Actual Covid-19 deaths

Michael Marshn made this Freedom of Information request to University Hospitals Sussex NHS Foundation Trust

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The request was partially successful.

Dear University Hospitals Sussex NHS Foundation Trust,

Please can you provide the following information:

*A weekly data set of actual covid deaths that have occurred in patients with whom have no pre-existing medical conditions / co-morbidities; up to present date (13/04/2021 or when the responder collects the data), if the data is available.

*A weekly or monthly figure for unconfirmed Covid-19 deaths (deaths that have occurred without a positive test result from either a lateral flow or PCR test).
 
*A total monthly figure of tests (in totality) undertaken by staff members at the trust.

*A monthly figure (to date) of all staff at the trust who have been required to retest after a positive lateral flow result, with a PCR test. 

*Should a staff member or an inpatient receive a 2nd positive test result, are both positive test results being inputted in to the daily figures as two positive cases? Or is there differentiation between the groups?.

*At what CT value is the PCR test conducted at? And is this individualised to the Trust or set nationally?.

*What has trust identified the false positive rate to be of the PCR test to date ?

Please provide the number of samples of live SARS-COV-2 isolated in Southampton laboratory or a laboratory within the United Kingdom in 2020 or 2021 and a copy of the standard operating procedure for handling and isolating SARS-COV-2 in laboratory within the trust or within the United Kingdom or can offer the alternative by providing the number of samples of live SARS-COV-2 isolated in the trusts lab in 2020 and a copy of the standard operating procedure for handling and isolating SARS-COV-2 in trusts or lab within the United Kingdom.

If the evidence is available then please can you provide an easy read data document and NOT links to the information/data and please could the data be up to date of when the responder collects the data.

Yours faithfully,

Michael Marshn

FREEDOMOFINFORMATION (UNIVERSITY HOSPITALS SUSSEX NHS FOUNDATION TRUST), University Hospitals Sussex NHS Foundation Trust

Dear Michael,

 

Thank you for contacting the Freedom of Information (FOI) Office at
University Hospitals Sussex NHS Foundation Trust.  This email confirms
that we have received your correspondence. 

 

We will now consider your request for information and reply in due
course.  Under the terms of the Act the Trust has 20 working days in which
to respond.  Your request has been assigned a reference number which has
been provided in the subject heading above.  Please quote this reference
number in any communication about your request.

 

The Freedom of Information Act contains a number of exemptions that may
apply to some or all of the information you are seeking.  If this is the
case, we will tell you that we have withheld information and why.  If
clarification is required to assist us in identifying the information you
have requested, we will contact you.  The 20-working day clock associated
with FOI processing will then restart once we have received clarification.

 

It is important to note that the NHS continues to face unprecedented
challenges associated with the coronavirus pandemic.  While we will make
every effort to respond to your request within 20 working days, our staff
remain focused on supporting patient care and restoring vital healthcare
services.  Staff availability for information rights work will remain
limited for some time.  It will not be possible for us to process large
requests for information that require an unreasonable level of staff
resources to complete.  If you would like to revise your request, please
let us know by emailing us.      

 

Information about submitting FOI requests to public authorities can be
found on the Information Commissioner’s website
- [1]https://ico.org.uk/your-data-matters/off...

 

If we can be of any further assistance, please do not hesitate to contact
us at - [2][UHSussex request email]  

 

Yours sincerely,

 

Freedom of Information Office

University Hospitals Sussex NHS Foundation Trust

 

 

 

 

 

 

 

show quoted sections

Dear FREEDOMOFINFORMATION (UNIVERSITY HOSPITALS SUSSEX NHS FOUNDATION TRUST),

Please can you provide the following information:
*A weekly data set of actual covid deaths that have occurred in patients with whom have no pre-existing medical conditions / co-morbidities; up to present date (13/04/2021 or when the responder collects the data), if the data is available.
*A weekly or monthly figure for unconfirmed Covid-19 deaths (deaths that have occurred without a positive test result from either a lateral flow or PCR test) from February 2020 up until present or when the data is collected by the responder.
 
