Linked Laboratory Data Research Articles

Impact of the COVID-19 Pandemic on HIV Test Uptake Among People Who Inject Drugs in the Context of an HIV Outbreak

Glasgow, Scotland’s largest city, has been experiencing an HIV outbreak among people who inject drugs (PWID) since 2015. A key focus of the public health response has been to increase HIV testing among those at risk of infection. Our aim was to assess the impact of COVID-19 on HIV testing among PWID in Glasgow. HIV test uptake in the last 12 months was quantified among: (1) PWID recruited in six Needle Exchange Surveillance Initiative (NESI) surveys (n = 6110); linked laboratory data for (2) people prescribed opioid agonist therapy (OAT) (n = 14,527) and (3) people hospitalised for an injecting-related hospital admission (IRHA) (n = 12,621) across four time periods: pre-outbreak (2010–2014); early-outbreak (2015–2016); ongoing-outbreak (2017–2019); and COVID-19 (2020–June 21). From the pre to ongoing period, HIV testing increased: the highest among people recruited in NESI (from 28% to 56%) and on OAT (from 17% to 54%) while the lowest was among people with an IRHA (from 15% to 42%). From the ongoing to the COVID-19 period, HIV testing decreased markedly among people prescribed OAT, from 54% to 37% (aOR 0.50, 95% CI 0.48–0.53), but increased marginally among people with an IRHA from 42% to 47% (aOR 1.19, 95% CI 1.08–1.31). In conclusion, progress in increasing testing in response to the HIV outbreak has been eroded by COVID-19. Adoption of a linked data approach could be warranted in other settings to inform efforts to eliminate HIV transmission.

Association Between Adherence, A1C Improvement, and Type of Continuous Glucose Monitoring System in People with Type1 Diabetes or Type2 Diabetes Treated with Intensive Insulin Therapy.

Use of continuous glucose monitoring (CGM) systems by people with diabetes is associated with improved glycemic outcomes, including lower glycated hemoglobin (A1C). Less is known about adherence to CGM systems, whether glycemic outcomes are impacted by levels of adherence, or whether adherence rates differ between types of CGM systems-intermittently scanned CGM (isCGM) or real-time CGM (rtCGM). A retrospective analysis of de-identified US administrative health claims and linked laboratory data was conducted using the Merative™ MarketScan® Research Database. The cohort included CGM-naïve people with type1 diabetes (T1D) or type2 diabetes treated with intensive insulin therapy (T2D-IIT) who initiated rtCGM or isCGM between August1, 2019 and March31, 2021 (defined as the index date). Adherence was calculated over a 12-month period using the proportion of days covered (PDC) with PDC ≥ 0.8 defined as adherent. A1C values were obtained within 6months of the index date. A total of 7669 individuals were identified. Subgroups included T1D using isCGM (n = 1578), T1D using rtCGM (n = 1244), T2D-IIT using isCGM (n = 3567), and T2D-IIT using rtCGM (n = 1280). After 12months, PDC was 0.71 (0.30)-0.72 (0.31) (mean(SD)) for T1D and T2D-IIT rtCGM users and 0.55 (0.34)-0.56 (0.34) for T1D and T2D-IIT isCGM users. The proportion of adherent users (PDC ≥ 0.8) was 56.8-59.7% for rtCGM users and 36.3-37.6% for isCGM users. Overall, regardless of diabetes type, the odds of adherence were over two times higher for rtCGM users compared to isCGM users. For those with available A1C information (T1D n = 213; T2D-IIT n = 346), independent of CGM type, adherence to CGM was associated with a greater reduction in A1C and more people reaching A1C targets of < 7.0% or < 8.0%. For people with T1D or T2D-IIT, higher adherence to CGM is associated with greater reductions in A1C, and higher adherence rates were observed with rtCGM systems than with isCGM systems.

Usability of OMOP Common Data Model for Detailed Lab Microbiology Results.

Anti-microbial resistance surveillance systems in Europe are limited by the inability to link laboratory data and patient data. The OMOP Common Data Model (OMOP CDM) is an option to store and use patient data in an international context supporting observational research. Detailed medical microbiology laboratory data are usually not stored in OMOP CDM. We propose here a solution to deal with the inherent complexity of microbiology data and store those in the OMOP CDM v5.4. We demonstrate the feasibility of our approach by capturing data from a microbiology in vitro diagnostic middleware, modeling in OMOP CDM 5.4 and querying for visualization.

