Comparison of the Strengths and Weaknesses of Machine Learning Algorithms and Feature Selection on KEGG Database Microbial Gene Pathway Annotation and Its Effects on Reconstructed Network Topology.

The development of tools for the annotation of genes from newly sequenced species has not evolved much from homologous alignment to prior annotated species. While the quality of gene annotations continues to decline as we sequence and assemble more evolutionary distant gut microbiome species, machine learning presents a high quality alternative to traditional techniques. In this study, we investigate the relative performance of common classical and nonclassical machine learning algorithms in the problem of gene annotation using human microbiome-associated species genes from the KEGG database. The majority of the ensemble, clustering, and deep learning algorithms that we investigated showed higher prediction accuracy than CD-Hit in predicting partial KEGG function. Motif-based, machine-learning methods of annotation in new species were faster and had higher precision-recall than methods of homologous alignment or orthologous gene clustering. Gradient boosted ensemble methods and neural networks also predicted higher connectivity in reconstructed KEGG pathways, finding twice as many new pathway interactions than blast alignment. The use of motif-based, machine-learning algorithms in annotation software will allow researchers to develop powerful tools to interact with bacterial microbiomes in ways previously unachievable through homologous sequence alignment alone.

Sustainable and equitable provision of wheelchairs in low- and middle-income countries: an economic assessment of the models for wheelchair provision in Tajikistan.

INTRODUCTION: Reaching universal coverage of assistive technologies remains a challenge in many low- and middle-income countries. Tajikistan has recently adopted several policies and national strategies to strengthen the rights of people with disabilities and improve the provision of assistive products. However, Tajikistan faces a number of challenges, including ensuring sustainable funding for the provision of wheelchairs in the medium and long term. METHODS: This study presents the results of a recent analysis of the economic aspects of the provision of wheelchairs in Tajikistan to inform policy making in other low- and middle-income countries. The study draws on several sources of information, including local cost data, consultations with national and international experts and stakeholders, and reviews of the existing evidence. RESULTS: Countries are advised to adopt an incremental approach to wheelchair provision. In the short term, countries may wish to import wheelchairs to move towards universal coverage. In the medium-to-long term, countries may wish to invest in national capacities for local production. CONCLUSION: Countries will need to continue implementing strategies to ensure universal access to wheelchairs without the risk of financial hardship for users, regardless of the approach to provision that has been chosen.Implication for RehabilitationReaching universal coverage of assistive technologies remains a challenge in many low- and middle-income countries.Countries are advised to adopt an incremental approach to wheelchair provision.The model of wheelchair importation may be a realistic model over the short- to medium-term for many LMICs countries to ensure effective and equitable provision of wheelchairs.In this article, we identify that sufficient funding needs to be allocated to the provision of wheelchairs regardless of the model of provision.

National priority assistive product list development in low resource countries: lessons learned from Tajikistan.

INTRODUCTION: Developing a national assistive products list is an important part of an assistive technology policy and requires knowledge of total population need, and product costs and benefits; information is not always readily available in low-income countries. Our experience in Tajikistan of developing a national assistive products list provides guidance for others. METHODS: Two hundred people with disabilities participated in a survey on self-reported need for assistive products, user experiences and barriers to access; 12 focus groups, of over 100 people with disabilities and older adults, conducted discussions on assistive technology. Major providers of assistive technology (government, nongovernmental organizations, local producers) were interviewed. RESULTS: These results were presented at a meeting with government and other stakeholders, which led to a consensus on 30 assistive products for the national assistive products list. CONCLUSION: We identified the essential stakeholders responsible for developing the assistive products list, and discussed the data needed (total need, cost-effectiveness, unmet need, resources, barriers, system analysis) to make an informed decision on which products to include. This work can be used as a case study for developing an assistive products list quickly on a small budget without compromising on a user-centred approach or active participation of stakeholders.Implications for RehabilitationIncorporating rehabilitation and assistive technology in universal health coverage.Establishing and strengthening networks and partnerships in rehabilitation and building on existing resources (stakeholders, knowledge, government policy documents) to strengthen rehabilitation and assistive technology particularly in low- and middle-income countries.Developing a national assistive products list is an important part of an assistive technology policy.Creating a national assistive products list requires knowledge of population need, and product costs and benefits; information that is not always readily available in low-income countries.In this article, we identify the essential stakeholders responsible for developing the assistive products list and the data needed for informed decisions.We demonstrate that developing an assistive products list can be carried out quickly and on a small budget.

