Performing the Union: the Prüm Decision and the European dream

In 2005, seven European countries signed the so-called Prüm Treaty to increase transnational collaboration in combating international crime, terrorism and illegal immigration. Three years later, the Treaty was adopted into EU law. EU member countries were now obliged to have systems in place to allow authorities of other member states access to nationally held data on DNA, fingerprints, and vehicles by August 2011. In this paper, we discuss the conditions of possibility for the Prüm network to emerge, and argue that rather than a linear ascent towards technological and political convergence and harmonisation, the (hi)story of Prüm is heterogeneous and halting. This is reflected also in the early stages of implementing the Prüm Decision which has proven to be more challenging than it was hoped by the drivers of the Prüm process. In this sense, the Prüm network sits uncomfortably with success stories of forensic science (many of which served the goal of justifying the expansion of technological and surveillance systems). Instead of telling a story of heroic science, the story of Prüm articulates the European dream: one in which goods, services, and people live and travel freely and securely.

Proposal for a data publication and citation framework when sharing biomedical research resources

Research data and biospecimen repositories are valuable resources for biomedical investigators. Sharing these resources has great potential benefits including efficient use of resources, avoiding duplicate experiments, gathering adequate sample sizes, and promoting collaboration. However, concerns from data producers about difficulties of getting proper acknowledgement for their data contributions are increasingly becoming obstacles for efficient and large-scale data sharing in reality. In this research project we analyzed the inadequacy of current policy-based solution for promoting data sharing. The recommendations in this paper emphasize data publication and citation. This project aims to promote the acknowledgement of data contributors with realizable informatics tools that augment informal policy-level strategies, and do so in a way that promotes data sharing.

DNA profiles, computer searches, and the Fourth Amendment

Pursuant to federal statutes and to laws in all fifty states, the United States government has assembled a database containing the DNA profiles of over eleven million citizens. Without judicial authorization, the government searches each of these profiles one-hundred thousand times every day, seeking to link database subjects to crimes they are not suspected of committing. Yet, courts and scholars that have addressed DNA databasing have focused their attention almost exclusively on the constitutionality of the government's seizure of the biological samples from which the profiles are generated. This Note fills a gap in the scholarship by examining the Fourth Amendment problems that arise when the government searches its vast DNA database. This Note argues that each attempt to match two DNA profiles constitutes a Fourth Amendment search because each attempted match infringes upon database subjects' expectations of privacy in their biological relationships and physical movements. The Note further argues that database searches are unreasonable as they are currently conducted, and it suggests an adaptation of computer-search procedures to remedy the constitutional deficiency.

[Regulations concerning data transparency- a comparison between the USA and Europe]

Since 2007 a far-reaching obligation to register and publish clinical trials of pharmaceuticals on the generally accessible website www.clinicaltrials.gov has applied under the US Food and Drug Administration Amendment Act ("FDAAA") section 801. This obligation also comprises clinical trials results. In the EU clinical trials are registered with the EudraCT data base. The published data are strictly confidential and only accessible to public authorities. The publicly accessible data base Eudrapharm does not generate information on trials; there have been vague extension plans. Since 2011, § 42b of the German Drugs Act provides that the results of clinical trials need to be reported (on the "PharmNet.Bund" website) in order to improve information for doctors and patients. The US regulations serve as a role model for an approach to keeping the general public fully informed about the start and the results of clinical drug trials and to avoiding publication bias.

Informed consent elements. Final rule

The Food and Drug Administration (FDA) is amending the current informed consent regulations to require that informed consent documents and processes for applicable drug (including biological products) and device clinical trials include a specific statement that clinical trial information will be entered into a databank. The databank referred to in this final rule is the clinical trial registry databank maintained by the National Institutes of Health/National Library of Medicine (NIH/NLM) which was created by statute. The submission of clinical trial information to this data bank also is required by statute. This amendment to the informed consent regulations is required by the Food and Drug Administration Amendments Act of 2007 (FDAAA) and is designed to promote transparency of clinical research to participants and patients.