Incidence of Cancer Among Adults With Thrombocytosis in Ontario, Canada

Individuals with newly diagnosed cancer often have a high platelet count (thrombocytosis). Whether thrombocytosis is associated with the presence of an undiagnosed cancer remains unknown. To assess whether a new diagnosis of thrombocytosis is associated with a subsequent risk of cancer among adults. This population-based retrospective cohort study was conducted using linked laboratory data from Ontario, Canada, from January 1, 2007, to December 31, 2017, with follow-up until December 31, 2018. The study cohort included adults aged 40 to 75 years on the date of a routine complete blood count (CBC) test (index test) who had a normal platelet count in the 2 previous years and no history of cancer. Data analysis was performed in December 2020. Exposed individuals were those with a platelet count greater than 450 × 109/L. Matched unexposed control individuals had a platelet count within the reference range (150 × 109/L to 450 × 109/L) reported within 30 days of the exposure. Incident cancers within 5 years after diagnosis of thrombocytosis. Absolute and relative risks for cancer associated with thrombocytosis were estimated for all cancers and for cancers at specific sites. Of the 3 386 716 Ontario residents with a recorded routine CBC test result, 53 339 (1.6%) had thrombocytosis and a prior normal platelet count. Among individuals with thrombocytosis, the median age was 59.7 years (interquartile range, 50.2-67.4 years) and 37 349 (70.0%) were women. Among the 51 624 individuals with thrombocytosis included in the matched analysis, 2844 (5.5%) had received a diagnosis of a solid cancer in the 2-year follow-up period and 3869 (7.5%) had received a diagnosis within 5 years. The relative risk (RR) for developing any solid cancer within 2 years was 2.67 (95% CI, 2.56-2.79). Associations were found between thrombocytosis and cancers of the ovary (RR, 7.11; 95% CI, 5.59-9.03), stomach (RR, 5.53; 95% CI, 4.12-7.41), colon (RR, 5.41; 95% CI, 4.80-6.10), lung (RR, 4.41; 95% CI, 4.02-4.85), kidney (RR, 3.64; 95% CI, 2.94-4.51), and esophagus (RR, 3.64; 95% CI, 2.46-5.40). In this cohort study, an increased platelet count was associated with an increased risk of cancer for at least 2 years. The results suggest that individuals with unexplained thrombocytosis should be offered screening for several cancers.

Island medicine: using data linkage to establish the kidney health of the population of Tasmania, Australia.

ObjectiveTo report (using linked laboratory data) the incidence, prevalence and geographic variation of chronic kidney disease (CKD) across the whole island population of Tasmania, Australia.MethodsA retrospective cohort study (the Tasmanian Chronic Kidney Disease study (CKD.TASlink)) using linked data from five health and two pathology datasets from the island state of Tasmania, Australia between 1/1/2004 and 31/12/2017. We used data on 460,737 Tasmanian adults (aged 18 years and older, representing 86.8% of the state’s population) who had a serum creatinine measured during the study period. We defined CKD as per Kidney Disease Outcomes Quality Initiative, requiring two measures of estimated glomerular filtration rate (eGFR) <60 mL/min/1.73m2, at least three months apart. Kidney replacement therapy (KRT) included dialysis or kidney transplantation.ResultsWe identified 56,438 Tasmanians with CKD during the study period, equating to an age-standardised annual incidence of 1.0% and a prevalence of 6.5%. These figures were higher in women, older Tasmanians and people living in the North-West region of Tasmania. Testing for urinary albumin:creatinine ratio is increasing, with 28.5% of women and 30.8% of men with stage 3 CKD having both an eGFR and uACR in 2017. Use of KRT was consistently seen in >65% of Tasmanians with eGFR <15 mL/min/1.73m2.ConclusionThere is geographic and gender variation in the incidence and prevalence of CKD, but it is reassuring to see that the majority of people with end-stage kidney failure are actually receiving treatment with dialysis or transplantation.

The Lines That Held Us: Assessing Racial and Socioeconomic Disparities in SARS-CoV-2 Testing.

