Social and Clinical Variables Associated with Outpatient Mental Health Care Utilization following Positive Suicide Risk Screening.

Risk stratification systems (RSSs) have had an increasing role in standardizing thyroid ultrasound reports. The VA Northern California Healthcare System (VA-NCHCS) Radiology department adopted the American College of Radiology Thyroid Imaging Reporting and Data System (TI-RADS) in 2018. We aimed to assess what effect the adoption of TI-RADS at VA-NCHCS had on thyroid surgical practices. A 10-year retrospective review of the VA corporate data warehouse was completed (approximately 5 years prior and 5 years after universal adoption of TI-RADS) (i.e: 1/1/2013-7/1/2018 and 7/2/2018-12/30/2023). Using CPT and diagnosis codes, data were collected on all thyroid surgeries, including demographics, type of surgery performed, final pathology, staging of malignancy, and any incidental findings. A two-sample t-test with equal and unequal variances was used for comparative statistics. 3985 patients (1921 PRE-TIRADS vs. 2064 POST-TIRADS) and 7908 thyroid ultrasounds (3411 vs. 4497) were identified. 2859 FNAs were performed (1245 vs. 1614). One hundred and ninety-three surgeries (96 vs. 97) were performed with a decreasing trend in surgeries for benign pathology (56 vs. 45) and an increasing trend in surgeries for malignancy (39 vs. 51). We identified an increase in partial thyroidectomy surgeries for cancer diagnoses (11 vs. 18). Finally, there was a significant decrease in total thyroidectomies performed for benign pathology (30 vs. 13, p = 0.02). After the institution of TIRADs at our single institution, there was a dramatic increase in the number of ultrasounds and FNAs performed, despite near stable thyroid surgical numbers. There was a significant trend towards less-invasive surgical practices.

Does increasing primary care team panel size affect health care costs: Findings from a VHA pilot program.

Characterise longitudinal patterns of chiropractic visits for neck pain or low back pain by using machine learning (ML) methods and explainable models. Using de-identified claims data from 2016 to 2023 for adults from the Optum Labs Data Warehouse, we applied spectral clustering (SC) to identify novel patient clusters. Then we used explainable boosting machines (EBM) for feature ranking followed by hierarchical group lasso regression for feature selection. A logistic regression model used for parameter estimates. SC identified 3 clusters-low, moderate and high dose-based on their pattern of chiropractic visits. An interesting finding was a small cluster where patients received persistently higher care for several months. Age, gender and number of prior visits to a chiropractor, primary care provider, or physical therapist emerged as strong indicators for provider type and frequency of visits. Patients receiving spinal manipulative therapy sorted into 3 markedly different trajectories of utilisation. This unexpected variation mandates further investigation to identify optimal dose based on patient and provider characteristics. We also present EBM, a robust alternative to computationally heavy feature selection methods, to identify features necessary for predictive models. This approach obviates the need for opaque feature selection methods. Results show the use of advanced, explainable methods to discover knowledge that can be missed by other methods. We present an approach to identify hidden patterns in large data that can guide hypothesis driven research. Our work can identify factors that drive high utilisation of services and inform practice guidelines.

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) is a rare but potentially life-threatening drug-induced hypersensitivity reaction. Approximately 15% of patients require admission to an intensive care unit (ICU). To identify factors associated with ICU admission in patients with DRESS in order to improve risk stratification and management. We conducted a multicentre retrospective cohort study including adult patients with probable or definite DRESS (RegiSCAR score ≥4) hospitalized in Greater Paris area hospitals between July 2017 and January 2023. Data were extracted from the Assistance Publique-Hôpitaux de Paris Health Data Warehouse, covering 39 centres. The primary endpoint was DRESS-related ICU admission. Secondary endpoints included in-hospital mortality and therapeutic interventions inside and outside the ICU. A total of 207 DRESS cases were included of whom 35 (17%) required ICU admission. Median age was 58 years [IQR 41-72], with a female predominance (62%) and a median Charlson comorbidity score of 3 [1-6]. Anti-epileptic drugs were the most frequently implicated agents (22%). Hepatic involvement was the most common visceral manifestation (70%), followed by renal (30%), haemodynamic (6.3%), cardiac (5.3%) and pulmonary involvement (1.9%). Disease severity was classified as mild in 40%, moderate in 35% and severe in 25% of cases. Nearly, all patients received corticosteroids, predominantly topical in mild to moderate forms and systemic in severe cases. Overall, in-hospital mortality was 4.8% (n = 10), rising to 20% (n = 7) among ICU patients. In multivariable analysis, hospital-acquired DRESS (adjusted odds ratio, aOR = 5.21; 95% CI [1.96; 14.1]; p = 0.001) and DRESS severity were independently associated with ICU admission (moderate forms: aOR = 3.74 [1.13; 14.9] and severe forms: aOR = 12.5 [3.79; 51.3], versus minor forms; p < 0.001). Nearly one in five hospitalized patients with DRESS required ICU management. Hospital-acquired DRESS and disease severity were the main determinants of critical care admission, underscoring their prognostic importance.

