Framework synthesis to inform the ideation and design of a paper-based health information system (PHISICC)

Background: Health information systems (HIS) are meant to support decision-making at all levels of the system, including frontline health workers. In field studies in Côte d’Ivoire, Mozambique and Nigeria, we observed health workers' interactions with the HIS and identified twelve decision-making components of HIS. The objective of this framework synthesis is to portray these components in HIS research, in order to inform the ideation of a paper-based HIS intervention (PHISICC). Methods: We searched studies in the Cochrane Central Register of Controlled Trials (CENTRAL), Embase, Epistemonikos, Medline, in-Process on the Ovid platform, OpenGrey, PDQ Evidence (“pretty darnd quick” Evidence), the World Health Organization (WHO) Global Health Library and included studies focussing on HIS interventions, data quality, information support tools and data use for decision-making in the context of the governmental health care sector. We assessed the methodological quality of studies using the Critical Appraisal Skills Programme tool. We synthesised the findings based on the decision-making components of HIS and thematic areas. Results: The search identified 6784 studies; 50 were included. Most of the 50 studies had quality concerns. All studies included at least one of the decision-making components: the most prominent were the technical aspects of ‘recording’ and ‘reporting’. Data use for decision-making was much less represented. Conclusion: HIS research focuses on the more technical aspects of HIS. Further research on HIS, given the strong push towards HIS digitalisation, should consider putting at the centre the human experience of decision-making and data use, in order to make HIS relevant for quality of care

Framework synthesis to inform the ideation and design of a paper-based health information system (PHISICC)

BACKGROUND: Health information systems (HIS) are meant to support decision-making at all levels of the system, including frontline health workers. In field studies in Cote d'Ivoire, Mozambique and Nigeria, we observed health workers' interactions with the HIS and identified twelve decision-making components of HIS. The objective of this framework synthesis is to portray these components in HIS research, in order to inform the ideation of a paper-based HIS intervention (PHISICC). METHODS: We searched studies in the Cochrane Central Register of Controlled Trials (CENTRAL), Embase, Epistemonikos, Medline, in-Process on the Ovid platform, OpenGrey, PDQ Evidence ("pretty darnd quick" Evidence), the World Health Organization (WHO) Global Health Library and included studies focussing on HIS interventions, data quality, information support tools and data use for decision-making in the context of the governmental health care sector. We assessed the methodological quality of studies using the Critical Appraisal Skills Programme tool. We synthesised the findings based on the decision-making components of HIS and thematic areas. RESULTS: The search identified 6784 studies; 50 were included. Most of the 50 studies had quality concerns. All studies included at least one of the decision-making components: the most prominent were the technical aspects of 'recording' and 'reporting'. Data use for decision-making was much less represented. CONCLUSION: HIS research focuses on the more technical aspects of HIS. Further research on HIS, given the strong push towards HIS digitalisation, should consider putting at the centre the human experience of decision-making and data use, in order to make HIS relevant for quality of care

Residential energy efficiency interventions: A meta-analysis of effectiveness studies