Racial disparities in SARS-CoV-2 prevalence are apparent. Race is a sociocultural construct, necessitating investigation into how sociocultural factors contribute. This cross-sectional study linked laboratory data of adult patients between February 29 and May 15, 2020 with socio-demographics variables from the 2018 American Community Survey (ACS). Medical sites included healthcare organizations in Michigan, New York, North Carolina, California, Florida, Pennsylvania, and Washington. Race was treated as a proxy for racism and not biological essentialism. Laboratory data included patient age, sex, race, ethnicity, test result, test location, and residential ZIP code. ACS data included economic and educational variables contributing to an SES Index, population density, proportion Medicaid, and racial composition for corresponding ZIP code. Associations between race/socioeconomic variables and test results were examined using odds ratios (OR). Of 126 452 patients [mean (SD) age 51.9 (18.4) years; 52 747 (41.7%) men; 68 856 (54.5%) White and 27 805 (22.0%) Black], 18 905 (15.0%) tested positive. Of positive tests, 5238 (SD 27.7%) were White and 7223 (SD 38.2%) were Black. Black race increased the odds of a positive test; this finding was consistent across sites [OR 2.11 (95% CI 1.95-2.29)]. When subset by race, higher SES increased the odds of a positive test for White patients [OR 1.10 (95% CI 1.05-1.16)] but decreased the odds for Black patients [OR 0.92 (95% CI 0.86-0.99)]. Black patients, but not White patients, who tested positive overwhelmingly resided in more densely populated areas. Black race was associated with SARS-CoV-2 positivity and the relationship between SES and test positivity differed by race, suggesting the impact of socioeconomic status on test positivity is race-specific.

Costs Associated with Nontuberculous Mycobacteria Infection, Ontario, Canada, 2001–2012

To determine incidence-based healthcare costs attributable to nontuberculous mycobacterial (NTM) pulmonary disease (PD) and NTM pulmonary isolation (PI), from the healthcare payer perspective, we conducted a population-based matched cohort study in Ontario, Canada. We established cohorts of patients with incident NTM-PD and NTM-PI during 2001–2012 by using individually linked laboratory data and health administrative data, matched to unexposed persons from the general population. To estimate attributable costs for acute and long-term illness, we used a phase-of-care approach. Costs were stratified by age, sex, and healthcare resource, and reported in 2018 Canadian dollars (CAD) and US dollars (USD), standardized to 10 days. Costs were highest during the before-death phase (NTM-PD CAD $1,352 [USD $1,044]; NTM-PI CAD $731 [USD $565]). The cumulative mean attributable 1-year costs were CAD $14,953 (USD $11,541) for NTM-PD and CAD $8,729 (USD $6,737) for NTM-PI. Costs for patients with NTM-PD and NTM-PI were higher than those for unexposed persons.

2172. True Positivity of Common Blood Culture Contaminants among Pediatric Hospitalizations in the United States, 2009–2016

BackgroundDistinguishing blood culture (BC) results between common contaminants (CC) and truly pathogenic organisms can be challenging, especially among pediatric patients, but is important for effective clinical care. However, no recent studies have analyzed the true positivity of common BC contaminants in pediatric patients using linked laboratory data from a large national sample of United States hospitals.MethodsWe conducted a retrospective cohort study among patients ages < 19 using the Premier Healthcare Database (2009–2016), limiting to hospitals reporting ≥ 4 years of BC data and encounters with one of the five most frequent CC among laboratory-confirmed BC. True positivity was defined for each CC as a second positive BC within 48 hours among all BCs. A multivariable logistic regression model including all variables significant in univariate analyses was created comparing encounters: (1) with and without a second BC; and (2) second BC positive vs. negative, with corresponding adjusted odds ratios (aOR) and 95% confidence intervals (CI) reported.ResultsA total of 5056 isolates corresponding to 4915 encounters with a CC were included in this analysis; 3075 (61%) isolates had a second BC within 48 hours. Adjusted odds of a second BC were higher for encounters from urban (aOR: 1.73, 95% CI: 1.31, 2.29) and ≥ 500 bed hospitals (aOR 1.40, 95% CI: 1.20,1.63). True positivity was 20.2% for coagulase-negative staphylococci (CoNS), 5.9% for Bacillus spp., 5.2% for Viridans group streptococci, 5.0% for Diphtheroids spp., and 3.1% for Micrococcus spp. True positivity for CoNS was higher among neonates but all other organisms were higher for non-neonates (figure). Adjusted odds of true positivity were higher for encounters with chronic conditions (OR 1.44, 95% CI: 1.13, 1.82), a central line in place (OR: 1.65, 95% CI: 1.30, 2.10), per length of stay day (OR: 1.01 (1.01, 1.01), and with an intensive care unit admission (OR: 1.39, 95% CI: 1.08, 1.77).ConclusionTrue positivity varied substantially by organism, and in most cases was higher among non-neonates. Regional variations for conducting a second BC within 48 hours were found, and more seriously ill patient encounters were more likely to have a common contaminant be pathogenic. Disclosures All authors: No reported disclosures.

