Protection against discrimination in national dementia guideline recommendations: A systematic review

Background National dementia guidelines provide recommendations about the most effective approaches to diagnosis and interventions. Guidelines can improve care, but some groups such as people with minority characteristics may be disadvantaged if recommended approaches are the same for everyone. It is not known if dementia guidelines address specific needs related to patient characteristics. The objectives of this review are to identify which countries have national guidelines for dementia and synthesise recommendations relating to protected characteristics, as defined in the UK Equality Act 2010: age, disability, gender identity, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex, and sexual orientation. Methods and findings We searched CINAHL, PsycINFO, and Medline databases and the Guideline International Network library from inception to March 4, 2020, for dementia guidelines in any language. We also searched, between April and September 2020, Google and the national health websites of all 196 countries in English and in each country’s official languages. To be included, guidelines had to provide recommendations about dementia, which were expected to be followed by healthcare workers and be approved at a national policy level. We rated quality according to the iCAHE guideline quality checklist. We provide a narrative synthesis of recommendations identified for each protected characteristic, prioritising those from higher-quality guidelines. Forty-six guidelines from 44 countries met our criteria, of which 18 were rated as higher quality. Most guidelines (39/46; 85%) made at least one reference to protected characteristics, and we identified recommendations relating to age, disability, race (or culture, ethnicity, or language), religion, sex, and sexual orientation. Age was the most frequently referenced characteristic (31/46; 67%) followed by race (or culture, ethnicity, or language; 25/46; 54%). Recommendations included specialist investigation and support for younger people affected by dementia and consideration of culture when assessing whether someone had dementia and providing person-centred care. Guidelines recommended considering religion when providing person-centred and end-of-life care. For disability, it was recommended that healthcare workers consider intellectual disability and sensory impairment when assessing for dementia. Most recommendations related to sex recommended not using sex hormones to treat cognitive impairment in men and women. One guideline made one recommendation related to sexual orientation. The main limitation of this study is that we only included national guidelines applicable to a whole country meaning guidelines from countries with differing healthcare systems within the country may have been excluded. Conclusions National guidelines for dementia vary in their consideration of protected characteristics. We found that around a fifth of the world’s countries have guidelines for dementia. We have identified areas of good practice that can be considered for future guidelines and suggest that all guidelines provide specific evidence-based recommendations for minority groups with examples of how to implement them. This will promote equity in the care of people affected by dementia and help to ensure that people with protected characteristics also have high-quality clinical services.

Indoor PM2.5 Mortality in China when Outdoor Air Meets 2021 WHO AQG

The World Health Organization (WHO) Air Quality Guidelines (AQG) 2021 for PM2.5 is tightened to be 5 μg/m3. We firstly estimated deaths attributable to human exposure to PM2.5 (DAHP) to be 455 thousand (372-527) in urban China in 2019, of which indoor sources contributed 253 thousand (207-294) deaths. The economic losses related to PM2.5 from indoor sources were 0.98 trillion (0.80-1.14) RMB, accounting for 56% of the total economic losses. We then further projected the DAHP at 328 thousand (260-392) when the outdoor PM2.5 concentration is 5 μg/m3, while PM2.5 from indoor sources still causes 297 thousand (235-355) deaths and 1.27 trillion (1.00, 1.51) in economic losses each year. There are significant health hazards and economic losses caused by indoor PM2.5, even the outdoor air is clean enough. The formulation and implementation of more air pollution policies are therefore in urgent need to control indoor sources of PM2.5.

Tracking Recent DDT Contamination in a Northern New England Watershed

Research on declines in loon populations at Squam Lake, New Hampshire, U.S.A., point to multiple potential causes since 2005, including dichlorodiphenyltrichloroethane (DDT). This study narrows down sources of DDT in a small sub-watershed by focusing mainly on collecting and analyzing soil and sediment samples, achieving rapid source area determination of DDT. We find presence of p,p’ isomers of DDT and DDE in the Bennett Brook sub-watershed arising from long-term soil and sediment storage of applications 60 years ago, plus a concentrated and current source area at a former barn. Highest concentrations, 723 μg/kg p,p’-DDT and 721 μg/kg p,p’-DDE, occur in the soils adjacent to the barn’s foundation remnants. DDT exceeds that of the metabolite, DDE, in many soils around Bennett Brook, including but not limited to the barn site. In soils where DDT>DDE, we infer mechanisms that delayed breakdown of DDT over the last 60 years. A Pb-210 dated lake sediment core, collected near the outlet of Bennet Brook, shows continuous accumulation of p,p’-DDE and p,p-DDD after 1951. These residuals likely derived from multiple sources within the sub-watershed, including orchard soils, the barn site, and from mobilized sediment deposits following extreme floods in the watershed. Although the DDT residues fall below mandatory soil remediation levels for the State of New Hampshire, Bennett Brook sediments exceed sediment quality guidelines for protection of aquatic life. Crayfish collected in Bennett Brook have significantly higher concentrations of p,p’-DDE than crayfish collected elsewhere in Squam Lake.

Annotation Difficulties in Natural Language Inference

State-of-the-art models have obtained high accuracy on mainstream Natural Language Inference (NLI) datasets. However, recent research has suggested that the task is far from solved. Current models struggle to generalize and fail to consider the inherent human disagreements in tasks such as NLI. In this work, we conduct an experiment based on a small subset of the NLI corpora such as SNLI and SICK. It reveals that some inference cases are inherently harder to annotate than others, although good-quality guidelines can reduce this difficulty to some extent. We propose adding a Difficulty Score to NLI datasets, to capture the human difficulty level of agreement.