1. A total monthly figure of tests (in totality) undertaken by staff members at the trust (from February 2020 up until present date or when the responder collects the data).
2. A monthly figure (to date) of all staff at the trust who have been required to retest after a positive lateral flow result, with a PCR test. 
3. Should a staff member or an inpatient receive a 2nd positive test result whether this be a PCR test or a lateral flow test, then are both positive test results inputted in to the daily covid-19 figures as two positive cases? Or is there differentiation between the groups?.
4. At what CT value is the PCR test conducted at? And is this individualised to the Trust or set nationally?.
5. What has trust identified the false positive rate to be of the PCR test to date? (up to the date that the data is captured by the responder).
6. Please provide the number of samples of live SARS-COV-2 which has been if so, isolated within Southampton laboratory or a laboratory within the United Kingdom in 2020 or 2021 and a copy of the standard operating procedure for handling and isolating SARS-COV-2 in laboratory within the trust or within the United Kingdom or can offer the alternative by providing the number of samples of live SARS-COV-2 isolated in the trusts lab in 2020 and a copy of the standard operating procedure for handling and isolating SARS-COV-2 in trusts or lab within the United Kingdom.

If the evidence is available then please can you provide an easy read data document and NOT links to the information/data. Please could all the data given be from February 2020 up to present date of when the responder collects the data.

Yours sincerely,

Michael Marshn

FREEDOMOFINFORMATION (UNIVERSITY HOSPITALS SUSSEX NHS FOUNDATION TRUST), University Hospitals Sussex NHS Foundation Trust

Dear Michael,

 

We are writing with regard to your recent request for information under
the Freedom of Information (FOI) Act 2000.

 

Your request:

           

1.    A weekly data set of actual covid deaths that have occurred in
patients with whom have no pre-existing medical conditions /
co-morbidities; up to present date (13/04/2021 or when the responder
collects the data), if the data is available.

 

2.    A weekly or monthly figure for unconfirmed Covid-19 deaths (deaths
that have occurred without a positive test result from either a lateral
flow or PCR test).

 

3.    A total monthly figure of tests (in totality) undertaken by staff
members at the trust.

 

4.    A monthly figure (to date) of all staff at the trust  who have been
required to retest after a positive lateral flow result, with a PCR test.

 

5.    Should a staff member or an inpatient receive a 2nd positive test
result, are both positive test results being inputted in to the daily
figures as two positive cases? Or is there differentiation between the
groups?

 

6.    At what CT value is the PCR test conducted at? And is this
individualised to the Trust or set nationally?

 

7.    What has trust identified the false positive rate to be of the PCR
test to date ?

 

8.    Please provide the number of samples of live SARS-COV-2 isolated in
Southampton laboratory or a laboratory within the United Kingdom in 2020
or 2021 and a copy of the standard operating procedure for handling and
isolating SARS-COV-2 in laboratory within the trust or within the United
Kingdom or can offer the alternative by providing the number of samples of
live SARS-COV-2 isolated in the trusts lab in 2020 and a copy of the
standard operating procedure for handling and isolating SARS-COV-2 in
trusts or lab within the United Kingdom.

 

If the evidence is available then please can you provide an easy read data
document and NOT links to the information/data and please could the data
be up to date of when the responder collects the data.

 

Our response:

 

The Trust has a responsibility under section 16 of the Act to provide
assistance with FOI requests where possible and reasonable to do so. 

 

University Hospitals Sussex NHS Foundation Trust 2021 was formed on 1
April 2021, with the merger of Brighton and Sussex University Hospitals
NHS Trust (BSUH) and Western Sussex Hospitals NHS Foundation Trust
(WSHT).  Some departments within the former Trusts are expected to operate
individually for some time to ensure there is no disruption to our
services.  We will provide information relevant to the new Trust where
possible, however, it may be necessary for us to report information held
by both former Trusts separately.  We regret any inconvenience this may
cause.

 

1.  The Trust is currently collecting and reporting data relevant to
Covid-related deaths according to the national definitions issued by
Public Health England (PHE).  Although we appreciate that there is a level
of public interest in alternative information relevant to Covid-related
deaths, we are currently unable to provide this additional data within the
‘appropriate limit’ as outlined in the Fees Regulations and the engagement
of section 12 exemption [cost limit] under the Act is appropriate at this
time. 