Generalizability of the FOURIER trial to routine clinical care: Do trial participants represent patients in everyday practice?

In the FOURIER trial, evolocumab, a proprotein convertase subtilisin-kexin type 9 inhibitor, reduced cardiovascular events in patients with atherosclerotic cardiovascular disease (ASCVD). We aimed to examine how closely patients in routine practice resemble the FOURIER trial participants and to assess the observed cardiovascular risks based on trial eligibility and underrepresentativeness. Using a large US administrative database with linked laboratory data, we identified adult patients with ASCVD between January 1, 2012, and December 31, 2016. We identified the excluded and underrepresented populations and examined the risk of cardiovascular events (a composite endpoint of myocardial infarction [MI], stroke, angina, and coronary revascularization) based on trial eligibility and underrepresentativeness. Only 15.2% of 233,977 patients met the FOURIER eligibility. Nearly 60% of the ineligible patients met at least 2 exclusion criteria. Among trial-eligible patients, elderly patients, women, minorities, and those without prior MI were underrepresented in FOURIER. Patients who would have been excluded from FOURIER had a diverse risk profile but, on average, had a lower cardiovascular risk than those who would have qualified (hazard ratio [HR] 0.84 [0.81-0.88], P < .001). Among the underrepresented patients, women and patients without prior MI had a lower cardiovascular risk (HR 0.77 [0.71-0.82], P < .001; HR 0.67 [0.63-0.72], P < .001, respectively). Only 47.2% of patients were on moderate-/high-intensity statins. One in 7 ASCVD patients in practice would have qualified for FOURIER. The excluded and underrepresented populations were at a particularly low or high cardiovascular risk. Statin therapy was underused, and physicians may need to evaluate adherence before adding a proprotein convertase subtilisin-kexin type 9 inhibitor.

Growth responses to elevated temperatures and the importance of ontogenetic niche shifts in Bromeliaceae.

Epiphytic bromeliads represent a major component of Neotropical forests, but the potential effect of climate change on these plants is unclear. We investigated whether and how bromeliads are affected by the predicted 3°C temperature rise by the end of the century. We conducted growth experiments with 17 epiphytic bromeliad species at different temperatures to determine their fundamental thermal niches. By comparing those with niches for germination, we tested whether ontogenetic niche shift or niche contraction occurs in Bromeliaceae. Applying a classical growth analysis, we assessed the relative importance of the underlying growth components on interspecific variations in growth. Members of two bromeliad subfamilies differed in their response to elevated temperatures: Tillandsioideae may be negatively affected, whereas Bromelioideae moved closer to their thermal optimum. Across different ontogenetic stages, thermal niche characteristics revealed both niche shift and niche contraction. Interspecific variation in growth was driven almost exclusively by net assimilation rate at all temperatures. We conclude that the vulnerability of tropical plants to a future increase in temperature may be more variable than suggested by previous studies. We emphasize the importance of assessing niche breadth over multiple life stages and the need for better microclimatic data to link laboratory data with field conditions.

Trends in admissions for acute respiratory infections in children: an inter-country comparison between Western Australia and England

