Backlogs and Bulges: Can Value Chains Fix the National Health Service Waiting List?

Previous solutions to the waiting list for elective care in England have been too narrowly focused, thereby shifting the problem to other parts of the care pathway

Agricultural biotechnology and the pulbic good

Biopiracy refers to the development of new biotechnologies based on genetic material and informal innovation of the southern hemisphere when it does not benefit the original owners of the genetic materials and processes. To counteract this, the notion of intellectual property rights over living materials needs broad societal review. Intellectual property laws are designed to promote innovation, but are failing to protect the control of biological products and processes. Patents are important marketing tools for biotechnology firms, but they may be stifling the free flow of information and genetic. The principle of farmers’ rights should be strengthened and implemented as a protocol to the Biodiversity Convention

FlowR: Aspect oriented programming for information flow control in ruby

This paper reports on our experience with providing Information Flow Control (IFC) as a library. Our aim was to support the use of an unmodified Platform as a Service (PaaS) cloud infrastructure by IFC-aware web applications. We discuss how Aspect Oriented Programming (AOP) overcomes the limitations of RubyTrack, our first approach. Although use of AOP has been mentioned as a possibility in past IFC literature we believe this paper to be the first illustration of how such an implementation can be attempted. We discuss how we built FlowR (Information Flow Control for Ruby), a library extending Ruby to provide IFC primitives using AOP via the Aquarium open source library. Previous attempts at providing IFC as a language extension required either modification of an interpreter or significant code rewriting. FlowR provides a strong separation between functional implementation and security constraints which supports easier development and maintenance; we illustrate with practical examples. In addition, we provide new primitives to describe IFC constraints on objects, classes and methods that, to our knowledge, are not present in related work and take full advantage of an object oriented language (OO language). The experience reported here makes us confident that the techniques we use for Ruby can be applied to provide IFC for any Object Oriented Program (OOP) whose implementation language has an AOP library.This is the final version published by ACM in Proceedings of the 13th international conference on Modularity (MODULARITY '14). ACM, New York, NY, USA, 37-48, available from the ACM Digital Library here: http://dl.acm.org/citation.cfm?doid=2577080.2577090

The impact of having a carer on adult health and social care utilisation across five settings of care: A matched cohort study

INTRODUCTION: An estimated 6.8 million people are (informal) carers in the UK. The economic value of annual carer contributions is an estimated .·132bn. Reliance on carers appears to be increasing. There is mixed evidence on whether carers are substitutes for formal care. This study investigated the association between having a carer and service use patterns across five care settings when compared to a matched cohort without a carer. MATERIALS AND METHODS: A matched case-control group analysis using person-level data in Barking and Dagenham (B&D), a London borough in the U.K., to assess the impact of having a carer in terms of the differences in cost-weighted utilisation relative to a matched control group. RESULTS: In 2016/17, for adult residents of B&D, having a carer (n = 1,295) was associated with 27% increased cost-weighted utilisation (mean difference of £2,662, CI £1,595, £3,729, p<0.001) compared to a matched cohort without a carer. 39% of the cost difference was social care. CONCLUSIONS: Findings suggest additional service use induced by carers may dominate any substitution effect. Having a carer may be a key element in enabling access to services. As such, there may be wider inequalities in service access for people without a carer. For an ageing society with projections suggesting there will be more people without carers in the future, these inequalities need to be addressed

Multiple long-term conditions within households and use of health and social care: a retrospective cohort study

Background: The daily management of long-term conditions falls primarily on individuals and informal carers, but the impact of household context on health and social care activity among people with multiple long-term conditions (MLTCs) is understudied. Aim: To test whether co-residence with a person with MLTCs (compared with a co-resident without MLTCs) is associated with utilisation and cost of primary, community, secondary health care, and formal social care. Design & setting: Linked data from health providers and local government in Barking and Dagenham for a retrospective cohort of people aged ≥50 years in two-person households in 2016–2018. Method: Two-part regression models were applied to estimate annualised use and cost of hospital, primary, community, mental health, and social care by MLTC status of individuals and co-residents, adjusted for age, sex, and deprivation. Applicability at the national level was tested using the Clinical Practice Research Datalink (CPRD). Results: Forty-eight per cent of people with MLTCs in two-person households were co-resident with another person with MLTCs. They were 1.14 (95% confidence interval [CI] = 1.00 to 1.30) times as likely to have community care activity and 1.24 (95% CI = 0.99 to 1.54) times as likely to have mental health care activity compared with those co-resident with a healthy person. They had more primary care visits (8.5 [95% CI = 8.2 to 8.8] versus 7.9 [95% CI = 7.7 to 8.2]) and higher primary care costs. Outpatient care and elective admissions did not differ. Findings in national data were similar. Conclusion: Care utilisation for people with MLTCs varies by household context. There may be potential for connecting health and community service input across household members

HAWKS: Evolving Challenging Benchmark Sets for Cluster Analysis

Comprehensive benchmarking of clustering algorithms is rendered difficult by two key factors: (i) the elusiveness of a unique mathematical definition of this unsupervised learning approach and (ii) dependencies between the generating models or clustering criteria adopted by some clustering algorithms and indices for internal cluster validation. Consequently, there is no consensus regarding the best practice for rigorous benchmarking, and whether this is possible at all outside the context of a given application. Here, we argue that synthetic datasets must continue to play an important role in the evaluation of clustering algorithms, but that this necessitates constructing benchmarks that appropriately cover the diverse set of properties that impact clustering algorithm performance. Through our framework, HAWKS, we demonstrate the important role evolutionary algorithms play to support flexible generation of such benchmarks, allowing simple modification and extension. We illustrate two possible uses of our framework: (i) the evolution of benchmark data consistent with a set of hand-derived properties and (ii) the generation of datasets that tease out performance differences between a given pair of algorithms. Our work has implications for the design of clustering benchmarks that sufficiently challenge a broad range of algorithms, and for furthering insight into the strengths and weaknesses of specific approaches

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

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

Inhibition of neutral cholesteryl ester hydrolase by a naturally occurring cytosolic protein in macrophages

AbstractThe soluble fraction from a number of macrophage cell lines has been shown to contain a protein(s) that inhibits neutral cholesteryl ester hydrolase. The inhibition is dependent on the concentration of soluble protein used, and the efficiency of the inhibitor can be influenced by the inclusion of oleate and an inhibitor of ACAT. It is suggested that the presence of this material indicates that the macrophage contains a means of negatively controlling the activity of the hydrolytic phase of the cholesterol/cholesteryl ester cycle

Bayesian inference of a new Mallows model for characterising symptom sequences applied in primary progressive aphasia

Machine learning models offer the potential to understand diverse datasets in a data-driven way, powering insights into individual disease experiences and ensuring equitable healthcare. In this study, we explore Bayesian inference for characterising symptom sequences, and the associated modelling challenges. We adapted the Mallows model to account for partial rankings and right-censored data, employing custom MCMC fitting. Our evaluation, encompassing synthetic data and a primary progressive aphasia dataset, highlights the model's efficacy in revealing mean orderings and estimating ranking variance. This holds the potential to enhance clinical comprehension of symptom occurrence. However, our work encounters limitations concerning model scalability and small dataset sizes.Comment: Extended Abstract presented at Machine Learning for Health (ML4H) symposium 2023, December 10th, 2023, New Orleans, United States, 8 page