BackgroundRepeated blood product ordering is associated with order entry errors and potential patient harm. Traditional electronic health record order sets require repeated re-entry for recurrent transfusions, creating inefficiencies and opportunities for error, and contributing to physician burnout. Historically, we have used order sets to order blood products, which must be re-entered each time a transfusion is needed. Reusable transfusion therapy plans may address these challenges by standardizing and streamlining transfusion workflows. We conducted a pre-post study at a single pediatric academic center, evaluating the implementation of reusable transfusion therapy plans for packed red blood cells and platelets in oncology patients and those undergoing hematopoietic stem cell transplantation.ObjectiveThe primary outcome was to evaluate the proportion of transfusions originating from the transfusion therapy plans during the postimplementation period. Secondary outcomes included evaluating (1) the proportion of eligible patients with applied transfusion therapy plans, (2) changes in transfusion efficiency (time from laboratory result to transfusion release and administration, premedication timing, and estimated overnight pages), and (3) the impact on safety (guideline-concordant dosing, irradiated product ordering, and transfusion thresholds). We also assessed health care practitioner experience using an adaptation of the technology acceptance model survey.MethodsThe prestudy period consisted of the 1-year preimplementation, and the postperiod consisted of the 1-year post implementation. We used our institution’s enterprise data warehouse (SickKids Enterprise-Wide Data in Azure Repository) to obtain demographic and transfusion details for all eligible patients. The adapted technology acceptance model survey was administered to eligible oncology clinicians.ResultsThe preimplementation cohort had 558 unique patients who received a total of 2678 transfusions. The postimplementation cohort had 521 unique patients who received 2777 transfusions. During the postimplementation period, 59% of transfusion orders originated from a therapy plan, increasing to 71% in the final month. Compared with order sets, therapy plan–derived transfusions were released and administered significantly faster following laboratory results (P<.001). Guideline-concordant transfusion volumes increased significantly postimplementation for both packed red blood cells and platelets (P<.001), as did the ordering of irradiated blood products (P<.001). No differences were observed in pretransfusion hemoglobin or platelet thresholds between study periods. Use of therapy plans was associated with an average avoidance of 4 overnight blood product entries per night. Survey responses from nurses and providers demonstrated high perceived usefulness and ease of use, with 95% endorsing continued use.ConclusionsReusable transfusion therapy plans improved efficiency, standardized safe ordering practices, and were highly acceptable to clinicians. This longitudinal, noninterruptive electronic health record intervention represents a scalable approach to supporting high-risk transfusion workflows in pediatric oncology.

