Twenty years of human research ethics committees in the Baltic States

Two decades have passed since the first attempts were made to establish systematic ethical review of human research in the Baltic States. Legally and institutionally much has changed. In this paper we provide an historical and structural overview of ethical review of human research and identify some problems related to the role of ethical review in establishing quality research environment in these countries. Problems connected to (a) public availability of information, (b) management of conflicts of interest, (c) REC composition and motivation of REC members, and (d) differing levels of stringency of ethical review for different types of studies, are identified. Recommendations are made to strengthen cooperation among the Baltic RECs.

MAC-bridging for multi-PHYs communication in BAN

Body Area Network (BAN) is a collection of low-power, miniaturised, and intelligent sensor nodes that are used for unobtrusive and ambulatory health monitoring of a patient without any additional constraints. These nodes operate on different frequency bands or Multiple Physical Layers (Multi-PHYs). Additionally, some BAN applications demand a logical connection between different nodes working on different Multi-PHYs. In this paper, the idea of controlling Multi-PHYs using one MAC protocol is introduced. Unlike existing procedures where different nodes working on different channels are connected at the link layer bridging/switching, the proposed procedure called bridging logically connects them at the MAC layer. In other words, the bridge is used to relay or filter packets between different PHYs in the same BAN. Numerical approximations are presented to analyze the stochastic behaviour of the bridges, all of them having Multi-PHYs interfaces. The MICS and the ISM bands are regarded as PHY1 and PHY2, respectively. The performance results are presented for PHY2 (given that data is already received from PHY1) in terms of probability of successful transmission, number of failed requests, power consumption, and delay. Simulations are conducted to validate the analytical results. It can be seen that the deployment of multiple bridges along with the corresponding nodes allows Multi-PHYs communication with high transmission probability, low power consumption, and tolerable delay.

Continuous production of flexible carbon nanotube-based transparent conductive films

This work shows a simple, single-stage, scalable method for the continuous production of high-quality carbon nanotube-polymer transparent conductive films from carbon feedstock. Besides the ease of scalability, a particular advantage of this process is that the concentration of nanotubes in the films, and thus transparency and conductivity, can be adjusted by changing simple process parameters. Therefore, films can be readily prepared for any application desired, ranging from solar cells to flat panel displays. Our best results show a surface resistivity of the order of 300 Ω square^-1 for a film with 80% transparency, which is promising at this early stage of process development.

Value-by-alpha maps: An alternative technique to the cartogram

The cartogram, or value-by-area map, is a popular technique for cartographically representing social data. Such maps visually equalize a basemap prior to mapping a social variable by adjusting the size of each enumeration unit by a second, related variable. However, to scale the basemap units according to an equalizing variable, cartograms must distort the shape and/or topology of the original geography. Such compromises reduce the effectiveness of the visualization for elemental and general map-reading tasks. Here we describe a new kind of representation, termed a value-by-alpha map, which visually equalizes the basemap by adjusting the alpha channel, rather than the size, of each enumeration unit. Although not without its own limitations, the value-by-alpha map is able to circumvent the compromise inherent to the cartogram form, perfectly equalizing the basemap while preserving both shape and topology.

The value of using top-down and bottom-up approaches for building trust and transparency in biobanking

With the domestic and international proliferation of biobanks and their associated connections to health information databases, scholarly attention has been turning from the ethical issues arising from the construction of biobanks to the ethical issues that emerge in their operation and management. Calls for greater transparency in governance structures, coupled with stern reminders of the value of maintaining public trust, are seen as critical components in the success of these resources. Two different approaches have been adopted for addressing these types of ethical issues: the first is a 'top-down' approach which focuses on developing policy, procedures, regulations and guidelines to aid decision-makers. The second is a 'bottom-up' approach, which begins with those who are most affected by the issues and attempts to inductively develop consensus recommendations and policy. While both approaches have merit, I argue that more work needs to be done on 'bottom-up' strategies if trust and transparency are to be more than mere slogans. Using 2 case examples from Indiana, the paper summarizes data from a set of surveys we recently conducted that address issues arising from biobanks that provide some insight into issues associated with trust and transparency.

Does price transparency legislation allow the uninsured to shop for care?

BACKGROUND

The majority of states have enacted price transparency laws to allow patients to shop for care and to prevent price discrimination of the uninsured. In California, hospitals must provide a price estimate to a requesting uninsured patient and cannot bill for an amount greater than the reimbursement the hospital would receive from a government payer.

OBJECTIVE

To assess the response rate of California hospitals to a patient price request and to compare the price estimates received to Medicare reimbursement.

DESIGN

We sent letters to California acute-care hospitals from a fictional uninsured patient requesting an estimate for one of three common elective procedures: a laparoscopic cholecystectomy, a hysterectomy, or routine screening colonoscopy.

PARTICIPANTS

Three hundred and fifty-three hospitals in California.

