Transparent deep learning to identify autism spectrum disorders (ASD) in EHR using clinical notes

OBJECTIVE

Machine learning (ML) is increasingly employed to diagnose medical conditions, with algorithms trained to assign a single label using a black-box approach. We created an ML approach using deep learning that generates outcomes that are transparent and in line with clinical, diagnostic rules. We demonstrate our approach for autism spectrum disorders (ASD), a neurodevelopmental condition with increasing prevalence.

METHODS

We use unstructured data from the Centers for Disease Control and Prevention (CDC) surveillance records labeled by a CDC-trained clinician with ASD A1-3 and B1-4 criterion labels per sentence and with ASD cases labels per record using Diagnostic and Statistical Manual of Mental Disorders (DSM5) rules. One rule-based and three deep ML algorithms and six ensembles were compared and evaluated using a test set with 6773 sentences (N = 35 cases) set aside in advance. Criterion and case labeling were evaluated for each ML algorithm and ensemble. Case labeling outcomes were compared also with seven traditional tests.

RESULTS

Performance for criterion labeling was highest for the hybrid BiLSTM ML model. The best case labeling was achieved by an ensemble of two BiLSTM ML models using a majority vote. It achieved 100% precision (or PPV), 83% recall (or sensitivity), 100% specificity, 91% accuracy, and 0.91 F-measure. A comparison with existing diagnostic tests shows that our best ensemble was more accurate overall.

CONCLUSIONS

Transparent ML is achievable even with small datasets. By focusing on intermediate steps, deep ML can provide transparent decisions. By leveraging data redundancies, ML errors at the intermediate level have a low impact on final outcomes.

A Review of the Cost-Effectiveness Evidence for FDA-Approved Cell and Gene Therapies

Cell and gene therapy (CGT) innovations have provided several significant breakthroughs in recent years. However, CGTs often come with a high upfront cost, raising questions about patient access, affordability, and long-term value. This study reviewed cost-effectiveness analysis (CEA) studies that have attempted to assess the long-term value of Food and Drug Administration (FDA)-approved CGTs. Two reviewers independently searched the Tufts Medical Center CEA Registry to identify all studies for FDA-approved CGTs, per January 2023. A data extraction template was used to summarize the evidence in terms of the incremental cost-effectiveness ratio expressed as the cost per quality-adjusted life year (QALY) and essential modeling assumptions, combined with a template to extract the adherence to the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. The review identified 26 CEA studies for seven CGTs. Around half of the base-case cost-effectiveness results indicated that the cost per QALY was below $100,000-$150,000, often used as a threshold for reasonable cost-effectiveness in the United States. However, the results varied substantially across studies for the same treatment, ranging from being considered very cost-effective to far from cost-effective. Most models were based on data from single-arm trials with relatively short follow-ups, and different long-term extrapolations between studies caused large differences in the modeled cost-effectiveness results. In sum, this review showed that, despite the high upfront costs, many CGTs have cost-effectiveness evidence that can support long-term value. Nonetheless, substantial uncertainty regarding long-term value exists because so much of the modeling results are driven by uncertain extrapolations beyond the clinical trial data.

Fluorine-Containing Ionogels with Stretchable, Solvent-Resistant, Wide Temperature Tolerance, and Transparent Properties for Ionic Conductors

Stretchable ionogels, as soft ion-conducting materials, have generated significant interest. However, the integration of multiple functions into a single ionogel, including temperature tolerance, self-adhesiveness, and stability in diverse environments, remains a challenge. In this study, a new class of fluorine-containing ionogels was synthesized through photo-initiated copolymerization of fluorinated hexafluorobutyl methacrylate and butyl acrylate in a fluorinated ionic liquid 1-butyl-3-methyl imidazolium bis (trifluoromethylsulfonyl) imide. The resulting ionogels demonstrate good stretchability with a fracture strain of ~1300%. Owing to the advantages of the fluorinated network and the ionic liquid, the ionogels show excellent stability in air and vacuum, as well as in various solvent media such as water, sodium chloride solution, and hexane. Additionally, the ionogels display impressive wide temperature tolerance, functioning effectively within a wide temperature range from -60 to 350 °C. Moreover, due to their adhesive properties, the ionogels can be easily attached to various substrates, including plastic, rubber, steel, and glass. Sensors made of these ionogels reliably respond to repetitive tensile-release motion and finger bending in both air and underwater. These findings suggest that the developed ionogels hold great promise for application in wearable devices.