 

Any attempt to compile data where Covid-related deaths occurred in
patients with ‘no pre-existing medical conditions / co-morbidities’, would
require investigation into each patient’s medical history and the manual
audit of every relevant Medical Certificate of Cause of Death (MCCD) by a
medical examiner.  The reason this would be necessary is that the
distinction between those patients that died as a ‘direct result of
becoming infected with coronavirus’ and those patients that died ‘with
coronavirus’ is difficult to establish.  As an example, a patient who
tested positive for Covid-19 could have a heart attack two weeks later; a
number of factors would require careful consideration to determine whether
it was Covid-19 that caused the heart attack or if it was the result of an
underlying heart condition.  Unfortunately, such complex investigation
into each patient death in this context would require an unreasonable
level of staff resources to carry out.  We regret this decision, but we
simply do not have the spare capacity to carry out the work involved in
providing information in the format you have requested. 

 

We are, however, currently able to offer 2 different sets of data relevant
to your request.  The first is the total number of patients that died in
all Trust hospitals with COVID-19 indicated on their Medical Certificate
of Cause of Death (part 1 or 2) by month.  Please let us know if you would
like to receive this information. 

 

The Trust is also reporting Covid-related deaths in line with national
guidance issued by NHS England and Public Health England.  This
Trust-level data is reported daily and is accessible to the public using
this link -
[1]https://www.england.nhs.uk/statistics/st...
 Information about the definitions used for this data is also available
from this website.  Since this information is reasonably accessible via
other means, section 21 exemption under the FOIA is engaged.  Additional
information about Covid-related deaths across the UK, including a daily
dashboard of this activity, can be found on the government’s website using
this link – [2]https://coronavirus.data.gov.uk/details/...  

 

Please note that University Hospitals Sussex NHS Foundation Trust was
formed on 1 April 2021, with the merger of Brighton and Sussex University
Hospitals NHS Trust (BSUH) and Western Sussex Hospitals NHS Foundation
Trust (WSHT).  Prior to 1 April 2021, data was reported under Brighton and
Sussex University Hospitals NHS Trust and Western Sussex Hospitals NHS
Foundation Trust separately.  From 1 April 2021 we expect reporting for
both former Trusts to come under University Hospitals Sussex NHS
Foundation Trust, although this data may be reported under Western Sussex
Hospitals NHS Foundation Trust until NHS England update their reporting. 
We regret any confusion this might cause.

 

2.  Can you please clarify the nature of information you are seeking for
this part of your request?  A positive test result from a PCR test is
associated with all COVID-related deaths.

 

3.  The Trust does not hold a total figure that meets the criteria of your
request.  We can report on the number of positive PCR tests logged as
‘staff screening’ from the Trust’s Pathology system.  This data will
include cases tested at the ‘Pods’ outside A&E at each hospital, together
with staff on the wards who have been screened following contact tracing. 
Although the vast majority of this data will be relevant to Trust
employees, some family and household members who were also tested under
this programme will be included in our data.  It is also important to note
that a number of staff will have chosen to take their tests elsewhere at a
more convenient testing site, so the data we hold will not be a complete
picture.  Additionally, staff are given lateral flow test kits to carry
out routine testing at home and the Trust does not hold data regarding the
number of actual tests carried out.

 

4.  The Trust does hold data to this level of detail – please see response
to question 3.

 

5.  The Trust does not differentiate between staff or patients who have
had two or more tests from those who have had a single test.  Staff and
patients with a positive test result are only recorded and counted once.

 

6.  Response relevant to former Western Sussex Hospitals NHS Foundation
Trust - The vast majority of the Trust’s molecular tests for COVID-19 go
through a high throughput analyser that uses transcription mediated
amplification (TMA) to detect the SARS-CoV-2 virus. This test does not
give results expressed as Cycle thresholds (CTs) but gives qualitative
results which are determined by a cut-off (based on the total Relative
Light Units (RLU) and the kinetic curve type) to be either detected or
not.  The Trust also uses a PCR test and the threshold of a CT of 34 is
deemed detected.  Thresholds of tests are set by the manufacturer of the
kit based on their validation studies. 

 

Response relevant to former Brighton and Sussex University Hospitals NHS
Trust - The vast majority of the Trust’s molecular tests for COVID-19 go
through a high throughput extraction analysers and are then amplified
using RealTime RT-PCR amplification thermocyclers. The RT-PCR assays are
run over 40 cycles and results are expressed as Cycle thresholds (CTs) as
per the commercial manufacturer guidance.