ABSTRACTObjectiveAcute respiratory infections (ARI) including bronchiolitis, pneumonia and influenza are a major cause of hospital admissions in children worldwide. Linkage of administrative health datasets provides a platform to investigate temporal and seasonal trends in large populations over many years. We examined the similarities and differences in ARI admissions using linked datasets in Western Australia and England. ApproachThrough the availability of common data items in each jurisdiction, identical coding and data cleaning principles were applied to both datasets. Hospital admissions for ARI in children aged &lt;5 years between 2000 and 2012 were identified using International Classification of Diseases diagnosis codes. Admission rates per 1000 child-years by age, gender and admission year were calculated in each jurisdiction. A total population birth cohort was available in Western Australia and the denominator was person time at risk whereas for England, all hospitalisations were used with the mid-year population as the denominator. ResultsThe overall incidence of ARI was 18.3/1000 child-years in Western Australia and 14.4/1000 in England. In both countries, the highest incidence of ARI was observed in infants (47.9/1000 child-years in Western Australia and 42.1/1000 child-years in England). Bronchiolitis was the most common primary diagnosis in infants in both countries, accounting for 79.7% of ARI admissions in Western Australia and 78.3% in England. The most common primary diagnosis in 1-4 year olds was unspecified lower respiratory tract infections in England (48.8% of ARI admissions in this age group) and pneumonia in Western Australia (43.9% of ARI admissions in 1-4-year-olds). The annual incidence rate for ARI hospitalisations declined in Western Australia from 2000 to 2006 and since remained steady. ARI admission rates increased in England throughout the study period. Admission rates across all age groups were 1.1-1.5 times higher in boys than girls in both countries. ConclusionThe availability of similar datasets in two economically similar countries in different hemispheres has afforded the opportunity to characterise and compare the epidemiology of paediatric respiratory infections over a 13 year period. Future analyses will allow us to assess differences in coding practices, seasonality and risk factors such as socio-economic deprivation and prematurity. Furthermore the availability of linked laboratory data for respiratory pathogens in each jurisdiction will allow for comparisons of pathogen-specific epidemiology and the impact of universal vaccination programs.

Clinical characteristics, healthcare costs, and resource utilization in hepatitis C vary by genotype

Background: In the United States, approximately 3 million people are infected with hepatitis C virus (HCV). Genotypes of HCV variably affect disease progression and treatment response. However, the relationships between HCV genotypes and liver disease progression, healthcare resource utilization, and healthcare costs have not been fully explored.Research design and methods: In this retrospective study of patients with chronic hepatitis C (CHC), healthcare claims from a large US health plan were used to collect data on patient demographic and clinical characteristics.Main outcome measures: Main outcome measures include healthcare resource utilization (HCRU) and healthcare costs. Linked laboratory data provided genotype and select measures to determine liver disease severity.Results: The sample (mean age 50.6 years, 63.5% male) included 10,331 patients, of whom 79.1% had genotype (GT)1, 12.8% had GT2, and 8.1% had GT3. Descriptive analyses demonstrated variation by HCV genotype in liver and non-liver related comorbidities, liver disease severity, and healthcare costs. The highest percentage of patients with liver-related comorbidities and advanced liver disease was found among those with GT3. Meanwhile, patients with GT2 had lower HCRU and the lowest costs, and patients with GT1 had the highest total all-cause costs. These differences may reflect differing rates of non-liver-related comorbidities and all-cause care. Multivariable analyses showed that genotype was a significant predictor of costs and liver disease severity: compared with patients having GT1, those with GT3 were significantly more likely to have advanced liver disease. Patients with GT2 were significantly less likely to have advanced disease and more likely to have lower all-cause costs.Limitations: Results may not be generalizable to patients outside the represented commercial insurance plans, and analysis of a prevalent population may underestimate HCRU and costs relative to a sample of treated patients.Conclusions: These results suggest that liver disease progression varies by genotype and that CHC patients with GT3 appear to have more severe liver disease. These findings highlight the importance of effective HCV treatment for all patients and support guidelines for treatment of high-risk patients, including those with GT3.

Using Client's Routine Urinalysis Records From Multiple Treatment Systems to Model Five-Year Opioid Substitution Treatment Outcomes

ABSTRACT Background: At global, national, and local level, the need for ongoing, timely and cost efficient, comprehensive drug treatment monitoring, and evaluation systems have clearly been well recognized. Objectives: To test the feasibility of linking laboratory data and client intake data and its usefulness for modeling retrospectively, for the first time, 5-year longitudinal drug treatment outcomes in an Irish opiate treatment setting. Methods: A multisite, retrospective, longitudinal cohort study was implemented to evaluate outcomes for opiate users based on 1.7 million routine urinalysis results collected from 4,518 individuals presenting for opioid substitution treatment in Ireland from January 2006 to December 2010. Results: Analysis of opiates, cocaine, benzodiazepine, and cannabis use at treatment intake, 6 months and at 1–5 year follow-ups revealed differences in urinalysis protocols; significant differences in age of first drug use between those using and not using opiates at 5 years; significant decreases in opiate use; increases in benzodiazepine use and significant increasing effects of concurrent cocaine and benzodiazepine use on the odds of using opiates. Time series analysis of weekly proportions opiate positive predicted 16% (95% confidence interval: 7%–25%) of clients would be opiate positive 5 years postinitial intake. ConclusionsImportance: Underutilized urinalysis data can be used to address the need for cost effective, efficient evidence of drug-treatment outcomes across time, place, and systems. Linking and matching the cross-sectional data across sites and times also revealed where improvements in electronic records could be made.

