of RP and SSc in many patients suggests diagnostic delay in SSc remains an important unmet need.

The relationship between duration of heart failure, serum potassium concentration and adverse clinical outcomes

Abstract Background Hyper- and hypokalaemia are frequent complications in patients with heart failure (HF). The association between all-cause mortality (ACM), major adverse cardiovascular events (MACE) and serum potassium (K+) has previously been characterised in a UK incident HF population, with hypo- and hyperkalaemic patients being at increased risk of adverse clinical outcomes. Purpose This study aimed to assess the generalisability and findings of previously published risk equations in a broader HF population, spanning both incident and prevalent HF cases regardless of chronic kidney disease (CKD), and to explore the relationship between duration of HF and elevated risk associated with hypo- or hyperkalaemia. Methods A retrospective cohort study was conducted using linked UK Clinical Practice Research Datalink (CPRD) GOLD and Hospital Episode Statistics (HES) data. Eligible patients included individuals ≥18 years with HF (identified using READ codes) during the study period (January 2008 to June 2018) or five-year lookback period (2003 to 2007). Patients' index date was set to 1st January 2008 for prevalent patients or date of HF diagnosis for incident patients. Adverse clinical outcomes included ACM and MACE, a composite of arrhythmia, HF, myocardial infarction and stroke. Published risk equations for ACM and MACE for incident HF without CKD were refitted to this broader study population using original covariates and model forms. Coefficient values were adjusted for the inclusion of HF duration (≤5 and >5 years). Incidence rate ratios (IRRs) were recalculated with K+ concentration 4.5 to <5.0 mmol/L as the reference category. Results The HF cohort consisted of 84,210 patients with a mean follow-up of 5.01 years. The cohort was predominantly male (53.0%), with a mean age of 77.3 years at index. Ischaemic heart disease, hypertension, atrial fibrillation and type 2 diabetes were present in 42.24%, 61.39%, 40.89% and 20.38% of the population, respectively. CKD stage 3+ was present in 39.13% of patients, with a cohort mean estimated glomerular filtration rate of 56.9 mL/min/1.73m2 at index. Crude ACM and MACE event rates were 159.5 (95% confidence interval (CI): 157.9–161.0) and 575.8 (95% CI: 572.8–578.7) per 1,000 patient years, respectively. Hypo- and hyperkalaemia were generally associated with increased risk of ACM and MACE in comparison with patients with K+ concentrations of 4.5 to <5.0 mmol/L (figure 1); these associations were maintained irrespective of the duration of HF. Conclusion A real-world analysis of UK patients suggests that previously published associations between hypo- and hyperkalaemia and increased risk of adverse clinical outcomes in an incident HF population are generalisable to a cohort of incident and prevalent HF patients, irrespective of HF duration and the presence of comorbid CKD. Improved monitoring and management of K+ may have the potential to improve outcomes in these patients. Figure 1. IRRs of ACM and MACE Funding Acknowledgement Type of funding source: Private company. Main funding source(s): AstraZeneca