Gender and the premature deaths of people with intellectual disabilities: an international expert consultation

People with intellectual disabilities die at much younger ages than the general population, with this gap in life expectancy greater for females than males. This study aimed to seek the views of international experts concerning evidence relating to gender and the premature deaths of people with intellectual disabilities, their views on priorities for future research, and recommendations for future research and policy. Twenty international experts on the health and/or mortality of people with intellectual disabilities were invited to complete an online questionnaire. The questionnaire was based on summary statements from a literature review on gender and premature death among people with intellectual disabilities compared to the general population. Summary statements included general topics such as mortality and specific major causes of death (e.g., cancer). For each summary statement, respondents rated on 5-point scales: their agreement with the statement; the importance of the topic; and the adequacy of the evidence. Participants then indicated their top three priorities for future research, and gave recommendations for future research and policy. Eighteen (90% response rate) respondents from nine countries participated. There was consensus among respondents regarding the greater inequality in intellectual disability vs. general population mortality rates for women compared to men. Evidence was considered inadequate for most topics. Evidence on cause-specific death rates was the most frequently mentioned main research priority, followed by age trends in mortality compared to the general population. Recommendations ranged from the need to use consistent methodology and case definition in future research, to the need for governments to be called to account on the issue. Further evidence on gender and mortality is urgently needed; an international consensus on recommendations for future research pertaining to gender and the premature deaths of people with intellectual disabilities would greatly assist the development of evidence-based policy and practice. © 2020 The Authors. Journal of Policy and Practice in Intellectual Disabilities published by International Association of the Scientific Study of Intellectual and Developmental Disabilities and Wiley Periodicals LLC

Access to health care for older people with intellectual disability:a modelling study to explore the cost-effectiveness of health checks

Background: Whilst people with intellectual disability grow older, evidence has emerged internationally about the largely unmet health needs of this specific ageing population. Health checks have been implemented in some countries to address those health inequalities. Evaluations have focused on measuring process outcomes due to challenges measuring quality of life outcomes. In addition, the cost-effectiveness is currently unknown. As part of a national guideline for this population we sought to explore the likely cost-effectiveness of annual health checks in England. Methods: Decision-analytical Markov modelling was used to estimate the cost-effectiveness of a strategy, in which health checks were provided for older people with intellectual disability, when compared with standard care. The approach we took was explorative. Individual models were developed for a selected range of health conditions, which had an expected high economic impact and for which sufficient evidence was available for the modelling. In each of the models, hypothetical cohorts were followed from 40 yrs. of age until death. The outcome measure was cost per quality-adjusted life-year (QALY) gained. Incremental cost-effectiveness ratios (ICER) were calculated. Costs were assessed from a health provider perspective and expressed in 2016 GBP. Costs and QALYs were discounted at 3.5%. We carried out probabilistic sensitivity analysis. Data from published studies as well as expert opinion informed parameters. Results: Health checks led to a mean QALY gain of 0.074 (95% CI 0.072 to 0.119); and mean incremental costs of £4787 (CI 95% 4773 to 5017). For a threshold of £30,000 per QALY, health checks were not cost-effective (mean ICER £85,632; 95% CI 82,762 to 131,944). Costs of intervention needed to reduce from £258 to under £100 per year in order for health checks to be cost-effective. Conclusion: Whilst findings need to be considered with caution as the model was exploratory in that it was based on assumptions to overcome evidence gaps, they suggest that the way health systems deliver care for vulnerable populations might need to be re-examined. The work was carried out as part of a national guideline and informed recommendations about system changes to achieve more equal health care provisions. © 2019 The Author(s)

The euBusinessGraph ontology: A lightweight ontology for harmonizing basic company information

Company data, ranging from basic company information such as company name(s) and incorporation date to complex balance sheets and personal data about directors and shareholders, are the foundation that many data value chains depend upon in various sectors (e.g., business information, marketing and sales, etc.). Company data becomes a valuable asset when data is collected and integrated from a variety of sources, both authoritative (e.g., national business registers) and non-authoritative (e.g., company websites). Company data integration is however a difficult task primarily due to the heterogeneity and complexity of company data, and the lack of generally agreed upon semantic descriptions of the concepts in this domain. In this article, we introduce the euBusinessGraph ontology as a lightweight mechanism for harmonising company data for the purpose of aggregating, linking, provisioning and analysing basic company data. The article provides an overview of the related work, ontology scope, ontology development process, explanations of core concepts and relationships, and the implementation of the ontology. Furthermore, we present scenarios where the ontology was used, among others, for publishing company data (business knowledge graph) and for comparing data from various company data providers. The euBusinessGraph ontology serves as an asset not only for enabling various tasks related to company data but also on which various extensions can be built upon.publishedVersio

Assessing the suitability of three proxy sources for the development of detectors of special nuclear materials

Numerous techniques and equipment have been developed to provide a capability for the detection of special nuclear materials (SNM), but due to the necessary security measures surrounding these materials alternate, or proxy, neutron sources are often utilised in their stead. In this paper we report the neutron and gamma pulse shape discrimination response of plastic scintillator to mixed neutron/gamma beams produced from two radionuclide neutron sources, and also from an SNM source of weapons-grade plutonium. We discuss the suitability of using radionuclide sources, with appropriate shielding configurations as proxy sources for SNM.A 3σnth-γ discrimination level has been achieved for an SNM source at a low-level energy threshold of ~220 keVee when a shielding configuration of 5 cm of lead was implemented. Varying amounts of lead and high-density polyethylene (HDPE) shielding were also investigated with the 3σ limit being reached by ~240 keVee.This work shows that an AmBe neutron source serves as an appropriate SNM proxy achieving a comparable value for figure of merit above ~1 MeVee. For energies below 1 MeVee down to ~100 keVee a closer approximation of the expected FoM for SNM can be attained when using 252Cf as a proxy source or by utilising an 'enhanced' AmBe source with the addition of a further low energy γ ray source

