Diagnostic accuracy of PAT-POPS and ManChEWS for admissions of children from the emergency department

Background The Pennine Acute Trust (PAT) Paediatric Observation Priority Score (PAT-POPS) is a specific emergency department (ED) physiological and observational aggregate scoring system, with scores of 0–18. A higher score indicates greater likelihood of admission. The Manchester Children’s Early Warning System (ManChEWS) assesses six physiological observations to create a trigger score, classified as Green, Amber or Red. Methods Prospectively collected data were used to calculate PAT-POPS and ManChEWS on 2068 patients aged under 16 years (mean 5.6 years, SD 4.6) presenting over 1 month to a UK District General Hospital Paediatric ED. Receiver operating characteristics (ROC) comparison, using STATA V.13, was used to investigate the ability of ManChEWS and PAT-POPS to predict admission to hospital within 72 h of presentation to the ED. Results Comparison of the area under the ROC curve indicates that the ManChEWS ROC is 0.67 (95% CI 0.64 to 0.70) and the PAT-POPS ROC is 0.72 (95% CI 0.68 to 0.75). The difference is statistically significant. At a PAT-POPS cut-off of ≥2, 80% of patients had their admission risk correctly classified ( positive likelihood ratio 3.40, 95% CI 2.90 to 3.98) whereas for ManChEWS with a cut off of ≥Amber only 71% of patients were correctly classified ( positive likelihood ratio 2.18, 95% CI 1.94 to 2.45). Conclusions PAT-POPS is a more accurate predictor of admission risk than ManChEWS. Replacing ManChEWS with PAT-POPS would appear to be clinically appropriate in a paediatric ED. This needs validation in a multicentre study

An intra-COVID-19 assessment of hand hygiene facility, policy and staff compliance in two hospitals in Sierra Leone: is there a difference between regional and capital city hospitals?

Although hand hygiene (HH) is the most effective intervention to reduce the spread of infections, there are limited data on HH facilities, policy, and compliance in sub-Saharan Africa. This cross-sectional study is aimed at assessing HH using the WHO HH self-assessment framework, HH technical reference manual, and a modified infection control self-assessment tool in two hospitals in Sierra Leone. Only 10% and 9% of regional and capital city hospitals had running tap water, respectively. Veronica buckets were the resources for HH in 89% of units in the regional hospital and 92% of units in capital city hospital. Constant supply of soap and alcohol-based hand rub was available in 82% and 68%; and 74% and 79% of units in the capital city and regional hospitals, respectively. Only 10% of the units in both hospitals had hand-drying facilities and functional sinks. Overall HH compliance for the two hospitals was 18.6% and was higher in the regional (20.8%) than the capital city (17.0%) hospitals. The HH levels for the capital city and regional hospitals were 277.5 and 262.5 respectively. Despite the COVID-19 pandemic, there are still challenges with HH compliance in Sierra Leone. It is, therefore, necessary to strengthen the HH multi-modal strategy

Making GDPR Usable: A Model to Support Usability Evaluations of Privacy

We introduce a new model for evaluating privacy that builds on the criteria proposed by the EuroPriSe certification scheme by adding usability criteria. Our model is visually represented through a cube, called Usable Privacy Cube (or UP Cube), where each of its three axes of variability captures, respectively: rights of the data subjects, privacy principles, and usable privacy criteria. We slightly reorganize the criteria of EuroPriSe to fit with the UP Cube model, i.e., we show how EuroPriSe can be viewed as a combination of only rights and principles, forming the two axes at the basis of our UP Cube. In this way we also want to bring out two perspectives on privacy: that of the data subjects and, respectively, that of the controllers/processors. We define usable privacy criteria based on usability goals that we have extracted from the whole text of the General Data Protection Regulation. The criteria are designed to produce measurements of the level of usability with which the goals are reached. Precisely, we measure effectiveness, efficiency, and satisfaction, considering both the objective and the perceived usability outcomes, producing measures of accuracy and completeness, of resource utilization (e.g., time, effort, financial), and measures resulting from satisfaction scales. In the long run, the UP Cube is meant to be the model behind a new certification methodology capable of evaluating the usability of privacy, to the benefit of common users. For industries, considering also the usability of privacy would allow for greater business differentiation, beyond GDPR compliance.Comment: 41 pages, 2 figures, 1 table, and appendixe

Bringing the social into vaccination research: Community-led ethnography and trust-building in immunization programs in Sierra Leone