BACKGROUND: The residential sector releases around 17% of global greenhouse gas emissions and making residential buildings more energy efficient can help mitigate climate change. Engineering models are often used to predict the effects of residential energy efficiency interventions (REEI) on energy consumption, but empirical studies find that these models often over-estimate the actual impact of REEI installation. Different empirical studies often estimate different impacts for the same REEI, possibly due to variations in implementation, climate and population. Funding for this systematic review was provided by the evaluation function at the European Investment Bank Group. OBJECTIVES: The review aims to assess the effectiveness of installing REEIs on the following primary outcomes: energy consumption, energy affordability, CO2 emissions and air quality indices and pollution levels. SEARCH METHODS: We searched CAB Abst, Econlit, Greenfile, Repec, Academic Search Complete, WB e-lib, WoS (SCI and SSCI) and other 42 databases in November 2020. In addition, we searched for grey literature on websites, checked the reference lists of included studies and relevant reviews, used Google Scholar to identify studies citing included studies, and contacted the authors of studies for any ongoing and unpublished studies. We retrieved a total of 13,629 studies that we screened at title and abstract level, followed by full-text screening and data extraction. SELECTION CRITERIA: We included randomised control trials, and quasi-experimental studies that evaluated the impact of installing REEIs anywhere in the world and with any comparison. DATA COLLECTION AND ANALYSIS: Two independent reviewers screened studies for eligibility, extracted data and assessed risk of bias. When more than one included study examined the same installation of the same type of REEI for a similar outcome, we conducted a meta-analysis. We also performed subgroup analyses. MAIN RESULTS: A total of 16 studies were eligible and included in the review: two studies evaluated the installation of efficient lighting, three studies the installation of attic/loft insulation, two studies the installation of efficient heat pumps, eight studies the installation of a bundle of energy efficiency measures (EEMs), and one study evaluated other EEMs. Two studies, neither appraised as having a low risk of bias, find that lighting interventions lead to a significant reduction in electricity energy consumption (Hedges' g = −0.29; 95% confidence interval [CI]: −0.48, −0.10). All the other interventions involved heating or cooling, and effects were synthesizised by warmer or colder climate and then across climates. Four studies examined the impact of attic/loft insulation on energy consumption, and two of these studies were appraised as having a low risk of bias. Three studies took place in colder climates with gas consumption as an outcome, and one study took place in a warmer climate, with the electricity consumption (air conditioning) as the outcome. The average impact across all climates was small (Hedges' g = 0.04; 95% CI: −0.09, 0.01) and statistically insignificant. However, two of the studies appear to have evaluated the effect of installing small amounts (less than 75 mm) of insulation. The other two studies, one of which was appraised as low risk of bias and the other involving air conditioning, found significant reductions in consumption. Two studies examined the impact of installing electric heat pumps. The average impact across studies was not statistically significant (Hedges' g = −0.11; 95% CI: −0.41, 0.20). However, there was substantial variation between the two studies. Replacing older pumps with more efficient versions significantly reduced electricity consumption in a colder climate (Hedges' g = −0.36; 95% CI, −0.57, −0.14) in a high risk of bias study. However, a low risk of bias study found a significant increase in electricity consumption from installing new heat pumps (Hedges' g = 0.09; 95% CI, 0.06, 0.12). Supplemental analyses in the latter study indicate that households also used the heat pumps for cooling and that the installed heat pumps most likely reduced overall energy consumption across all sources—that is, households used more electricity but less gas, wood and coal. Seven studies examined bundled REEIs where the households chose which EEMs to install (in five studies the installation occurred after an energy audit that recommended which EEMs to install). Overall, the studies estimated that installing an REEI bundle is associated with a significant reduction in energy consumption (Hedges' g = −0.36; 95% CI, −0.52, −0.19). In the two low risk of bias studies, conducted with mostly low-income households, installed bundles reduced energy consumption by a statistically significant amount (Hedges' g = −0.16; 95% CI, −0.13, −0.18). AUTHORS' CONCLUSIONS: The 16 included studies indicate that installing REEIs can significantly reduce energy consumption. However, the same type of REEI installed in different studies caused different effects, indicating that effects are conditional on implementation and context. Exploring causes of this variation is usually not feasible because existing research often does not clearly report the features of installed interventions. Additional high quality impact evaluations should be commissioned in more diverse contexts (only one study was conducted in either Asia or Africa—both involved lighting interventions—and no studies were conducted in South America or Southern Europe)

PROTOCOL: Residential energy efficiency interventions: An effectiveness systematic review

This review aims to identify, appraise and synthesise the evidence available on the effectiveness of energy efficiency measure installations, including those bundled with behavioural interventions. The synthesis will estimate the overall impact of these interventions as well as examine possible causes of variation in impacts. We will also attempt to assess the cost-effectiveness of residential energy efficiency interventions

TaLoS: secure and transparent TLS termination inside SGX enclaves

We introduce TaLoS1, a drop-in replacement for existing transport layer security (TLS) libraries that protects itself from a malicious environment by running inside an Intel SGX trusted execution environment. By minimising the amount of enclave transitions and reducing the overhead of the remaining enclave transitions, TaLoS imposes an overhead of no more than 31% in our evaluation with the Apache web server and the Squid proxy

The effects of radiofrequency electromagnetic fields exposure on human self-reported symptoms: a protocol for a systematic review of human experimental studies

BACKGROUND: The technological applications of radiofrequency electromagnetic fields (RF-EMF) have been steadily increasing since the 1950s across multiple sectors exposing large proportions of the population. This fact has raised concerns related to the potential consequences to people's health. The World Health Organization (WHO) is assessing the potential health effects of exposure to RF-EMF and has carried out an international survey amongst experts, who have identified six priority topics to be further addressed through systematic reviews, whereof the effects on symptoms is one of them. We report here the systematic review protocol of experimental studies in humans assessing the effects of RF-EMF on symptoms. OBJECTIVE: Our objectives are to assess the effects of exposure to electromagnetic fields (compared to no or lower exposure levels) on symptoms in human subjects. We will also assess the accuracy of perception of presence of exposure in volunteers with and without idiopathic environmental intolerance attributed to electromagnetic fields (IEI-EMF). ELIGIBILITY CRITERIA: We will search relevant literature sources (e.g. the Web of Science, Medline, Embase, Epistemonikos) for randomized trials (comparing at least two arms) and randomised crossover trials of RF-EMF exposure that have assessed the effects on symptoms. We will also include studies that have measured the accuracy of the perception of the presence or absence of exposure. We will include studies in any language. STUDY APPRAISAL AND SYNTHESIS: Studies will be assessed against inclusion criteria by two independent reviewers. Data on study characteristics, participants, exposure, comparators and effects will be extracted using a specific template for this review, by two independent reviewers. Discrepancies will be solved by consensus. Risk of bias (ROB) will be assessed using the ROB Rating Tool for Human and Animal Studies and the level of confidence in the evidence of the exposure-outcome relations will be assessed using the GRADE approach. For the perception studies, we will use adapted versions of the ROB tool and GRADE assessment. Where appropriate, data will be combined using meta-analytical techniques

