Healthcare, as with other sectors, has undergone progressive digitalization, generating an ever-increasing wealth of data that enables research and the analysis of patient movement. This can help to ...evaluate treatment processes and outcomes, and in turn improve the quality of care. This scoping review provides an overview of the algorithms and methods that have been used to identify care pathways from healthcare utilization data.
This review was conducted according to the methodology of the Joanna Briggs Institute and the Preferred Reporting Items for Systematic Reviews Extension for Scoping Reviews (PRISMA-ScR) Checklist. The PubMed, Web of Science, Scopus, and EconLit databases were searched and studies published in English between 2000 and 2021 considered. The search strategy used keywords divided into three categories: the method of data analysis, the requirement profile for the data, and the intended presentation of results. Criteria for inclusion were that health data were analyzed, the methodology used was described and that the chronology of care events was considered. In a two-stage review process, records were reviewed by two researchers independently for inclusion. Results were synthesized narratively.
The literature search yielded 2,865 entries; 51 studies met the inclusion criteria. Health data from different countries (Formula: see text) and of different types of disease (Formula: see text) were analyzed with respect to different care events. Applied methods can be divided into those identifying subsequences of care and those describing full care trajectories. Variants of pattern mining or Markov models were mostly used to extract subsequences, with clustering often applied to find care trajectories. Statistical algorithms such as rule mining, probability-based machine learning algorithms or a combination of methods were also applied. Clustering methods were sometimes used for data preparation or result compression. Further characteristics of the included studies are presented.
Various data mining methods are already being applied to gain insight from health data. The great heterogeneity of the methods used shows the need for a scoping review. We performed a narrative review and found that clustering methods currently dominate the literature for identifying complete care trajectories, while variants of pattern mining dominate for identifying subsequences of limited length.
In contrast to summer smog, the contribution of photochemistry to the formation of winter haze in northern mid-to-high latitude is generally assumed to be minor due to reduced solar UV and water ...vapor concentrations. Our comprehensive observations of atmospheric radicals and relevant parameters during several haze events in winter 2016 Beijing, however, reveal surprisingly high hydroxyl radical oxidation rates up to 15 ppbv/h, which is comparable to the high values reported in summer photochemical smog and is two to three times larger than those determined in previous observations during winter in Birmingham (Heard et al. Geophys. Res. Lett. 2004, 31, (18)), Tokyo (Kanaya et al. J. Geophys. Res.: Atmos. 2007, 112, (D21)), and New York (Ren et al. Atmos. Environ. 2006, 40, 252–263). The active photochemistry facilitates the production of secondary pollutants. It is mainly initiated by the photolysis of nitrous acid and ozonolysis of olefins and maintained by an extremely efficiently radical cycling process driven by nitric oxide. This boosted radical recycling generates fast photochemical ozone production rates that are again comparable to those during summer photochemical smog. The formation of ozone, however, is currently masked by its efficient chemical removal by nitrogen oxides contributing to the high level of wintertime particles. The future emission regulations, such as the reduction of nitrogen oxide emissions, therefore are facing the challenge of reducing haze and avoiding an increase in ozone pollution at the same time. Efficient control strategies to mitigate winter haze in Beijing may require measures similar as implemented to avoid photochemical smog in summer.
The oxidation of carbonyl sulfide (OCS) is the primary, continuous source of stratospheric sulfate aerosol particles, which can scatter shortwave radiation and catalyze heterogeneous reactions in the ...stratosphere. While it has been estimated that the oxidation of dimethyl sulfide (DMS), emitted from the surface ocean accounts for 8%–20% of the global OCS source, there is no existing DMS oxidation mechanism relevant to the marine atmosphere that is consistent with an OCS source of this magnitude. We describe new laboratory measurements and theoretical analyses of DMS oxidation that provide a mechanistic description for OCS production from hydroperoxymethyl thioformate, a ubiquitous, soluble DMS oxidation product. We incorporate this chemical mechanism into a global chemical transport model, showing that OCS production from DMS is a factor of 3 smaller than current estimates, displays a maximum in the tropics consistent with field observations and is sensitive to multiphase cloud chemistry.
Plain Language Summary
Accurate estimates of marine carbonyl sulfide (OCS) sources are critical for both modeling stratospheric aerosol concentrations, as OCS is an important precursor to stratospheric sulphate aerosol particles, and for estimating gross primary production, as OCS is readily consumed by the terrestrial biosphere. Despite the importance of OCS to both stratospheric aerosol chemistry and as an effective proxy for CO2 plant uptake, considerable uncertainty remains in the sources and sinks of OCS. A large source of this uncertainty arises in the marine sources, dominated by the oxidation of marine sulfur gases. Here, we examine the global production of OCS from the oxidation of a marine biologically produced molecule, dimethyl sulfide (DMS). We show that the multi‐generational production of OCS proceeds through the oxidation of stable, water‐soluble intermediates. Using a global chemical transport model, we find that OCS production is largest in the tropics, where cloud loss of hydroperoxymethyl thioformate, the primary precursor to OCS in the DMS oxidation mechanism, is at a minimum.