 

7.  The Trust has identified the false positive rate of the PCR test to be
less than 1%.

 

8.  The laboratory does not culture samples for live virus in-house or
refer samples to another laboratory for this.

 

With the above in mind, we are writing to you under section 16 of the Act
[duty to assist] to offer you the opportunity to revise your request.  If
you would like to receive the data that we are currently able to provide
for question 1 of your request as outlined above, please let us know and
we will make every effort to get this information to you.

 

Please note that the 20 working day clock associated with FOI requests
will restart once we have received a response from you.

 

We look forward to your reply and will respond in due course.  Some
information, however, might be withheld due to exemptions which are
allowed for by the Act. If this is the case, we will tell you that we have
withheld information and why.

 

In the meantime, if we can be of further assistance please do not hesitate
to contact the Trust at: [3][email address]

 

Yours sincerely, 

 

Freedom of Information Office

University Hospitals Sussex NHS Foundation Trust

 

 

 

 

 

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Dear FREEDOMOFINFORMATION (UNIVERSITY HOSPITALS SUSSEX NHS FOUNDATION TRUST),

Thank you for the information, I will overlook the information you have provided and I may have some follow up questions moving forward, however for the moment please could I be provided with the information that you say you are able to provide me with in regards to questions number 1.

Yours sincerely,

Michael Marshn

Dear FREEDOMOFINFORMATION (UNIVERSITY HOSPITALS SUSSEX NHS FOUNDATION TRUST),

After overlooking the reply could you please provide me with your offer of 2 different sets of data relevant
to my request. Could you also detail if COVID-19 death was listed as category 1 or 2.

Yours sincerely,

Michael Marshn

FREEDOMOFINFORMATION (UNIVERSITY HOSPITALS SUSSEX NHS FOUNDATION TRUST), University Hospitals Sussex NHS Foundation Trust

Thank you for your message.

We will forward the request to our subject leads, and we will contact you again in due course with the requested information.

Freedom of Information Office
University Hositals Sussex NHS Foundation Trust

show quoted sections

FREEDOMOFINFORMATION (UNIVERSITY HOSPITALS SUSSEX NHS FOUNDATION TRUST), University Hospitals Sussex NHS Foundation Trust

1 Attachment

Dear Michael,

 

Thank you for your recent request for information under the Freedom of
Information (FOI) Act 2000.

 

We are now in a position to respond to your request.

 

Your request:

 

Please can you provide the following information:

 

1.     *A weekly data set of actual covid deaths that have occurred in
patients with whom have no pre-existing medical conditions /
co-morbidities; up to present date (13/04/2021 or when the responder
collects the data), if the data is available.

 

2.     *A weekly or monthly figure for unconfirmed Covid-19 deaths (deaths
that have occurred without a positive test result from either a lateral
flow or PCR test).

 

3.     *A total monthly figure of tests (in totality) undertaken by staff
members at the trust.

 

4.     *A monthly figure (to date) of all staff at the trust  who have
been required to retest after a positive lateral flow result, with a PCR
test.

 

5.     *Should a staff member or an inpatient receive a 2nd positive test
result, are both positive test results being inputted in to the daily
figures as two positive cases? Or is there differentiation between the
groups?.

 

6.     *At what CT value is the PCR test conducted at? And is this
individualised to the Trust or set nationally?.

 

7.     *What has trust identified the false positive rate to be of the PCR
test to date ?

 

8.     Please provide the number of samples of live SARS-COV-2 isolated in
Southampton laboratory or a laboratory within the United Kingdom in 2020
or 2021 and a copy of the standard operating procedure for handling and
isolating SARS-COV-2 in laboratory within the trust or within the United
Kingdom or can offer the alternative by providing the number of samples of
live SARS-COV-2 isolated in the trusts lab in 2020 and a copy of the
standard operating procedure for handling and isolating SARS-COV-2 in
trusts or lab within the United Kingdom.

           

Assistance provided under Section 16 [duty to assist] on 12 May 2021:

 

           The Trust has a responsibility under section 16 of the Act to
provide assistance with FOI requests where possible and reasonable to do
so. 