Linkage of Laboratory Results to Medicare Fee-for-Service Claims.

Medicare is the single largest purchaser of laboratory testing in the United States, yet test results associated with Medicare laboratory claims have historically not been available. The purpose of this study was to describe both the linkage of laboratory results data to Medicare claims and the completeness of these results data. In a subgroup of beneficiaries initiating angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, we also demonstrate the generalizability of Medicare beneficiaries with laboratory values compared with those without laboratory values. We end with a discussion of the limitations and potential uses of these linked data. We obtained information about laboratory orders and results for all Medicare fee-for-service beneficiaries in 10 eastern states who had outpatient laboratory tests conducted by a large national laboratory services vendor in 2011. Using a combination of direct identifiers and patient demographic characteristics, we linked patients in these laboratory data to Medicare beneficiaries, enabling us to associate test results with existing claims. Nearly all patients in the laboratory data were able to be linked to Medicare beneficiaries. There were over 2 million distinct beneficiaries with nearly 125 million specific test results in the laboratory data. For specific tests ordered in an outpatient or office setting in these 10 states, between 5% and 15% of them had linked laboratory data. Medicare beneficiaries initiating angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers who had laboratory results data had similar patient characteristics to those without results data. This novel linkage of laboratory results data to Medicare claims creates unprecedented opportunities for conducting comparative effectiveness research related to patient safety and quality.

Analysis of Potential Drug‐Drug Interactions in Medical Intensive Care Unit Patients

To describe the frequency and type of potential drug-drug interactions (pDDIs) in a general intensive care unit (ICU) and to make recommendations to improve the management of these pDDIs. Retrospective observational study. General ICU of a tertiary care hospital. All patients admitted for more than 24hours between May 2009 and December 2010 who were prescribed at least one medication. Based on the G-Standaard, the Dutch national drug database, pDDIs were identified and classified into categories of potential clinical outcome and management advice. In total, 35,784 medication episodes were identified, resulting in 2887 pDDIs (8.1%). These 2887 pDDIs occurred in 1659 patients for a mean frequency of 1.7 (95% confidence interval [CI] 1.6-1.9) pDDIs per patient. Overall, 54% of the patients experienced at least one pDDI with pDDIs present during 27% of all ICU admission days. All pDDIs could be reconstructed using 81 of the 358 (23%) relevant unique pDDI pairs described in the G-Standaard. The most frequently occurring potential clinical consequence was an increased risk of side effects or toxicity (91% of the pDDIs) such as electrolyte disturbances and masking of hypoglycemia. The most important advised management strategy was monitoring (81%), consisting of monitoring of laboratory values (52%), clinical monitoring of toxicity or effectiveness (48%), or monitoring of physical parameters such as electrocardiogram and blood pressure (11%). Potential drug-drug interactions occur in 54% of all ICU patients, which is two times more than the rate seen in patients on general wards. A limited set of 20 pDDI pairs is responsible for more than 90% of all pDDIs. Therefore, it is worthwhile to develop guidelines for the management of these specific pDDIs. As the vast majority of the interactions can be managed by monitoring, advanced clinical decision support systems linking laboratory data to prescription data may be an effective risk management strategy.

Identifying geographical regions serviced by hospitals to assess laboratory-based outcomes

ObjectiveTo define geographical regions (forward sortation areas; FSAs) in Southwestern Ontario, Canada from which patients would reliably present to a hospital with linked laboratory data if they developed adverse events...