Data Quality Barriers for Transparency in Public Procurement

Governments need to be accountable and transparent for their public spending decisions in order to prevent losses through fraud and corruption as well as to build healthy and sustainable economies. Open data act as a major instrument in this respect by enabling public administrations, service providers, data journalists, transparency activists, and regular citizens to identify fraud or uncompetitive markets through connecting related, heterogeneous, and originally unconnected data sources. To this end, in this article, we present our experience in the case of Slovenia, where we successfully applied a number of anomaly detection techniques over a set of open disparate data sets integrated into a Knowledge Graph, including procurement, company, and spending data, through a linked data-based platform called TheyBuyForYou. We then report a set of guidelines for publishing high quality procurement data for better procurement analytics, since our experience has shown us that there are significant shortcomings in the quality of data being published. This article contributes to enhanced policy making by guiding public administrations at local, regional, and national levels on how to improve the way they publish and use procurement-related data; developing technologies and solutions that buyers in the public and private sectors can use and adapt to become more transparent, make markets more competitive, and reduce waste and fraud; and providing a Knowledge Graph, which is a data resource that is designed to facilitate integration across multiple data silos by showing how it adds context and domain knowledge to machine-learning-based procurement analytics.publishedVersio

Evaluation of the Ability of LL-37 to Neutralise LPS In Vitro and Ex Vivo

BACKGROUND: Human cathelicidin LL-37 is a cationic antimicrobial peptide (AMP) which possesses a variety of activities including the ability to neutralise endotoxin. In this study, we investigated the role of LPS neutralisation in mediating LL-37's ability to inhibit Pseudomonas aeruginosa LPS signalling in human monocytic cells. METHODOLOGY/PRINCIPAL FINDINGS: Pre-treatment of monocytes with LL-37 significantly inhibited LPS-induced IL-8 production and the signalling pathway of associated transcription factors such as NF-κB. However, upon removal of LL-37 from the media prior to LPS stimulation, these inhibitory effects were abolished. These findings suggest that the ability of LL-37 to inhibit LPS signalling is largely dependent on extracellular LPS neutralisation. In addition, LL-37 potently inhibited cytokine production induced by LPS extracted from P. aeruginosa isolated from the lungs of cystic fibrosis (CF) patients. In the CF lung, polyanionic molecules such as glycosaminoglycans (GAGs) and DNA bind LL-37 and impact negatively on its antibacterial activity. In order to determine whether such interactions interfere with the LPS neutralising ability of LL-37, the status of LL-37 and its ability to bind LPS in CF sputum were investigated. Overall our findings suggest that in the CF lung, the ability of LL-37 to bind LPS and inhibit LPS-induced IL-8 production is attenuated as a result of binding to DNA and GAGs. However, LL-37 levels and its concomitant LPS-binding activity can be increased with a combination of DNase and GAG lyase (heparinase II) treatment. CONCLUSIONS/SIGNIFICANCE: Overall, these findings suggest that a deficiency in available LL-37 in the CF lung may contribute to greater LPS-induced inflammation during CF lung disease

Influence of age on the diagnosis of myocardial infarction

The 99th centile of cardiac troponin, derived from a healthy reference population, is recommended as the diagnostic threshold for myocardial infarction, but troponin concentrations are strongly influenced by age. Our aim was to assess the diagnostic performance of cardiac troponin in older patients presenting with suspected myocardial infarction. METHODS: In a secondary analysis of a multicenter trial of consecutive patients with suspected myocardial infarction, we assessed the diagnostic accuracy of high-sensitivity cardiac troponin I at presentation for the diagnosis of type 1, type 2, or type 4b myocardial infarction across 3 age groups (<50, 50–74, and ≥75 years) using guideline-recommended sex-specific and age-adjusted 99th centile thresholds. RESULTS: In 46 435 consecutive patients aged 18 to 108 years (mean, 61±17 years), 5216 (11%) had a diagnosis of myocardial infarction. In patients <50 (n=12 379), 50 to 74 (n=22 380), and ≥75 (n=11 676) years, the sensitivity of the guideline-recommended threshold was similar at 79.2% (95% CI, 75.5–82.9), 80.6% (95% CI, 79.2–82.1), and 81.6% (95% CI, 79.8–83.2), respectively. The specificity decreased with advancing age from 98.3% (95% CI, 98.1–98.5) to 95.5% (95% CI, 95.2–95.8), and 82.6% (95% CI, 81.9–83.4). The use of age-adjusted 99th centile thresholds improved the specificity (91.3% [90.8%–91.9%] versus 82.6% [95% CI, 81.9%–83.4%]) and positive predictive value (59.3% [57.0%–61.5%] versus 51.5% [49.9%–53.3%]) for myocardial infarction in patients ≥75 years but failed to prevent the decrease in either parameter with increasing age and resulted in a marked reduction in sensitivity compared with the use of the guideline-recommended threshold (55.9% [53.6%–57.9%] versus 81.6% [79.8%–83.3%]. CONCLUSIONS: Age alters the diagnostic performance of cardiac troponin, with reduced specificity and positive predictive value in older patients when applying the guideline-recommended or age-adjusted 99th centiles. Individualized diagnostic approaches rather than the adjustment of binary thresholds are needed in an aging population