 

University Hospitals Sussex NHS Foundation Trust was formed on 1 April
2021, with the merger of Brighton and Sussex University Hospitals NHS
Trust (BSUH) and Western Sussex Hospitals NHS Foundation Trust (WSHT). 
Some departments within the former Trusts are expected to operate
individually for some time to ensure there is no disruption to our
services.  We will provide information relevant to the new Trust where
possible, however, it may be necessary for us to report information held
by both former Trusts separately.  We regret any inconvenience this may
cause.

 

1.  The Trust is currently collecting and reporting data relevant to
Covid-related deaths according to the national definitions issued by
Public Health England (PHE).  Although we appreciate that there is a level
of public interest in alternative information relevant to Covid-related
deaths, we are currently unable to provide this additional data within the
‘appropriate limit’ as outlined in the Fees Regulations and the engagement
of section 12 exemption [cost limit] under the Act is appropriate at this
time. 

 

Any attempt to compile data where Covid-related deaths occurred in
patients with ‘no pre-existing medical conditions / co-morbidities’, would
require investigation into each patient’s medical history and the manual
audit of every relevant Medical Certificate of Cause of Death (MCCD) by a
medical examiner.  The reason this would be necessary is that the
distinction between those patients that died as a ‘direct result of
becoming infected with coronavirus’ and those patients that died ‘with
coronavirus’ is difficult to establish.  As an example, a patient who
tested positive for Covid-19 could have a heart attack two weeks later; a
number of factors would require careful consideration to determine whether
it was Covid-19 that caused the heart attack or if it was the result of an
underlying heart condition.  Unfortunately, such complex investigation
into each patient death in this context would require an unreasonable
level of staff resources to carry out.  We regret this decision, but we
simply do not have the spare capacity to carry out the work involved in
providing information in the format you have requested. 

 

We are, however, currently able to offer 2 different sets of data relevant
to your request.  The first is the total number of patients that died in
all Trust hospitals with COVID-19 indicated on their Medical Certificate
of Cause of Death (part 1 or 2) by month.  Please let us know if you would
like to receive this information. 

 

The Trust is also reporting Covid-related deaths in line with national
guidance issued by NHS England and Public Health England.  This
Trust-level data is reported daily and is accessible to the public using
this link -
[1]https://www.england.nhs.uk/statistics/st...
 Information about the definitions used for this data is also available
from this website.  Since this information is reasonably accessible via
other means, section 21 exemption under the FOIA is engaged.  Additional
information about Covid-related deaths across the UK, including a daily
dashboard of this activity, can be found on the government’s website using
this link – [2]https://coronavirus.data.gov.uk/details/...  

 

Please note that University Hospitals Sussex NHS Foundation Trust was
formed on 1 April 2021, with the merger of Brighton and Sussex University
Hospitals NHS Trust (BSUH) and Western Sussex Hospitals NHS Foundation
Trust (WSHT).  Prior to 1 April 2021, data was reported under Brighton and
Sussex University Hospitals NHS Trust and Western Sussex Hospitals NHS
Foundation Trust separately.  From 1 April 2021 we expect reporting for
both former Trusts to come under University Hospitals Sussex NHS
Foundation Trust, although this data may be reported under Western Sussex
Hospitals NHS Foundation Trust until NHS England update their reporting. 
We regret any confusion this might cause.

 

2.  Can you please clarify the nature of information you are seeking for
this part of your request?  A positive test result from a PCR test is
associated with all COVID-related deaths.

 

3.  The Trust does not hold a total figure that meets the criteria of your
request.  We can report on the number of positive PCR tests logged as
‘staff screening’ from the Trust’s Pathology system.  This data will
include cases tested at the ‘Pods’ outside A&E at each hospital, together
with staff on the wards who have been screened following contact tracing. 
Although the vast majority of this data will be relevant to Trust
employees, some family and household members who were also tested under
this programme will be included in our data.  It is also important to note
that a number of staff will have chosen to take their tests elsewhere at a
more convenient testing site, so the data we hold will not be a complete
picture.  Additionally, staff are given lateral flow test kits to carry
out routine testing at home and the Trust does not hold data regarding the
number of actual tests carried out.

 

4.  The Trust does hold data to this level of detail – please see response
to question 3.

 

5.  The Trust does not differentiate between staff or patients who have
had two or more tests from those who have had a single test.  Staff and
patients with a positive test result are only recorded and counted once.