Gabapentinoids are widely prescribed in patients with chronic kidney disease (CKD), yet whether routine renal dose adjustment is sufficient to mitigate cognitive safety risk remains unresolved. Gabapentin and pregabalin differ markedly in pharmacokinetic behavior under impaired clearance: gabapentin half-life extends from 5–7 hours to 52–132 hours in advanced CKD (a 10-to 20-fold increase), versus an approximately 4-fold extension for pregabalin. We examined whether CKD amplifies gabapentin-associated dementia risk relative to pregabalin in a real-world active comparator cohort, with external replication.Among 33,791 adults aged ≥40 years with hypertension initiating gabapentinoids in the Rutgers Clinical Research Data Warehouse (2018–2024), gabapentin was associated with substantially elevated dementia risk in patients with CKD (hazard ratio [HR] 7.39; 95% CI, 3.43–15.92;P<0.001) versus a near-null association in patients without CKD (HR 1.09; 95% CI, 0.89–1.34;P=0.41). The elevated risk in CKD persisted within the low-dose stratum (≤300 mg: HR 5.06 in CKD vs. 1.27 in non-CKD), suggesting that dose adjustment alone may not fully offset cognitive safety risk. The signal concentrated in non-dialysis CKD (KDIGO G3b–G4: HR 4.54; 95% CI, 1.62–12.76) and attenuated in CKD stage 5 (HR 1.57;P=0.18), a pattern consistent with renal pharmacokinetic exposure as the dominant driver. External replication in the NIH All of Us Research Program (N=47,079) confirmed the gabapentin–pregabalin signal (HR 1.59; 95% CI, 1.35–1.88;P<0.001) with a directionally consistent eGFR gradient. FAERS pharmacovigilance analysis showed disproportionately higher renal adverse event reporting for gabapentin versus pregabalin (chronic kidney disease ROR 5.98; renal failure ROR 2.43).These findings are consistent with the interpretation that CKD may transform routine gabapentin prescribing into a renal pharmacokinetic cognitive safety problem, with risk concentrated in the non-dialysis CKD population and persisting even at low prescribed doses. Standard dose adjustment alone may be insufficient. Renal function stage warrants closer integration into gabapentinoid selection in patients with CKD, with pregabalin a candidate alternative where cardiovascular risk permits.Key PointsIn an active comparator new-user cohort of 33,791 gabapentinoid initiators, gabapentin was associated with substantially elevated dementia risk in patients with chronic kidney disease (CKD) compared with pregabalin, with the excess risk persisting even within the low-dose stratum (≤300 mg) — a pattern consistent with the interpretation that standard renal dose adjustment alone may not fully offset the cognitive safety risk of gabapentin in CKD.The signal concentrated in non-dialysis CKD (KDIGO stages G3b–G4) and attenuated in CKD stage 5, paralleling expected pharmacokinetic exposure: gabapentin half-life extends 10-to 20-fold in advanced CKD versus approximately 4-fold for pregabalin, while dialysis partially restores clearance.Convergent evidence from external replication in the NIH All of Us Research Program (N=47,079) and FDA FAERS pharmacovigilance data — including disproportionately higher renal adverse event reporting for gabapentin versus pregabalin (chronic kidney disease reporting odds ratio [ROR] 5.98; renal failure ROR 2.43) — supported the interpretation of a renal pharmacokinetic cognitive safety vulnerability.These findings suggest that renal function stage warrants closer integration into gabapentinoid selection in older adults with CKD, with pregabalin a candidate alternative where cardiovascular risk permits.

Abstract Introduction Rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia strongly associated with α-synucleinopathies, most commonly Parkinson’s disease (PD). Among Veterans, posttraumatic stress disorder (PTSD) is common and may influence RBD presentation and outcomes. The extent to which PTSD modifies demographic, medical, and mortality profiles in Veterans with RBD, and how these differ from those with RBD and Parkinson’s disease (PD), remains poorly characterized. Methods We conducted a retrospective cohort study using the Veterans Health Administration Corporate Data Warehouse. Veterans with at least one ICD-9 or ICD-10 diagnostic code for RBD were identified between 1999 - 2020 and categorized into three, mutually-exclusive groups based on the presence or absence of co-occurring ICD codes: RBD-only, RBD+PTSD, or RBD+PD. Demographics, comorbidities (Charlson Comorbidity Index [CCI]), and mortality outcomes were compared using logistic regression models adjusted for age, sex, race/ethnicity, BMI, and CCI. Results The cohort included 11,283 Veterans with RBD only, 17,527 with RBD+PTSD, and 5,675 with RBD+PD. Veterans with RBD+PTSD were younger (mean 58.9 ± 14.9 y) and had higher psychiatric comorbidity (94.2%) compared to RBD only (54.2%) or RBD+PD (46.5%). Those with RBD+PD were older (73.6 ± 8.1 y), predominantly male (98.9%), and had the highest neurological comorbidity (92.6%). Unadjusted mortality was lowest in RBD+PTSD (15.3%) and highest in RBD+PD (53.6%). Adjusted models showed reduced mortality risk for RBD+PTSD (aOR 0.73, 95% CI 0.70–0.80, p &amp;lt; 0.001) and increased risk for RBD+PD (aOR 2.43, 95% CI 2.3–2.6, p &amp;lt; 0.001) vs. RBD alone. Higher age, male sex, and greater comorbidity independently predicted mortality. Conclusion In this large national VA cohort, comorbid PTSD and Parkinson’s disease were associated with distinct demographic and clinical profiles among Veterans with RBD. RBD+PTSD was linked to younger age, greater psychiatric burden, and lower mortality. These findings underscore the heterogeneity of RBD in Veterans and support stratified approaches to surveillance for synucleinopathy and trauma-related sleep disturbances. Support (if any) VA CDA # IK2CX002363-01A1 (MJ); NHLBI K25 #1K25HL152006-01 (JR)