The prevalence of elder abuse in institutional settings: a systematic review and meta-analysis.

Background: A recent study has shown that close to one in six older adults have experienced elder abuse in a community setting in the past year. It is thought that abuse in institutions is just as prevalent. Few systematic evidence of the scale of the problem exists in elder care facilities. The aim of this review is to conduct a systematic review and meta-analysis of the problem in institutional settings and to provide estimates of the prevalence of elder abuse in the past 12 months. Methods: Fourteen academic databases and other online platforms were systematically searched for studies on elder abuse. Additionally, 26 experts in the field were consulted to identify further studies. All studies were screened for inclusion criteria by two independent reviewers. Data were extracted, and meta-analysis was conducted. Self-reported data from older residents and staff were considered separately. Results: Nine studies met the inclusion criteria from an initial of 55 studies identified for review. Overall abuse estimates, based on staff reports, suggest that 64.2% of staff admitted to elder abuse in the past year. There were insufficient studies to calculate an overall prevalence estimate based on self-reported data from older residents. Prevalence estimates for abuse subtypes reported by older residents were highest for psychological abuse (33.4%), followed by physical (14.1%), financial (13.8%), neglect (11.6%), and sexual abuse (1.9%). Conclusions: The prevalence of elder abuse in institutions is high. Global action to improve surveillance and monitoring of institutional elder abuse is vital to inform policy action to prevent elder abuse.

Country assessment framework for the integrated delivery of long-term care: working document: WHO European Framework for Action on Integrated Health Services Delivery

This document aims to provide guidance for assessing the integrated delivery of health and social services for long-term care. The assessment framework, which takes on a services and system perspective, serves as a blueprint for collecting data, structuring country visits, synthesizing information and drafting an assessment report. The framework identifies the main components for an assessment according to care needs, entitlements, health and social services, care pathways, the organization of providers and system enablers. Gender and human rights are streamlined throughout the framework and its taxonomy. The document also includes pointers for initial desk research, with a rich list of sources to access data and conduct research, with questionnaires for administrating interviews and outlines for conducting workshops and focus groups.

Is a healthy city also an age-friendly city?

Healthy Ageing is an important focus of the European Healthy Cities Network and has been supported by WHO since 2003 as a key strategic topic, since 2010 in cooperation with the Global Network of Age-friendly Cities and Communities. Based on the methodology of realist evaluation, this article synthesizes qualitative evidence from 33 structured case studies (CS) from 32 WHO European Healthy Cities, 72 annual reports from Network cities and 71 quantitative responses to a General Evaluation Questionnaire. City cases are assigned to three clusters containing the eight domains of an age-friendly city proposed by WHO's Global Age-friendly City Guide published in 2007. The analysis of city's practice and efforts in this article takes stock of how cities have developed the institutional prerequisites and processes necessary for implementing age-friendly strategies, programmes and projects. A content analysis of the CS maps activities across age-friendly domains and illustrates how cities contribute to improving the social and physical environments of older people and enhance the health and social services provided by municipalities and their partners.

Health expenditure trends in OECD countries, 1990-2001.

This article presents data on health care spending for 30 OECD countries from OECD Health Data 2003, the latest edition of OECD's annual data collection on health systems across industrialized countries. OECD data show health care expenditures as a proportion of gross domestic product at an all-time high, due to both increased expenditures and overall economic slow-down. The article discusses similarities and differences across countries in how health care expenditures are funded and how the health care dollar is spent among types of services.