Challenges for reducing inequities in health and healthcare for the 21st Century

Human life expectancy during the time of the Roman Empire was approximately 28 years. In 1990, global life expectancy had increased to 65 years. The advances in life expectancy in the 20th century were remarkable by any standard. Although many factors contributed to this enhanced life expectancy, including medical technologies, by far the largest proportion of the increase occurred as a consequence of economic growth, rising living standards and nutrition. Despite the large improvements in terms of life expectancy, significant health variations still remain between countries and across different socioeconomic classes with in countries. As the 20th century proceeded, a growing dichotomy existed between those who are healthy and have access to medical care and those who are not healthy and do not have access to such services. Moreover, evidence shows that such inequities in health and healthcare are increasing. The present paper will analyze the dynamics of shifts in health profile during the early period of the last century and describe the major determinants of inequities in health and healthcare at the international level. Challenges facing the reduction in inequalities in health and healthcare will be discussed

Trustee: Full Privacy Preserving Vickrey Auction on top of Ethereum

The wide deployment of tokens for digital assets on top of Ethereum implies the need for powerful trading platforms. Vickrey auctions have been known to determine the real market price of items as bidders are motivated to submit their own monetary valuations without leaking their information to the competitors. Recent constructions have utilized various cryptographic protocols such as ZKP and MPC, however, these approaches either are partially privacy-preserving or require complex computations with several rounds. In this paper, we overcome these limits by presenting Trustee as a Vickrey auction on Ethereum which fully preserves bids' privacy at relatively much lower fees. Trustee consists of three components: a front-end smart contract deployed on Ethereum, an Intel SGX enclave, and a relay to redirect messages between them. Initially, the enclave generates an Ethereum account and ECDH key-pair. Subsequently, the relay publishes the account's address and ECDH public key on the smart contract. As a prerequisite, bidders are encouraged to verify the authenticity and security of Trustee by using the SGX remote attestation service. To participate in the auction, bidders utilize the ECDH public key to encrypt their bids and submit them to the smart contract. Once the bidding interval is closed, the relay retrieves the encrypted bids and feeds them to the enclave that autonomously generates a signed transaction indicating the auction winner. Finally, the relay submits the transaction to the smart contract which verifies the transaction's authenticity and the parameters' consistency before accepting the claimed auction winner. As part of our contributions, we have made a prototype for Trustee available on Github for the community to review and inspect it. Additionally, we analyze the security features of Trustee and report on the transactions' gas cost incurred on Trustee smart contract.Comment: Presented at Financial Cryptography and Data Security 2019, 3rd Workshop on Trusted Smart Contract

Errors and discrepancies in the administration of intravenous infusions: a mixed methods multihospital observational study

Introduction Intravenous medication administration has traditionally been regarded as error prone, with high potential for harm. A recent US multisite study revealed few potentially harmful errors despite a high overall error rate. However, there is limited evidence about infusion practices in England and how they relate to prevalence and types of error. Objectives To determine the prevalence, types and severity of errors and discrepancies in infusion administration in English hospitals, and to explore sources of variation, including the contribution of smart pumps. Methods We conducted an observational point prevalence study of intravenous infusions in 16 National Health Service hospital trusts. Observers compared each infusion against the medication order and local policy. Deviations were classified as errors or discrepancies based on their potential for patient harm. Contextual issues and reasons for deviations were explored qualitatively during observer debriefs. Results Data were collected from 1326 patients and 2008 infusions. Errors were observed in 231 infusions (11.5%, 95% CI 10.2% to 13.0%). Discrepancies were observed in 1065 infusions (53.0%, 95% CI 50.8% to 55.2%). Twenty-three errors (1.1% of all infusions) were considered potentially harmful; none were judged likely to prolong hospital stay or result in long-term harm. Types and prevalence of errors and discrepancies varied widely among trusts, as did local policies. Deviations from medication orders and local policies were sometimes made for efficiency or patient need. Smart pumps, as currently implemented, had little effect, with similar error rates observed in infusions delivered with and without a smart pump (10.3% vs 10.8%, p=0.8). Conclusion Errors and discrepancies are relatively common in everyday infusion administrations but most have low potential for patient harm. Better understanding of performance variability to strategically manage risk may be a more helpful tactic than striving to eliminate all deviations

Antibacterial activity of Libyan Juniperus phoenicea L. leaves extracts against common nosocomial pathogens