To compare survivorship outcomes between patients with stage I testicular cancer (TCa) undergoing surveillance or adjuvant therapy and examine patient perceptions on counselling and management. Administrative claims data from the Optum Labs Data Warehouse (2007-2022) were reviewed to identify patients with stage I TCa managed with either surveillance or adjuvant therapy. Trends in TCa management were evaluated, and survivorship outcomes were assessed using propensity score matched survival analyses. Qualitative surveys and interviews explored patient perspectives on decision-making and identified themes in patient experiences with counseling. Of 3,613 stage I TCa patients, the mean age at diagnosis was 38.6 years (SD 13.6) with surveillance rates increasing up to 78.7% by 2022. When comparing the matched surveillance to chemotherapy groups, there were higher rates of men's health diagnoses in the chemotherapy group (35.2% vs 23.9%, p=0.027). However, time-to-event analysis showed no difference in survivorship outcomes between surveillance or adjuvant therapy. Twenty surveyed stage I TCa patients revealed satisfaction and understanding of their care but endorsed concerns regarding survivorship outcomes. Five interviewed patients communicated four key themes: 1) trust in physician recommendations, 2) proactive personal and family research, 3) gaps in communication of care, and 4) coping. This study suggests adjuvant chemotherapy may be linked to higher rates of men's health diagnoses, but over time, these risks do not differ significantly from surveillance. Patient perspectives underscore the importance of communication, shared decision-making, and addressing survivorship concerns as part of comprehensive care. Further research into survivorship outcomes is needed.

Infections after surgery remain a leading cause of morbidity and mortality, yet reliable risk stratification at the end of surgery is limited. Intraoperative vital signs are continuously recorded in modern operating rooms but remain an underexploited source of real-time prognostic information. We developed and validated a machine-learning model integrating intraoperative vital-sign dynamics to predict postoperative infections immediately at the end of surgery. We extracted arterial blood pressure, heart rate, oxygen saturation, temperature, and end-tidal CO₂ time-series from a clinical data warehouse, transforming these signals into interpretable summary, trend, and distributional descriptors. Using routine data from 10,719 surgical procedures, models incorporating interpretable intraoperative time-series features achieved an AUROC of 0.88 (95% CI, 0.85-0.91) for infection prediction at the end of surgery, significantly outperforming models based on preoperative variables alone. Model predictions were calibrated across major procedure clusters and interpretable through SHAP-based feature attribution. Our results demonstrate that intraoperative time-series data encode signatures of cumulative surgical and physiological stress, revealing early and clinically actionable signals of postoperative infection risk and enable an explainable machine-learning framework for perioperative monitoring systems. This explainable approach moves risk assessment from delayed postoperative testing to immediate, digital decision support, ready for integration into perioperative monitoring systems.

To assess the effectiveness and safety of anakinra in crystal-related disease (CRD) flares, and to identify factors associated with treatment failure and risk of infection. We conducted a single-centre, retrospective, observational study including adult patients treated with anakinra for a CRD flare between January 2011 and July 2024. Patients were identified in a hospital clinical data warehouse using an electronic query. CRD was confirmed by the presence of crystals in synovial fluid or by characteristic radiological features. Clinical and biological data were collected through medical record review. Treatment effectiveness was assessed retrospectively based on the treating physician's global clinical judgment documented in medical records. Treatment failure was defined as insufficient clinical response requiring treatment escalation or persistent symptoms. Adverse events, including infections, were collected up to one month after anakinra initiation. Factors associated with treatment failure and infection were explored using univariable and multivariable analyses. A total of 292 patients were included. Effectiveness of anakinra was observed in 92.8% of patients after a median treatment duration of 3 days. In multivariate analysis, longer CRD duration (OR 1.11, 95% CI 1.03-1.19) and a history of diabetes (OR 4.00, 95% CI 1.25-14.29) were independently associated with treatment failure. Thirteen patients (4.5%) developed an infection within one month after anakinra initiation, with a median delay of 11 days. No variable was independently associated with infection risk. This large real-life study supports the effectiveness and overall safety of anakinra in the management of acute CRD flares.