Privacy versus public health: the impact of current confidentiality rules

Public health research and practice often have been facilitated through the evaluation and study of population-based data collected by local, state, and federal governments. However, recent concerns about identify theft, confidentiality, and patient privacy have led to increasingly restrictive policies on data access, often preventing researchers from using these valuable data. We believe that these restrictions, and the research impeded or precluded by their implementation and enforcement, have had a significant negative impact on important public health research. Members of the public health community should challenge these policies through their professional societies and by lobbying legislators and health officials to advocate for changes that establish a more appropriate balance between privacy concerns and the protection of public health.

The law and incomplete database information as confounders in epidemiologic research on occupational injuries and illnesses

BACKGROUND

Capture-recapture studies report undercounting of work injuries/illnesses with days away from work (DAFW) in the Bureau of Labor Statistics annual Survey of Occupational Injuries and Illnesses (BLS SOII) by 25-68% depending on the state and undercounting by various state workers' compensation (WC) systems of eligible claims by 5-35%.

METHODS

Statutory/regulatory criteria defining eligible cases are used to adjust counts in the 1998-2001 Minnesota's WC system and the BLS SOII to permit comparison and to evaluate the recent studies. Missing information in the employer database used in the capture-recapture studies is tabulated. An attempt is made to harmonize results with two additional databases counting work injuries.

RESULTS

Counts in the BLS SOII moderately undercount by 10-16% the number of WC cases. We believe that matching in capture-recapture studies is adversely affected by misperceptions regarding the application of statutory/regulatory eligibility criteria and by missing data. The result is that the reported undercounts in both the BLS SOII and several state WC databases are overstated in the capture-recapture studies. Although three of four databases can be approximately harmonized, the fourth cannot.

CONCLUSIONS

More precisely targeted information is needed before decisions regarding redesign of the BLS survey are made or before legislative or administrative changes in the WC are contemplated.

Concept of computer-assisted clinical diagnostic documentation systems for the practice with the option of later scientific evaluations

Treatment data from practices and specialization centers, especially in the increasingly specialized areas which university clinics do not cover, are very important for evaluating the effectiveness and efficiency of dental examination and treatment methods. In the case of paper-based documentation, the evaluation of these data usually fails because of the cost it entails. With the use of electronic medical records, this expense can be markedly lower, provided the data acquisition and storage is structured accordingly. Since access to sensitive person-related data is simplified considerably by this method, such health data are protected, especially on the European level. Other than generally assumed, this protection is not restricted solely to the confidentiality principle, but also comprises the power of disposition over the data (data protection). The result is that from a legal point of view, the treatment data cannot be readily used for scientific studies, not even by dentists and physicians who have collected the data legally during the course of their therapeutic work. The technical separation of treatment data from the personal data offers a legally acceptable solution to this problem. It must ensure that a later assignment to individual persons will not be feasible at a realistic expense ("effective anonymization"). This article describes the legal and information technology principles and their practical implementation, as illustrated by the concept of a respective compliant IT architecture for the dentaConcept CMD fact diagnostic software. Here, a special export function automatically separates the anonymized treatment data and thus facilitates multicentric studies within an institution and among dental practices.

Clinical databases and data protection: are they compatible?

In the current climate of clinical governance and audit, and in the setting of an active academic unit, an effective clinical database is an invaluable tool. In this article, we will present our neurovascular database, discuss the issues related to setting up the ideal clinical database, discuss the problems related to accurate data input and review the legal requirements of data protection. The success of a clinical database is reflected by the completeness of the data, the accessibility of the information and how useful it has proven to be. After 4 years of experimentation we currently use a database designed on Microsoft Access. The form is a single page. Junior medical staff input the information as medical staff have been found to be the most reliable personnel for data input in terms of accuracy. However, time is generally in short supply amongst this group. For our purposes, the ideal database is one that is simple, that can be used to flag up cases, rather than provide all of the information and ensures a complete dataset. The arrival of the UK 1998 Data Protection Act has put many clinical databases and registries in jeopardy, and introduced further bureaucracy to research. We discuss the Act and its interpretation by the General Medical Council, Medical Research Council, British Medical Association, Department of Health and our own trust with respect to databases and research.