In ancient times, botanical extracts were essential complementary method for microbial control. This study has been carried out to assess the antibacterial activities of methanol, acetone, and aqueous leaf extracts of Libyan Juniperus phoenicea L. against multidrug-resistant (MDR) clinical isolates (Staphylococcus aureus, S. haemolyticus, Pseudomonas aeruginosa, and Proteus mirabilis) using the agar well diffusion method. Based on the inhibition zone's diameter or appearance, the tested MDR bacteria were identified as susceptible, intermediate, or resistant using the standard criteria. The current study's findings showed that the concentration, type of solvent and bacterial species had a significant impact on the effectiveness of the plant extracts. Results of the study revealed that the methanol and acetone extracts demonstrated moderate to excellent antibacterial properties against all tested bacteria at all predefined concentrations (25, 50, 75, and 100%), with the zone of inhibition ranging from 15.66 to 27.66 mm. Among the tested solvents, the aqueous extract of J. phoenicea was the least effective against the clinical bacterial isolates. Further, the plant's leaf extracts were more effective against Gram-positive bacteria than Gram-negative bacterial pathogens. Most importantly, neither the aqueous extract nor the standard antibiotics inhibited P. aeruginosa, while the methanol and acetone extracts displayed remarkable inhibition zones against all tested bacteria. Consequently, the plant extracts (acetone and methanol) in this study may provide insightful information about the potential use of J. phoenicea leaves as a natural antibacterial agent, which could be used to combat antibiotic-resistant bacteria

The role of diet and lifestyle in women with breast cancer: An update review of related research in the Middle East

© Zainab Taha and Sakina E. Eltom 2018. Breast cancer is the most common malignancy among Arab women in Eastern Mediterranean Region (EMR). The incidence of breast cancer has substantially increased in recent years among this women population, especially those younger than 50, and the incidence is expected to double by 2030. Considerable experimental evidence supports the potential role of dietary habits and lifestyle in cancer etiology and cancer prevention. In this review we examined the literature for evidence to link dietary choices and the rise in incidence and mortality of breast cancer among women in EMR. A literature search was conducted in PubMed and Ovid MEDLINE databases up to December 2017. The search terms used are breast cancer prevalence, breast cancer incidence worldwide, breast cancer and: nutrition, protein intake, Vitamin D intake, fat intake, phytoestrogens, EMR, Arab, Middle East, Gulf countries, the UAE Arab women, breast cancer risk, diet, and chemoprevention. We found evidence to suggest that there is an alarming epidemic of obesity among women in most of the EMR countries, especially Gulf Cooperation Council (GCC) countries. The rise in the new breast cancer cases among women could be attributed to excess body weight. Their dietary pattern, which correlates with obesity, can be an important factor in the etiology of cancer. Although very few studies were found to support a direct causal relationship between obesity and breast cancer in the EMR, circumstantial evidence clearly points to the possible role of the epidemic, obesity, in this population and the startling rise in cases of breast cancer. Well-designed and systematic studies are urgently needed to confirm these associations and to elucidate potential mechanisms. More urgently, calls to action are needed in many sectors and at all levels of society, to establish intensive strategies for reducing obesity and promoting an overall healthy diet. Continued and expanded research on diet, lifestyle, and breast cancer risk is urgently needed to build the foundation for future progress in evidence-based public health efforts

Effect of corrosion on mechanical properties of the joining of materials

The effect of corrosion behavior in critical environmental conditions on the mechanical properties of composite/metal materials joints was investigated by immersing metalic materials into 5wt% hydrochloric acid solutions. The current study was carried out on a single lab joint with a total thickness of 4mm; thus, a destructive test was undertaken to investigate the corrosion behavior induced degradation of mechanical properties followed by Scanning electron microscope analysis (SEM). The joined specimens were examined under both non-corrosive and corrosive environmental conditions. Moreover, the Taguchi analysis of experimental data for maximizing the required output is carried out to validate the impact and significance of input factors. Experimental results have shown that the weight losses of the mild steel and aluminum materials are 7.45% and 16.7%, respectively, in 5% wt hydrochloric acid after three weeks. The corrosive environment affected the strength of the joints and obtained an early failure on the joint region that leads to a reduction on the strength of the materials by almost 15% compared to the non-corroded joint. The joining of non-corroded similar steel obtained the highest maximum stress among all other specimens, where the maximum recorded stress was 140.5MPa as compared to 125MPa for corroded specimen. Furthermore, the mode of failure and hardness tests were obtained and analyzed for all specimens. A significant reduction in the hardness of the materials after exposure to the HCl acid was observed

Trajectory Design from GTO to Near-Equatorial Lunar Orbit for the Dark Ages Radio Explorer (DARE) Spacecraft

The trajectory design for the Dark Ages Radio Explorer (DARE) mission concept involves dropping the DARE spacecraft off in a generalized geosynchronous transfer orbit (GTO) as a secondary payload. From GTO, the spacecraft is then required to enter a near-equatorial lunar orbit that is stable (i.e., no station-keeping maneuvers are required) and yields the required number of cumulative hours (1,000) for science measurements while in the lunar farside radio quiet cone over a span of three years. Preliminary and expected results of the corresponding trajectory design are presented herein

Trajectory Design from GTO to Near-Equatorial Lunar Orbit for the Dark Ages Radio Explorer (DARE) Spacecraft

The trajectory design for the Dark Ages Radio Explorer (DARE) mission concept involves launching the DARE spacecraft into a geosynchronous transfer orbit (GTO) as a secondary payload. From GTO, the spacecraft then transfers to a lunar orbit that is stable (i.e., no station-keeping maneuvers are required with minimum perilune altitude always above 40 km) and allows for more than 1,000 cumulative hours for science measurements in the radio-quiet region located on the lunar farside