 

6.  Response relevant to former Western Sussex Hospitals NHS Foundation
Trust - The vast majority of the Trust’s molecular tests for COVID-19 go
through a high throughput analyser that uses transcription mediated
amplification (TMA) to detect the SARS-CoV-2 virus. This test does not
give results expressed as Cycle thresholds (CTs) but gives qualitative
results which are determined by a cut-off (based on the total Relative
Light Units (RLU) and the kinetic curve type) to be either detected or
not.  The Trust also uses a PCR test and the threshold of a CT of 34 is
deemed detected.  Thresholds of tests are set by the manufacturer of the
kit based on their validation studies. 

 

Response relevant to former Brighton and Sussex University Hospitals NHS
Trust - The vast majority of the Trust’s molecular tests for COVID-19 go
through a high throughput extraction analysers and are then amplified
using RealTime RT-PCR amplification thermocyclers. The RT-PCR assays are
run over 40 cycles and results are expressed as Cycle thresholds (CTs) as
per the commercial manufacturer guidance.

 

7.  The Trust has identified the false positive rate of the PCR test to be
less than 1%.

 

8.  The laboratory does not culture samples for live virus in-house or
refer samples to another laboratory for this.

 

With the above in mind, we are writing to you under section 16 of the Act
[duty to assist] to offer you the opportunity to revise your request.  If
you would like to receive the data that we are currently able to provide
for question 1 of your request as outlined above, please let us know and
we will make every effort to get this information to you.

 

Please note that the 20 working day clock associated with FOI requests
will restart once we have received a response from you.

 

Your response received 12 May 2021:

 

After overlooking the reply could you please provide me with your offer of
2 different sets of data relevant to my request. Could you also detail if
COVID-19 death was listed as category 1 or 2.

                       

Our response:

 

Under Section 1(1)(a) of the Freedom of Information Act (FOIA), the Trust
can confirm that it holds information relevant to your request and this
has been provided where possible below.

 

As indicated in our assistance email (see above), the Trust is reporting
Covid-related deaths in line with national guidance issued by NHS England
and Public Health England.  This Trust-level data is reported daily and is
accessible to the public using this link -
[3]https://www.england.nhs.uk/statistics/st...
 This is the most complete data relevant to the number of total
covid-related deaths in our hospitals.  Since this information is
reasonably accessible via other means, section 21 exemption under the FOIA
is engaged. 

 

The total number of patients that died with COVID-19 indicated on their
Medical Certificate of Cause of Death (part 1 or 2) by month is provided
in the tables below.  Data from April 2021 to date is still being
validated and is not currently available.

 

Information relevant to former Brighton and Sussex University Hospitals
NHS Trust

 

Month / Year Total number of deaths in Trust hospitals with
Covid-19 mentioned on the death certificate
March 2020 24
April 2020 80
May 2020 43
June 2020 16
July 2020 6
August 2020 1
September 2020 1
October 2020 11
November 2020 35
December 2020 60
January 2021 171
February 2021 66
March 2021 40

    

            Information relevant to former Western Sussex Hospitals NHS
Foundation Trust

           

Month / Year Total number of deaths in Trust hospitals with
Covid-19 mentioned on the death certificate
March 2020 11
April 2020 69
May 2020 24
June 2020 4
July 2020 0
August 2020 1
September 2020 9
October 2020 4
November 2020 9
December 2020 26
January 2021 209
February 2021 84
March 2021 12

 

[4]cid:e37a316a-2f96-4fe3-83d9-0a6a4e147994

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this Information is provided to you under the Open Government Licence
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If you require clarification or if we can be of any further assistance,
please do not hesitate to contact us at: [8][UHSussex request email]

 

If after contacting us with any questions or concerns you remain
dissatisfied with the outcome of your enquiry, you have the right to
appeal.  Please email us or write to:

 

Freedom of Information Office

C/O Company Secretary

University Hospitals Sussex NHS Foundation Trust

Worthing Hospital

Lyndhurst Rd,

Worthing BN11 2DH

 

After we have reviewed your complaint, if you are still not satisfied with
the outcome of your appeal you can contact the Information Commissioner’s
Office.  This can be done via their website
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via telephone - 0303 123 1113.

 

We hope you are happy with the handling of your request and that you find
any information we have provided helpful.

 

Yours sincerely,

 

Freedom of Information Office

University Hospitals Sussex NHS Foundation Trust

 

 

 

 

 

 

show quoted sections