MEASUREMENTS

Hospital response rates, difference between price estimates received, and Medicare reimbursement for equivalent procedures.

RESULTS

Only 28% (98/353) of hospitals responded and their response varied in content. Of the 98 responses, 15 (15%) did not provide a quote and instead asked for more information such as the billing code, 55 (56%) provided a price estimate for hospital services only, 10 (10%) included both physician and hospital services, and 18 (18%) did not specify what was covered. The median discounted price estimate was higher than Medicare reimbursement rates for all procedures: hysterectomy ($17,403 vs. $5,569; p<0.001), cholecystectomy ($14,014 vs. $7,196; p<0.001) and colonoscopy ($2,017 vs. $216; p<0.001).

CONCLUSIONS

Current California legislation fails to meet its objective of enabling uninsured patients to compare prices for hospital-based health care services.

Porous polymer coatings: a versatile approach to superhydrophobic surfaces

We present a facile and inexpensive approach to superhydrophobic polymer coatings. The method involves the in-situ polymerization of common monomers in the presence of a porogenic solvent to afford superhydrophobic surfaces with the desired combination of micro- and nano-scale roughness. The method is applicable to a variety of substrates and is not limited to small areas or flat surfaces. The polymerized material can be ground into a superhydrophobic powder, which, once applied to a surface, renders it superhydrophobic. The morphology of the porous polymer structure can be efficiently controlled by composition of the polymerization mixture, while surface chemistry can be adjusted by photografting. Morphology control is used to reduce the globule size of the porous architecture from micro down to nanoscale thereby affording a transparent material. The influence of both surface chemistry as well as the length scale of surface roughness on the superhydrophobicity is discussed.

Episode-based physician profiling: a guide to the perplexing

Most current strategies to improve quality and efficiency in health-care delivery focus on measuring and improving physician practice. A new "second generation" of physician profiling--episode-based profiling--is moving beyond legacy "first-generation" physician profiles based on population health and preventive services measures. Episode-based profiling measures physician practice at the "episode of care" level with sophisticated analytic methods and tools using data from claim and other administrative data sets, and it has an underlying "theory of change" consistent with the evolution of the US health-care marketplace. While offering potential advantages in informing consumer choice and enabling practice improvement, episode-based profiling also has limitations and challenges, both analytically and in the process of physician engagement and improvement. Nonetheless, episode-based profiling is likely to continue to spread and have growing influence, and it has significant implications for research, policy, and clinical stakeholders.

Uncomfortable implications: placebo equivalence in drug management of a functional illness

Using a fictional but representative general practice consultation, involving the diagnosis of irritable bowel syndrome in a patient who is anxious for some relief from the discomfort his condition entails, this paper argues that when both (a) a drug fails to out-perform placebo and (b) the condition in question is a functional illness with no demonstrable underlying pathology, then the action of the drug is not only no better than placebo, and it is also no different from it either. The paper also argues that, in the circumstances of the consultation described, it is striking that current governance deems it ethical for a practitioner to prescribe either a drug or a placebo, both of which appear to rely for their effectiveness on a measure of concealment on the part of the doctor, yet deems it unethical for a practitioner openly to prescribe a harmless and enjoyable substance which (in equivalent conditions of transparency and information) is likely to be no less effective than either drug or placebo and is also likely to be better-tolerated and cheaper than the drug.

Global integration of local color differences in transparency perception: An fMRI study

In normal viewing, the visual system effortlessly assigns approximately constant attributes of color and shape to perceived objects. A fundamental component of this process is the compensation for illuminant variations and intervening media to recover reflectance properties of natural surfaces. We exploited the phenomenon of transparency perception to explore the cortical regions implicated in such processes, using fMRI. By manipulating the coherence of local color differences around a region in an image, we interfered with their global perceptual integration and thereby modified whether the region appeared transparent or not. We found the major cortical activation due to global integration of local color differences to be in the anterior part of the parahippocampal gyrus. Regions differentially activated by chromatic versus achromatic geometric patterns showed no significant differential response related to the coherence/incoherence of local color differences. The results link the integration of local color differences in the extraction of a transparent layer with sites activated by object-related properties of an image.

Regulating medicines in Europe: the European Medicines Agency, marketing authorisation, transparency and pharmacovigilance

Following a review process lasting almost four years, and culminating in several pieces of new European legislation, adjustments have been made to the European Union's (EU) regulatory framework for pharmaceuticals. The European Commission laid out its priorities for the review as: simplifying the authorisation system, ensuring a high quality of public health, completing the internal market in medicines, and preparing for the enlargement of the Union. Amongst the most important changes brought about by the new rules are those relating to the European drug approval procedures, the functions and operational transparency of the European Medicines Agency (EMEA), and the EU's pharmacovigilance system. This article provides a brief examination of key elements of these changes, and considers the extent to which they serve the goal of improved public health protection within the EU.