Hepatology visits present an opportunity to engage patients with alcohol-associated liver disease in care. This quality improvement pilot integrated a behavioral health provider (BHP) into the hepatology clinic at one Veterans Health Administration site and assessed its impact on alcohol use disorder (AUD) treatment. Hepatologists across Veterans Health Administration facilities developed a workflow to refer patients with signs of unhealthy alcohol use to a BHP co-located in the hepatology clinic. Data during the first year of BHP integration (December 2022 to January 2024) were obtained through chart reviews and the Veterans Health Administration Corporate Data Warehouse. t tests and χ2 tests compared baseline characteristics and assessed the associations of referral status with receipt of evidence-based AUD treatments within 6 months of referral or index liver clinic appointment. Two hundred ninety-three patients with signs of unhealthy alcohol use were identified, representing 19.9% of all liver clinic patients engaged in care during the pilot. Of these, 86.4% had a prior mental health diagnosis, 79.2% had an AUD diagnosis, 57.7% had a positive AUDIT-C screen, 40.3% had an alcohol-associated liver disease diagnosis, and 71 patients (24% of patients with unhealthy alcohol use) were referred to the BHP. Referred patients were more likely to receive AUD psychotherapy and/or pharmacotherapy and had significantly more AUD pharmacotherapy fill days (35.2 vs. 10.3, p<0.001) but not AUD psychotherapy visits (5.2 vs. 3.2, p=0.172). Referral to a co-located BHP was associated with a higher likelihood of receiving AUD treatment and a greater amount of AUD treatment, but gaps in referral remain and need to be addressed. Integrating BHPs into general hepatology clinics may improve AUD treatment uptake, addressing an important gap in care.

Clopidogrel was added to the national formulary of the Veterans Health Administration (VHA) in 2000, with national guidance in the form of Criteria for Use (CFU) generated in 2007 by the Pharmacy Benefits Management office. Although the national CFU restricted the duration of clopidogrel to no more than 30 days following peripheral vascular intervention (PVI) for peripheral artery disease (PAD), each local VHA Veterans Affairs Medical Center (VAMC) determined its own strategies of implementation. Strategies ranged from passive diffusion of information to electronic health record-mandated pharmacist approval for noncompliant CFU prescribing. To characterize patterns of compliance to restricted duration of clopidogrel and determine the factors associated with compliance. In a retrospective cohort study, we used the Veterans Affairs Surgical Quality Initiative Program (2007-2022) to identify index PVI performed for PAD and integrated post-PVI medication information from the VA Clinical Data Warehouse. Our primary outcome was to evaluate compliance with the CFU. During the active CFU period (2007-2018), we compared patient, procedural, and VAMC features by CFU compliance and determined their associations with compliance using multivariable logistic regression. We also characterized variation in compliance across the Veterans Integrated Service Network (VISN), VAMC, and surgeons. Among 7,206 PVIs with postoperative clopidogrel, 35% and 26% had post-PVI clopidogrel durations of no more than 30 days during and after the CFU period, respectively. During the active CFU period, we found no strong association among patient, PVI, and VAMC characteristics with compliance. Compliance during the active CFU period varied significantly among VISNs (16%-55%), VAMCs (0%-93%), and surgeons (0%-100%). Adherence to no more than 30 days of clopidogrel post-PVI was low during and after the active CFU period and varied substantially among the VISNs, VAMCs, and surgeons. Given that national guidance implementation was directed by local VHA pharmacies, this study highlights the importance and limitations of local implementation strategies on national guidance compliance.