Key Points
Carbonyl sulfide (OCS) is formed in the OH‐oxidation of dimethyl sulfide (DMS) under conditions relevant to the marine boundary layer
The multi‐generational OCS production proceeds through soluble, stable intermediates making it sensitive to multiphase, cloud chemistry
Implementing a new DMS oxidation mechanism in a global chemical transport model yields a more robust depiction of DMS‐derived OCS production
Although health inequalities in adolescence are well documented, the underlying mechanisms remain unclear. Few studies have examined the role of the family in explaining the association between the ...family's socioeconomic position and adolescents' self-rated health. The current study aimed to explore whether the association between socioeconomic position and self-rated health was mediated by familial determinants.
Using data from wave 2 of the"German Health Interview and Examination Survey for Children and Adolescents" (KiGGS) (1,838 female and 1,718 male 11- to 17-year-olds), linear regression analyses were conducted to decompose the total effects of income, education, occupational status, socioeconomic position index and adolescents' subjective social status on self-rated health into direct effects and indirect effects through familial determinants (family cohesion, parental well-being, parental stress, parenting styles, parental obesity, smoking and sporting activity).
A significant total effect of all socioeconomic position indicators on self-rated health was found, except for income in male adolescents. In female adolescents, more than 70% of the total effects of each socioeconomic position indicator were explained by familial mediators, whereas no significant direct effects remained. The most important mediator was parental well-being, followed by family cohesion, parental smoking and sporting activity. In male adolescents, the associations between income, parental education, the socioeconomic position index and subjective social status were also mediated by familial determinants (family cohesion, parental smoking, obesity and living in a single-mother family). However, a significant direct effect of subjective social status remained.
The analysis revealed how a family's position of socioeconomic disadvantage can lead to poorer health in adolescents through different family practices. The family appears to play an important role in explaining health inequalities, particularly in female adolescents. Reducing health inequalities in adolescence requires policy interventions (macro-level), community-based strategies (meso-level) and programs to improve parenting and family functioning (micro-level).
Despite the recent decrease in pollution events in Chinese urban areas, the World Health Organization air quality guideline values are still exceeded. Observations from monitoring networks show a ...stronger decrease of organic aerosol directly emitted to the atmosphere relative to secondary organic aerosol (SOA) generated from oxidation processes. Here, the uptake of water‐soluble gas‐phase oxidation products is reported as a major SOA contribution to particulate pollution in Beijing, triggered by the increase of aerosol liquid water. In pollution episodes, this pathway is enough to explain the increase in SOA mass, with formaldehyde, acetaldehyde, glycolaldehyde, formic acid, and acetic acid alone explaining 15%–25% of the SOA increase. Future mitigation strategies to reduce non‐methane volatile organic compound emissions should be considered to reduce organic particulate pollution in China.
Plain Language Summary
In the rapidly developing Chinese economy, air pollution from particulate matter (PM) is a major human health risk factor. We show that secondary organic aerosol (SOA) generated from oxidation processes represent 50%–80% of the organic PM in Beijing. We find that non‐equilibrium dissolution of C1−C2 carbonyl compounds to particles is a major pathway of SOA formation during pollution events. These compounds are ubiquitous products in the chemical oxidation of hydrocarbons; thus, the reduction of a single volatile organic compound precursor would not reduce the organic PM, but rather a broad reduction of the organic reactivity is required.
Key Points
Secondary organic aerosol generated from oxidation processes dominates organic particulate pollution in Beijing
Non‐equilibrium dissolution of carbonyl compounds to particles is a major pathway of SOA formation during haze episodes
A broad reduction of the gas‐phase organic reactivity is required to reduce secondary organic aerosol formation in haze events
The time evolution and the asymptotic outcome of a Landau-Zener-Stueckelberg-Majorana (LZ) process under continuous weak non-selective measurement is analyzed. We compare two measurement protocols in ...which the populations of either the adiabatic or the non-adiabatic levels are (continuously and weakly) monitored. The weak measurement formalism, described using a Gaussian Kraus operator, leads to a time evolution characterized by a Markovian dephasing process, which, in the non-adiabatic measurement protocol is similar to earlier studies of LZ dynamics in a dephasing environment. Casting the problem in the language of measurement theory makes it possible for us to compare diabatic and adiabatic measurement scenarios, to consider engineered dephasing as a control device and to examine the manifestation of the Zeno effect under the different measurement protocols. In particular, under measurement of the non-adiabatic populations, the Zeno effect is manifested not as a freezing of the measured system in its initial state, but rather as an approach to equal asymptotic populations of the two diabatic states. This behavior can be traced to the way by which the weak measurement formalism behaves in the strong measurement limit, with a built-in relationship between measurement time and strength.