Background Vaccine hesitancy is a complex, contested social phenomenon and existing research highlights the multifaceted role of trust in strengthening vaccine confidence. However, understanding public engagement with vaccination through the lens of (mis)trust requires more contextual evidence on trust's qualitative determinants. This includes expanding the geographic focus beyond current studies' focus on High Income Countries. Furthermore, obstacles remain in effectively integrating social science findings in the design of vaccine deployment strategies, and in ensuring that those who implement interventions and are affected by them are directly involved in producing knowledge about vaccination challenges. Methods We piloted a community-led ethnographic approach, training Community Health Workers (CHWs) in Kambia District, Sierra Leone, in qualitative social science methods. Methods included participant observation, participatory power mapping and rumour tracking, focus group discussions and key stakeholder interviews. CHWs, with the support of public health officials and professional social scientists, conducted research on vaccination challenges, analysed data, tested new community engagement strategies based on their findings and elicited local perspectives on these approaches. Results Our findings on vaccine confidence in five border communities highlighted three key themes: the impact of prior experiences with the health system on (mis)trust; relevance of livelihood strategies and power dynamics for vaccine uptake and access; and the contextual nature of knowledge around vaccines. Across these themes, we show how expressions of trust centered on social proximity, reliability and respect and the role of structural issues affecting both vaccine access and confidence. The pilot also highlighted the value and practical challenges to meaningfully co-designed research. Conclusion There is scope for broader application of a community-led ethnographic approach will help redesign programming that is responsive to local knowledge and experience. Involving communities and low-cadre service providers in generating knowledge and solutions can strengthen relationships and sustain dialogue to bolster vaccine confidence

Lower Bounds for Encrypted Multi-Maps and Searchable Encryption in the Leakage Cell Probe Model

Encrypted multi-maps (EMMs) enable clients to outsource the storage of a multi-map to a potentially untrusted server while maintaining the ability to perform operations in a privacy-preserving manner. EMMs are an important primitive as they are an integral building block for many practical applications such as searchable encryption and encrypted databases. In this work, we formally examine the tradeoffs between privacy and efficiency for EMMs. Currently, all known dynamic EMMs with constant overhead reveal if two operations are performed on the same key or not that we denote as the $\mathit{global\ key\text{-}equality\ pattern}$. In our main result, we present strong evidence that the leakage of the global key-equality pattern is inherent for any dynamic EMM construction with $O(1)$ efficiency. In particular, we consider the slightly smaller leakage of $\mathit{decoupled\ key\text{-}equality\ pattern}$ where leakage of key-equality between update and query operations is decoupled and the adversary only learns whether two operations of the $\mathit{same\ type}$ are performed on the same key or not. We show that any EMM with at most decoupled key-equality pattern leakage incurs $\Omega(\log n)$ overhead in the $\mathit{leakage\ cell\ probe\ model}$. This is tight as there exist ORAM-based constructions of EMMs with logarithmic slowdown that leak no more than the decoupled key-equality pattern (and actually, much less). Furthermore, we present stronger lower bounds that encrypted multi-maps leaking at most the decoupled key-equality pattern but are able to perform one of either the update or query operations in the plaintext still require $\Omega(\log n)$ overhead. Finally, we extend our lower bounds to show that dynamic, $\mathit{response\text{-}hiding}$ searchable encryption schemes must also incur $\Omega(\log n)$ overhead even when one of either the document updates or searches may be performed in the plaintext

SQL on Structurally-Encrypted Databases

We show how to encrypt a relational database in such a way that it can efficiently support a large class of SQL queries. Our construction is based solely on structured encryption (STE) and does not make use of any property-preserving encryption (PPE) schemes such as deterministic and order-preserving encryption. As such, our approach leaks considerably less than PPE-based solutions which have recently been shown to reveal a lot of information in certain settings (Naveed et al., CCS \u2715). Our construction is efficient and---under some conditions on the database and queries---can have asymptotically-optimal query complexity. We also show how to extend our solution to be dynamic while maintaining the scheme\u27s optimal query complexity

Lower Limb Amputation at the 34 Military Hospital in Freetown, Sierra Leone: Causes and Indications.