Forensic databases: implications of the cases of S and Marper

The recent judgment of the European Court of Human Rights in the cases of S and Marper highlights some of the crucial ethical and legal issues relating to privacy, informed consent and discrimination raised by the use of forensic databases. This article explains the judgment and discusses some broader questions, in particular the reliability of fingerprint and DNA evidence and its effectiveness in preventing and detecting crime. The approach of the European judges is strongly rights-based, in contrast to the unsophisticated utilitarianism of the English courts. Their main objection is to the 'blanket and indiscriminate' retention of all kinds of forensic bioinformation. Not only does this make it difficult to justify a compulsory population-wide database, but it will also require strict criteria for retention of each kind of bioinformation and adequate safeguards for both convicted and unconvicted individuals.

Clinical trials registries: towards improved access to therapeutic data

(1) On July 1, 2005, several leading biomedical journals decided to publish only the results of clinical trials that had been listed in approved registries; (2) More and more clinical trials are now being recorded in a variety of national and international registries by an increasing number of private and public institutions; (3) The international network of WHO-approved registries, operational since 2007, provides access to more than 60 000 trials (in April 2008), but there is still no single comprehensive international registry of clinical trials; (4) The US registry (ClinicalTrials.gov) is publicly accessible, but the public does not have online access to the European registry (EudraCT); (5) These registries would be more useful if registration were transparent and mandatory in all countries where clinical trials are conducted; (6) Patients who agree to participate in a clinical trial should first verify that the study is listed in a WHO-approved registry and that the authors have committed to publish the results.

[Data sources for continual quality improvement in medical rehabilitation- the QS-Reha procedure of the statutory health insurance funds and the Eva-Reha documentation system of MDK Rhineland-palatinate]

Rehabilitation centers in Germany with a care supply contract according to section 111 Social Code Book Five - statutory health insurance (SGB V) are legally obligated to implement an internal quality management and to participate in comprehensive measures of external quality assurance which particularly aim at improving outcome quality ( section 135a SGB V). The legislator has left it to the central associations of health insurance funds and to the relevant umbrella organisations of care providers to develop these measures as well as the basic requirements on internal quality management in order to reach a joint agreement about it (cf. section 137d [1] and [1a] SGB V). The corresponding agreement was concluded on April 1, 2004. Whereas configuration of the internal quality management to a large extend lies in the discretion of the individual rehabilitation center, although it has to be geared to the objectives and principles set out in the agreement under section 137d SGB V, participation in the external quality assurance procedures of the central associations of health insurance funds (QS-Reha procedure) is obligatory for all rehabilitation centers with a care supply contract according to section 111 or 111a. The QS-Reha procedure comprises a survey of the central quality dimensions (structural, process and outcome quality as well as patient satisfaction) and permits related quality comparisons, which are utilized by the health insurance funds for quality oriented patient allocation and remuneration. The QS-Reha procedure had been developed to implement the legal requirements for external quality assurance in the field of medical rehabilitation ( section 135a in conjunction with section 137d SGB V) as well as to create a basis for quality focussed remuneration and patients allocation, whereas the Eva-Reha database had been developed by the Medical Service of Health Insurances in Rheinland-Pfalz for single case documentation with the objective of utilizing these data for internal quality management and, beyond this, also for various aspects of quality development across centers. The results generated in the framework of external quality assurance and internal management have to be integrated in the concept of internal quality management as they account for important sources of information with respect to the analysis of strengths or weaknesses of the facility. Irrespective of their origin quality relevant results should be integrated into a benchmarking system providing information to the operational and medical management of a rehabilitation center on the effectiveness and efficiency of the medical rehabilitation services provided. Up-to-date data, such as those generated by the Eva-Reha database, or sample survey data as those from the QS-Reha procedure can equally be used for such a benchmarking system and complement each another in a meaningful way. In this paper the main features of the QS-Reha procedure and the Eva-Reha database are described, with the objective of pointing out the particular perspectives of their data structure and results for continuous improvement in the framework of internal quality management.

The Italian market: procurement update

The procurement process in Italy is becoming more complex and expensive. In a complete overhaul of the system, there are new product classifications and new procedures to adopt.