IntroductionChildhood and adolescence are crucial life stages for health trajectories and the development of health inequalities in later life. The relevance of schools for health and well-being of ...children and adolescents has long been recognised, and there is some research regarding the association of contextual and compositional characteristics of schools and classes with health, health behaviour and well-being in this population. Little is known about the role of meso-level characteristics in relation to health inequalities. The aim of this scoping review is to retrieve and synthesise evidence about the mediating or moderating role of compositional or contextual characteristics of schools for the association between students’ socioeconomic position and health in primary and secondary education.Methods and analysisWe will conduct a systematic search of electronic databases in PubMed/Medline, Web of Science and Education Resources Information Center. Studies must meet the following inclusion criteria: (1) The population must be students attending primary or secondary schools in developed economies. (2) The outcomes must include at least one indicator for individual health, health behaviour or well-being. (3) The study must include at least one contextual or compositional characteristic of the school context and one individual determinant of socioeconomic position. (4) The study must also examine the mediating or moderating role of the contextual or compositional characteristic of the school context for the associations between socioeconomic position and health, health behaviour or well-being. (5) The study must be published since 1 January 2000 in English or German language. We will provide a narrative synthesis of findings.Ethics and disseminationWe will not collect primary data and only include secondary data derived from previously published studies. Therefore, ethical approval is not required. We intend to publish our findings in an international peer-reviewed journal and to present them at national and international conferences.
IntroductionAlthough the impact of macrolevel characteristics of health systems on socioeconomic inequity in health has been studied extensively, the impact of access characteristics on a smaller ...scale of health systems has received less attention. These mesolevel characteristics can influence access to healthcare and might have the potential to moderate or aggravate socioeconomic inequity in healthcare use. This scoping review aims to map the existing evidence of the association of socioeconomic inequity in healthcare use and mesolevel access characteristics of the health system.Methods and analysisIn conducting the scoping review, we follow the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols Extension for Scoping Reviews. The search will be carried out in four scientific databases: MEDLINE (via PubMed), Web of Science, Scopus and PsycINFO. Main eligibility criteria are inclusion in the analysis of a measure of socioeconomic position, a measure of individual healthcare use and a mesolevel determinant of access to healthcare services. The selection process consists of two consecutive screening stages (first: title/abstract; second: full text). At both stages, two reviewers independently assess the eligibility of studies. In case of disagreement, a third reviewer will be involved. Cohen’s kappa will be calculated to report inter-rater agreement between reviewers. Results are synthesised narratively, as a high heterogeneity of studies is expected.Ethics and disseminationNo primary data are collected for the presented scoping review. Therefore, ethical approval is not necessary. The scoping review will be published in an international peer-reviewed journal, and findings will be presented on national and international conferences.
Besides macrolevel characteristics of a health care system, mesolevel access characteristics can exert influence on socioeconomic inequalities in healthcare use. These reflect access to healthcare, ...which is shaped on a smaller scale than the national level, by the institutions and establishments of a health system that individuals interact with on a regular basis. This scoping review maps the existing evidence about the influence of mesolevel access characteristics and socioeconomic position on healthcare use. Furthermore, it summarizes the evidence on the interaction between mesolevel access characteristics and socioeconomic inequalities in healthcare use.
We used the databases MEDLINE (PubMed), Web of Science, Scopus, and PsycINFO and followed the 'Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols extension for scoping reviews (PRISMA-ScR)' recommendations. The included quantitative studies used a measure of socioeconomic position, a mesolevel access characteristic, and a measure of individual healthcare utilisation. Studies published between 2000 and 2020 in high income countries were considered.
Of the 9501 potentially eligible manuscripts, 158 studies were included after a two-stage screening process. The included studies contained a wide spectrum of outcomes and were thus summarised to the overarching categories: use of preventive services, use of curative services, and potentially avoidable service use. Exemplary outcomes were screening uptake, physician visits and avoidable hospitalisations. Access variables included healthcare system characteristics such as physician density or distance to physician. The effects of socioeconomic position on healthcare use as well as of mesolevel access characteristics were investigated by most studies. The results show that socioeconomic and access factors play a crucial role in healthcare use. However, the interaction between socioeconomic position and mesolevel access characteristics is addressed in only few studies.
Socioeconomic position and mesolevel access characteristics are important when examining variation in healthcare use. Additionally, studies provide initial evidence that moderation effects exist between the two factors, although research on this topic is sparse. Further research is needed to investigate whether adapting access characteristics at the mesolevel can reduce socioeconomic inequity in health care use.
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