The purpose of the study was to evaluate the proportional reporting of neurological adverse events (AEs) associated with feline topical parasiticide products containing macrocyclic lactones (MLs; including eprinomectin) and emodepside by use of postapproval pharmacovigilance data. The intent was to provide veterinarians prescribing these products for their feline patients with the overall comparative context of neurological AE reporting for these products, which have been characterized as substrates for P-glycoprotein transporters. The openFDA and EudraVigilance Veterinary Data Warehouse databases were queried for neurological AEs cumulatively reported through December 31, 2024, for marketed parasiticide products containing MLs (eprinomectin, selamectin, moxidectin) and emodepside for topical administration to cats. The frequencies of neurological AE reporting were compared between products with proportional report rates and disproportionality statistical measures. The reporting frequencies of neurological AEs associated with these feline topical parasiticide products were similar. For all products, ataxia was the most frequently reported neurological AE, with proportional report rates ranging from 5.3% to 14.0%. Proportional report rates ranged from 1.7% to 10.7% for convulsion and muscle tremor. An evaluation of pharmacovigilance data from 2 different sources revealed no evidence of greater proportional reporting for neurological AEs specific to the use of eprinomectin-containing products in cats than for other MLs or emodepside. These findings supported the conclusion that ML-containing products (including eprinomectin-containing products) and emodepside are comparable in the frequencies and types of neurological AEs associated with feline topical parasiticide products described as substrates for P-glycoprotein transporters.

Dipeptidyl peptidase-4 (DPP-4) inhibitors and sodium-glucose co-transporter 2 (SGLT2) inhibitors are contemporary oral antidiabetic medications, each offering distinct advantages and challenges. Understanding their comparative effectiveness in real-world settings is crucial for optimizing treatment strategies. We retrospectively analyzed adults with type 2 diabetes mellitus who switched between DPP-4 inhibitors and SGLT2 inhibitors from December 1, 2014, to November 26, 2023, using a clinical data warehouse. All participants had baseline glycosylated hemoglobin (HbA1c) levels between 6.5% and 10.0% and were receiving metformin. To reduce baseline imbalance in HbA1c and fasting plasma glucose (FPG), we excluded patients with an estimated glomerular filtration rate <45 mL/min/1.73 m² and performed 1:1 propensity-score matching on baseline levels of HbA1c and FPG. The matched cohort included 168 patients (84 per group). The primary outcome was the between-group difference in change in HbA1c over 3 months. Secondary outcomes were changes in FPG, body mass index (BMI), liver enzymes, and renal function. Switching to DPP-4 inhibitors was associated with a greater reduction in HbA1c (β, -0.26; 95% confidence interval [CI], -0.51 to -0.01; P<0.001). In contrast, switching to SGLT2 inhibitors led to significant improvements in FPG (β, 10.50; 95% CI, 0.22 to 20.78; P<0.001) and liver enzyme levels. Older patients and those with a lower BMI, higher baseline HbA1c, or chronic kidney disease derived greater benefit from switching to DPP-4 inhibitors. Transitioning to DPP-4 inhibitors reduced HbA1c levels significantly, whereas switching to SGLT2 inhibitors improved FPG and liver-related metabolic parameters.

As part of a long-term effort of modernizing the procurement infrastructure and becoming digital, Ivalua, a worldwide supplier group, adopted Ivalua as its single procurement system used by all its operations and partner entities. There were three areas of implementation Master Data Management, Transactional Data Integration and System Interoperability. Data centralization by supplier, contract, store and distribution center data were guaranteed to achieve data consistency of 98 per cent and the simplified invoices purchases and requisition processes minimized procurement cycles by 35 per cent. The connection with the important enterprise systems like SAP and Enterprise Data Warehouse allowed the real-time data flow and financial reconciliation to align the work of the procurement with the goals of business growth. The project methodology included the Ivalua development and customization, reporting and analyzing data, integration of the enterprise system, enabling, and continuous collaboration. Custom modules, such as a ticketing system, were created to streamline the process of support, which shortened the time to solving issues by 40%. SQL, Tableau, Power BI, SSIS and SSRS were used to generate analytical reports and dashboards that enhanced reporting performance by half and offered operational metrics and actionable data regarding supplier performance. SAP, regional financial system, and centralized data warehouse integration guaranteed 99 percent data integrity. Extensive user documentation, role-based training and practicals enhanced the adoption rate to 92 and helped to change to the new system easily. The outcomes provided evidence that there was a great deal of improvement in operations such as increased transparency, faster procurement processes and better reporting systems. The configurable and scalable Ivalua deployment offered a platform that was future-ready and able to meet many business changes, assist the business making of strategic decisions, and encourage digital transformation throughout the enterprise.