The effects of radiofrequency electromagnetic fields exposure on tinnitus, migraine and non-specific symptoms in the general and working population: a protocol for a systematic review on human observational studies

BACKGROUND: Applications emitting radiofrequency electromagnetic fields (RF-EMF; 100 kHz to 300 GHz) are widely used for communication (e.g. mobile phones), in medicine (diathermy) and in industry (RF heaters). Concern has been raised that RF-EMF exposure affects health related quality of life, because a part of the population reports to experience a variety of symptoms related to low exposure levels below regulatory limits. OBJECTIVES: To systematically review the effects of longer-term or repeated local and whole human body RF-EMF exposure on the occurrence of symptoms evaluating migraine, tinnitus, headaches, sleep disturbances and composite symptom scores as primary outcomes. METHODS: We will follow the WHO handbook for guideline development. For the development of the systematic review protocol we considered handbook for conducting systematic reviews for health effects evaluations from the National Toxicology Program-Office of Health Assessment and Translation (NTP-OHAT) and COSTER (Recommendations for the conduct of systematic reviews in toxicology and environmental health research). ELIGIBILITY CRITERIA: Peer-reviewed epidemiological studies in the general population or workers aiming to investigate the association between local or whole-body RF-EMF exposure for at least one week and symptoms are eligible for inclusion. Only cohort, case-control and panel studies will be included. INFORMATION SOURCES: We will search the scientific literature databases Medline, Web of Science, PsycInfo, Cochrane Library, Epistemonikos and Embase, using a predefined search strategy. This search will be supplemented by a search in the EMF-Portal and checks of reference lists of relevant papers and reviews. STUDY APPRAISAL AND SYNTHESIS METHOD: Data from included papers will be extracted according to predefined forms. Findings will be summarized in tables, graphical displays and in a narrative synthesis of the available evidence, complemented with meta-analyses. We will separately review effects of local, far field and occupational exposure. RISK OF BIAS: The internal validity of included studies will be assessed using the NTP-OHAT Risk of Bias Rating Tool for Human and Animal Studies, elaborated to observational RF-EMF studies. EVIDENCE APPRAISAL: To rate certainty of the evidence, we will use the OHAT GRADE-based approach for epidemiological studies. FRAMEWORK AND FUNDING: This protocol concerns one of the ten different systematic reviews considered in a larger systematic review of the World Health Organization to assess potential health effects of exposure to RF-EMF in the general and working population. REGISTRATION: PROSPERO CRD42021239432

Glamdring: automatic application partitioning for Intel SGX

Trusted execution support in modern CPUs, as offered by Intel SGX enclaves , can protect applications in untrusted environments. While prior work has shown that legacy applications can run in their entirety inside enclaves, this results in a large trusted computing base (TCB). Instead, we explore an approach in which we partition an applica- tion and use an enclave to protect only security-sensitive data and functions, thus obtaining a smaller TCB. We describe Glamdring , the first source-level parti- tioning framework that secures applications written in C using Intel SGX. A developer first annotates security- sensitive application data. Glamdring then automatically partitions the application into untrusted and enclave parts: (i) to preserve data confidentiality, Glamdring uses dataflow analysis to identify functions that may be ex- posed to sensitive data; (ii) for data integrity, it uses back- ward slicing to identify functions that may affect sensitive data. Glamdring then places security-sensitive functions inside the enclave, and adds runtime checks and crypto- graphic operations at the enclave boundary to protect it from attack. Our evaluation of Glamdring with the Mem- cached store, the LibreSSL library, and the Digital Bitbox bitcoin wallet shows that it achieves small TCB sizes and has acceptable performance overheads

Informing additive manufacturing technology adoption: total cost and the impact of capacity utilisation

Informing Additive Manufacturing (AM) technology adoption decisions, this paper investigates the relationship between build volume capacity utilisation and efficient technology operation in an inter-process comparison of the costs of manufacturing a complex component used in the packaging industry. Confronting the reported costs of a conventional machining and welding pathway with an estimator of the costs incurred through an AM route utilising Direct Metal Laser Sintering (DMLS), we weave together four aspects: optimised capacity utilisation, ancillary process steps, the effect of build failure and design adaptation. Recognising that AM users can fill unused machine capacity with other, potentially unrelated, geometries, we posit a characteristic of ‘fungible’ build capacity. This aspect is integrated in the cost estimation framework through computational build volume packing, drawing on a basket of sample geometries. We show that the unit cost in mixed builds at full capacity is lower than in builds limited to a single type of geometry; in our study, this results in a mean unit cost overstatement of 157%. The estimated manufacturing cost savings from AM adoption range from 36 to 46%. Additionally, we indicate that operating cost savings resulting from design adaptation are likely to far outweigh the manufacturing cost advantage