Linking laboratory data with pilot scale entrained flow coal gasification performance. Part 1: Laboratory characterisation

Pilot scale measurements play an important role in our understanding of the coal gasification process. To gain the most practical benefits from such testing it is important to have a good understanding of the fundamental processes that influence coal behaviour under industrial conditions. In this paper, a suite of Australian coals was characterised in detail at the laboratory scale and preliminary assessments made of their likely performance under practical entrained flow conditions. The same coals were then tested using a 5 MW th pilot-scale entrained flow gasifier in Part 2. The resulting gasification dataset for a suite of coals at both laboratory and pilot scale provides a unique opportunity to quantify the links between laboratory gasification measurements and coal gasification behaviour under realistic conditions. This paper presents a characterisation of four Australian thermal coals in terms of their slag formation and flow behaviour, coal devolatilisation and reactivity properties, and their gasification conversion behaviour. This work provides the basis for a relative assessment of their potential for use in entrained flow gasification, and identifies possible performance issues which may need consideration for use in larger-scale gasification systems. The second paper discusses the pilot-scale gasification behaviour of these coals, and relates those data with those presented here.

Linking laboratory data with pilot scale entrained flow coal gasification performance. Part 2: Pilot scale testing

By exploring the links between laboratory-scale gasification data (e.g. slag viscosity measurements, char reactivity considerations) and the performance of the same coals under realistic pilot-scale conditions, we are provided with a dataset that allow us to refine coal test procedures for entrained flow gasification, understand the entrained flow gasification process in significantly more detail than previously, and gain some new insight into how coal reactivity and slag viscosity properties interact to define operating envelopes for specific gasification technologies. The first paper in this two-part series presented a detailed characterisation of a suite of Australian coals using laboratory-scale gasification facilities. This paper presents gasification data obtained from pilot-scale testing of these same coals, and explores the links between laboratory data, coal assessments made using these data, and the performance of the coals under realistic conditions. The results demonstrate a high degree of consistency between laboratory indications of coal reactivity and coal gasification behaviour at pilot scale. This work also demonstrates the impact of interactions between coal conversion properties and slag formation and flow behaviour, and how these interactions dictate operational parameters for the gasifier.

Challenges and Benefits of Adding Laboratory Data to a Mortality Risk Adjustment Method

There is increased interest in improving the clinical acceptance and statistical performance of hospital mortality rate comparisons. This study assessed the feasibility of linking separate electronic feeds of laboratory data and claims-based information and, if successful, to identify laboratory data elements that significantly improved mortality rate predictions for All-Patient Refined Diagnosis Related Groups (APRDRGs), a risk of mortality (ROM) classification tool in regular use for public reporting purposes. The Florida Agency for Health Care Administration recruited 15 hospitals to supply computerized administrative and laboratory information that could be linked at the patient level. The hospitals, standardized computer code terminology, which was then merged with administrative data. We evaluated the ability of the merged data to improve APRDRG ROM predictions. We describe the procedures that the laboratory information systems used to link the electronic laboratory data with standard claims data. The addition of 11 clinical laboratory test results increased the C statistic by 0.574% and R2 by 4.53%. This study supports the feasibility of linking laboratory data elements with claims-based administrative data to enhance ROM assessments. This linkage resulted in modest statistical improvement in a commonly used ROM model.

Surveillance of extreme hyperbilirubinaemia in Denmark. A method to identify the newborn infants

To describe the incidence of infants born at term or near-term with extreme hyperbilirubinaemia. The study period was between 1 January 2002 and 31 December 2005, and included all infants born alive at term or near-term in Denmark. Medical reports on all newborn infants with a total serum bilirubin concentration (TSB) > or = 450 micromol/L were obtained by linking laboratory data to the unique Danish personal identification number. In total, 113 infants were included, that is, an incidence of 45/100,000 live births. Thirty-seven infants presented in hospital, 2 after home birth and the others after having been discharged. The maximum TSB was 485 (450-734) micromol/L (median [range]) and appeared latest amongst those infants admitted from home, but was not different from the maximum TSB of the nondischarged infants. Forty-three infants had symptoms of early-phase acute bilirubin encephalopathy; one infant had advanced-phase symptoms. Four infants received an exchange transfusion. ABO blood group incompatibility was present in 52 infants. Thirty-seven infants were of non-Caucasian descent. A method to obtain the national epidemiological data is presented. The observed incidence of extreme hyperbilirubinaemia is higher than previously reported in Denmark. This is mainly due to a very sensitive method of identifying the study group.