Asesmen Kualitas Lingkungan di PSIKLH Kawasan Puspiptek Serpong-Tangerang Selatan

Pusat Standardisasi Instrumen Kualitas Lingkungan Hidup (PSIKLH) merupakan salah satu instansi yang berada di kawasan Puspiptek dengan kegiatan laboratorium pengujian dan laboratorium kalibrasi. Asesmen kualitas lingkungan di PSIKLH dilakukan mencakup kualitas udara ambien, udara emisi, air, tanah, dan sedimen periode 2018-2020. Pengambilan contoh uji dan analisis parameter mengacu pada metode Standar Nasional Indonesia dan metode lainnya yang sudah baku. Hasil asesmen dibandingkan dengan baku mutu masing-masing parameter sesuai peraturan yang ada. Konsentrasi TSP, PM10, PM2,5, SO2, NO2, dan O3 di PSIKLH hampir semua berada di bawah baku mutu berdasarkan Peraturan Pemerintah No.41/1999 tentang Pengendalian Pencemaran Udara, namun ada 8 dari 28 data PM2,5 berada di atas baku mutu. Konsentrasi H2S dan NH3 berada di bawah baku mutu sesuai Keputusan Menteri Negara Lingkungan Hidup No. 50/1996 tentang Baku Tingkat Kebauan. Pada asesmen tahun 2018, konsentrasi partikulat, SO2, NOx, dan CO pada generator berada di bawah baku mutu berdasarkan PermenLH No. 21/2008. Setelah peraturan baru PP No.15/2019 dikeluarkan, konsentrasi CO dan NOx telah melebihi baku mutu tersebut. PSIKLH mengirimkan limbah bahan berbahaya dan beracun (B3) ke pihak eksternal untuk dapat diolah, sedangkan limbah cair domestik dilakukan pengolahan dan pengujian sebelum dibuang ke lingkungan. Kualitas limbah domestik parameter pH, BOD, COD, minyak lemak, TSS dan amoniak berada di bawah baku mutu berdasarkan Permen LHK No.68/2016 tentang Baku Mutu Air Limbah Domestik. Konsentrasi tanah di PSIKLH dan sedimen sungai di sekitar Kawasan Puspiptek berada di bawah baku mutu berdasarkan Canadian Soil Quality Guidelines for the Protection Of Environmental and Human Health dan juga Canadian Sediment Quality Guidelines for the Protection of Aquatic Life in Freshwater. Pemantauan rutin dan komprehensif lingkungan kawasan perlu dilakukan untuk mengetahui sumber pencemar yang potensial mencemari kawasan Puspiptek sehingga dampak pencemaran dapat diatasi.

Contamination Assessment of Heavy Metals in Sediment Cores from De Montigny Lake around Siscoe-Sullivan Former Mining Sites, Val-d’Or, Canada

Seven sediment cores were collected from De Montigny Lake in order to determine concentrations, and contamination assessment of heavy metals such as Cr, Zn, Ni, Pb, Cu, Co and Cd. The mean concentrations of heavy metals are as follows: 48.3 mg/kg for Cr, 36.4 mg/kg for Zn, 20.6 mg/kg for Ni, 14.7 mg/kg for Pb, 10.2 mg/kg for Cu, 6.7 mg/kg for Co and 0.1 mg/kg for Cd. Based on the sediment quality guidelines, the mean concentration metals such as Cr, Cu and Ni exceeded the US Environmental Protection Agency (USEPA) guideline. However, the concentration of Cr was more than the Canadian Water Quality Guidelines for Protection of Aquatic Life (CCME), and Threshold Effect Level (TEL) guidelines. The metal contamination in the sediments was also evaluated using Enrichment Factor (EF) and geoaccumulation index (Igeo) to assess natural and anthropogenic factors. The results of enrichment factor methods demonstrated that sediments from De Montigny Lake were moderately to high enriched, mainly controlled by through anthropogenic activities. According to Sediment Quality Guidelines (SQGs), the concentrations metals from the core sediment of De Montigny Lake are classified as having moderate impacts with potential adverse biotoxic effects.

Classical and disease-specific quality indicators in glioma surgery – Development of a quality checklist to improve treatment quality in glioma patients

Background There is a pressing demand for more accurate, disease-specific quality measures in the field of neurosurgery. Aiming at most adequately measuring and reflecting the quality of glioma therapy, we developed a novel quality indicator bundle in form of a checklist for all patients that are treated operatively for glioma. Methods On the basis of possible glioma-specific quality indicators retrieved from the literature and quality guidelines, a multidisciplinary team developed a checklist containing 13 patient-need-specific outcome measures. Subsequently, the checklist was prospectively applied to a total of 78 patients compared with a control group consisting of 322 patients. A score was generated based on the maximum of quality measures achieved. Results Significant improvements in quality after prospectively introducing the checklist were achieved for supplemental physical and occupational therapy during inpatient stay (89.4% vs. 100%, p= 0.002), consultation of a social worker during inpatient stay (64% vs. 92.3%, p< 0.001), psycho-oncological screening (14.3% vs. 70.5%, p< 0.001), psycho-oncological consultation (31.1% vs. 82.1%, p< 0.001), and consultation of the palliative care team (20% vs. 40%, p= 0.031). Overall, after introduction of the checklist one third (n= 23) of patients reached best-practice measures in all categories, and over half of the patients (n= 44) achieved above 90% with respect to the outcome measures. Conclusions Aiming at ensuring comprehensive, consistent and timely care of glioma patients the implementation of the checklist for routine use in glioma surgery represents an efficient, easily reproducible and powerful tool for significant improvements.