The article examines modern approaches to the design of decision support systems in the conditions of rapid growth of information volumes. Data warehousing information technology was born in the bowels of IBM and was finally formulated by B. Inmona and R. Kimball in the 90s of the last century as a method of solving information and analytical tasks in the field of decision-making and support. Arising at the intersection of database technology, decision support systems (DSS) and computer data analysis, the concept of data storage later evolved as it proved suitable for a wide range of applications in business, science and technology. Systems built on the basis of data warehouses have a number of characteristic features that distinguish them as a special class of information systems. Such features include the subject orientation of the system, the integration of data stored in it, collected from various sources, the invariance of this data over time, the relatively high stability of the data, the need to find a compromise in the redundancy of the data. The article examines the evolutionary transition from the use of isolated Data Warehouses and Data Lakes to a conceptually new hybrid Data Lakehouse architecture. The technological foundation of open table formats (Delta Lake, Apache Iceberg, Apache Hudi) and their role in ensuring the transactional reliability (ACID) of file systems are analyzed. The feasibility of applying the "medallion architecture" pattern (bronze, silver, and gold layers) for effective data quality management, collaborative work of machine learning algorithms, and management BI reporting preparation is substantiated.Received 2026-02-27Accepted 2026-04-08

Abstract. The increasing frequency and intensity of extreme rainfall events present a critical global challenge for urban areas. While flood risk management has historically prioritised fluvial hazards, pluvial flooding and urban overland runoff pathways require local and global attention and scalable, community-inclusive solutions. This proof-of-concept paper presents the local-scale development and implementation of a prototype Citizen and Community Science mobile application, designed within a municipal extreme rainfall context, where both the app's testing environment and current operational scale are spatially limited to neighbourhood and city level in the Ahr valley. The prototype enables residents to document, classify, and report pluvial flood risks, while supporting community-based risk minimisation through enhanced awareness and embedded educational guidance on hazard categorisation and preventive actions. Crowdsourced observations are transferred to a Geo Data Warehouse, providing local authorities with customisable dashboards for analysis, visualisation, and decision support. Although technical constraints remain – particularly restricted offline functionality and variability in Global Navigation Satellite System accuracy – the system architecture was intentionally designed to support iterative refinement. Despite its present local application, the prototype is based on a fully open-source, modular, and scalable design, allowing international transferability and future expansion to regional, national, or global datasets and governance frameworks. This proof-of-concept thus demonstrates the global scaling potential of combining citizen-generated flood risk data with centralised geospatial infrastructure as a pathway toward more climate-resilient and participatory urban pluvial flood risk management worldwide.

Cross-reactive immune responses between endemic human coronaviruses and SARS-CoV-2 have been proposed as a potential factor mitigating COVID-19 severity. Because parents may have more frequent exposure to seasonal respiratory viruses through contact with children, we investigated whether parental status was associated with improved survival among adults hospitalized with COVID-19. We conducted a retrospective cohort study using the Assistance Publique-Hôpitaux de Paris (AP-HP) Clinical Data Warehouse. We included all adults (≥18 years) hospitalized with RT-PCR-confirmed SARS-CoV-2 infection between January 29, 2020 and March 1, 2022. The primary endpoint was 90-day mortality after admission, analyzed as a time-to-event outcome using Cox proportional hazards models adjusted for demographics, comorbidities, admission period (pandemic wave), and baseline biological variables. Parental status was extracted from electronic health record text reports. We tested for interaction between age and parental status. Among 30,386 patients, 22,713 (75%) were classified as having children. Compared with patients without children, those with children were older and had more comorbidities. In the overall adjusted analysis, parental status was not associated with 90-day survival (HR = 1.00, 95%CI 0.94-1.07; p = 0.91). The association between parental status and survival was significantly modified by age (pinteraction = 0.002), with an association with lower mortality observed in younger adults that attenuated toward the null in older age groups. After stratification by age (<65 vs ≥ 65 years), having children was associated with improved 90-day survival in patients <65 years (Hazard Ratio (HR)=0.83, 95%CI 0.72-0.95; p = 0.009), whereas no significant association was observed in patients ≥65 years (HR = 1.07, 95%CI 0.99-1.15; p = 0.09). In this large EHR-based cohort of adults hospitalized with COVID-19, parenthood was associated with lower 90-day mortality among patients younger than 65 years. These findings are observational and may reflect unmeasured confounding; further studies are needed to clarify underlying mechanisms.

Implementation of addiction consult services and bridge clinics in the HEALing communities study in Massachusetts.