The global prevalence of diabetes mellitus is increasing substantially. This overall increment leads to the growth in the number of individuals with diabetic complications including lower limb amputation. In low-income countries like Sierra Leone, lack of access to adequate health care, poverty and social stigma attached to “amputation” all prevent people from seeking early medical treatment for diabetic foot.The purpose of this study was to document the causes and indications of lower limb amputations and to make appropriate recommendations to the health sector of Sierra Leone.This retrospective study was conducted at 34 Military Hospital, one of the major referral hospitals in Freetown, between January 2011 and December 2014. A team of medical staff was trained to extract data. The operating theatre and ward case records were searched for information (age, gender, cause and indication for amputation) of all the patients who underwent amputation during this period. The findings were statistically documented in tables.Twenty-seven patients (24 males and 3 females) were involved in the study. The age distribution was 15-65 years (Mean 43). Majority (77.7%) of the patients presented with gangrenous and infected diabetic feet, 18.5 % was due to Road Traffic Accident and 3.8% due to complication of HIV infection. The commonest level was transtibial amputation 85% and 67% was right sided. Hospital stay was 20-50 days (average 35). There was no postoperative mortality.As most amputations were done for diabetic feet, there is need for diabetes sensitization and prevention campaigns for the general public and improvement of diabetic care for individual patients including proper glycemic control and risk factors prevention. Increased funding is required by the health sector of Sierra Leone to implement these measures. Prevention of road traffic accidents by training/educating the drivers should also be considered by Sierra Leone Road Transport Authority.

Prevalence of sero-markers and non-invasive assessment of liver cirrhosis in patients with hepatitis B virus infection in Freetown, Sierra Leone: a cross-sectional study

BACKGROUND: Hepatitis B virus (HBV) is a major global health problem. Although sub-Saharan Africa has a high proportion of the global burden of HBV, the epidemiology and clinical features of HBV in this region are poorly characterized, and access to diagnostic and treatment services remain limited. METHODS: We conducted a retrospective study of HBV-infected children and adults of all age groups who were evaluated at public and private health facilities in Freetown, Sierra Leone between January 2017 and January 2019. We assessed their clinical presentation, HBV sero-markers, stages of liver disease, prevalence of cirrhosis by non-invasive tools, and the proportion of treatment eligible patients using the criteria recommended by the World Health Organization's 2015 treatment guidelines for HBV. Logistic regression was used to identify predictors of liver cirrhosis. RESULTS: 163 HBV patients included in the study, with mean age 32.6 years and 65.0% (106) being males. Most (84.0%) were asymptomatic at presentation. The majority (69.9%) were classified as having HBeAg-negative chronic infection (or inactive HBsAg carrier phase), 24.5% were in the HBeAg-negative immune active phase, 3.1% had HBeAg positive hepatitis, and 2.5% were HBsAg negative. The median Aspartate aminotransferase to Platelet Ratio (APRI) and Fibrosis-4 (FIB-4) scores were 0.37 and 0.80, respectively. The prevalence of cirrhosis was 7.6% and 6.2%, estimated by the APRI and FIB-4 scores, respectively. About 20.0% of patients were eligible for treatment with antiviral agents. Based on APRI scores, the presence of any symptom [adjusted odds ratio (aOR) 20.0, 95% confidence interval (CI) (4.1-85.9); p < 0.001], elevated direct bilirubin [aOR 12.1, 95% CI (1.9-63.0); p = 0.003], and elevated total bilirubin [aOR 16.1, 95% CI (3.2-80.8); p = 0.001] were independent predictors of cirrhosis. CONCLUSION: Although most patients with HBV infection were asymptomatic, the prevalence of liver cirrhosis and proportion of patients requiring antiviral treatment were substantial. This small study from a hyperendemic setting in Sierra Leone suggests that routine population-based screening may increase early detection and linkage of HBV patients to care before development of complications. Larger studies are needed to confirm our findings

Measuring Impact of Air and Agricultural Soil Pollution on Social Development in Saudi Arabia

This research aimed to measure the impact of air and agricultural soil pollution on social development in Saudi Arabia from the period 1995–2019 by using social development indicators, concentrating on the percentages of expenditure on education and health, and the Human Development Index. In addition, this study uses multiple regressions in estimating the model to study the impact of air pollution and agricultural soil on social development. Results of the study showed that a 10% change in the number of chemical fertilizers and pesticides used in Saudi agriculture leads to a change in the total number of inpatients by 0.7% and 0.5%, respectively. It was also found that an increased percentage of health expenditure to total government spending by 10% leads to a decrease in the total number of patients in the hospital by 1.8%. An increase in air pollution, expressed as a 10% increase in CO2 emissions, increases the total number of hospitalized patients by 11.1%.  The increasing total number of patients by 10% leads to a decrease in the total productivity of the worker, as an indicator of 1.8%. Furthermore, a change of 10% in the ratio of education expenditure to total government expenditure leads to a change in the same direction of the Human Development Index by 9.6%. In light of these results, it can be recommended that the country need to reduce air pollution by expanding the use of natural gas in the industrial and transportation sectors, in addition to reducing the use of nitrogenous fertilizers and pesticides in Saudi agriculture through the expansion of clean farming and good agricultural practices