Interactions between stoneworts (Charales) and waterbirds

Stoneworts (Charales) are green algae that represent an important food resource for many waterbird species in Europe and elsewhere. Browsing avian herbivores (e.g. swan, goose, duck and coot species) consume Charales plant vegetative parts, by head-dipping, up-ending or diving. A lower fibre content and longer growing season may make Charales as attractive to such herbivores as sympatric submerged higher plant species in some circumstances. Charales respond to environmental stress (e.g. drought) by producing abundant diaspores, in the form of oospores (sexual) and bulbils (asexual), both rich in starch, generating abundant food for waterbirds at critical stages in their annual migratory cycles. Waterbirds feed on these by diving (e.g. common pochard Aythya ferina and red-crested pochard Netta rufina) or by filtering from the water column (e.g. dabbling duck species), ensuring dispersal of sexually produced and vegetative diaspores locally (because of predator swamping) and remotely (through endo- and ectozoochorous dispersal by long-distance migratory waterbirds). Greater invertebrate density and diversity associated with Charales canopies enhances their attractiveness over other submerged macrophyte beds to diving predators [e.g. tufted duck Aythya fuligula, common pochard and Eurasian coot Fulica atra (hereafter coot)]. Fish fry preying on these invertebrates use such vegetation as predator cover, in turn providing prey for avian piscivores such as grebes and cormorants. Abundant Charales contribute to maintaining a transparent water column due to canopy density, nutrient effects, dampening of sedimentation/remobilisation of suspended matter and nutrients and allelopathic effects on other plants (especially phytoplankton). Shallow, relatively eutrophic waters can flip between clear-water high-biodiversity (where Charales thrive) and turbid species-poor depauperate stable states (lacking Charales). Shifts between turbid conditions and rich submerged Charales beds have profound elevating effects on aquatic diversity, to which waterbirds show rapid aggregative responses, making them ideal indicator species of ecological change; in the case of Charales specialists (such as red-crested and common pochard), indicators of the presence and abundance of these plants. Large-bodied colonial nesting birds (e.g. cormorants, gulls, heron and egrets) aggregating along lake shores contribute high N and P loadings to water bodies sensitive to such external and internal inputs and can cause local eutrophication and potential loss of Charales. Despite variation from complete seasonal removal of Charales biomass to undetectable grazing effects by herbivorous birds, evidence suggests little effect of avian grazing on biomass accumulation or the stability of community composition (under otherwise stable conditions), but we urge more research on this under-researched topic. We also lack investigations of the relative foraging profitability of different Charales organs to waterbirds and the degree of viability of gyrogonites (fertilised and calcified oospores), vegetative bulbils and plant fragments after passage through the guts of waterbirds. We especially need to understand better how much the carbonate armour of these organs affects their viability/dispersal via waterbirds and urge more research on these neglected plants and their relationships and interactions with other organisms in the aquatic biota.

United States' Nursing Home Finances: Spending, Profitability, and Capital Structure

Little is known about nursing home (NH) financial status in the United States even though most NH care is publicly funded. To address this gap, this descriptive study used 2019 Medicare cost reports to examine NH revenues, expenditures, net income, related-party expenses, expense categories, and capital structure. After a cleaning process for all free-standing NHs, a study population of 11,752 NHs was examined. NHs had total net revenues of US$126 billion and a profit of US$730 million (0.58%) in 2019. When US$6.4 billion in disallowed costs and US$3.9 billion in non-cash depreciation expenses were excluded, the profit margin was 8.84 percent. About 77 percent of NHs reported US$11 billion in payments to related-party organizations (9.54% of net revenues). Overall spending for direct care was 66 percent of net revenues, including 27 percent on nursing, in contrast to 34 percent spent on administration, capital, other, and profits. Finally, NHs had long-term debts that outweighed their total available financing. The study shows the value of analyzing cost reports. It indicates the need to ensure greater accuracy and completeness of cost reports, financial transparency, and accountability for government funding, with implications for policy changes to improve rate setting and spending limits.

Drug pricing and transparency in Europe and the United States: what is it and how does it work?

INTRODUCTION

As drug prices are viewed to be opaque, there have been increasing societal demands on policy and decision makers to implement initiatives that promote drug price transparency.

AREAS COVERED

This Perspective discusses what drug price transparency is and how it works in theory and in practice.

EXPERT OPINION

Transparency on drug prices may target payers, patients and health care professionals; and may relate to prices at each stage in a drug's distribution system. Although proponents claim that drug price transparency will reduce prices and increase patient access, others expect the opposite effect. Nevertheless, a number of international organizations, countries and consumer groups have taken steps to enhance drug price transparency. This has occurred despite a lack of theoretical clarity and of evidence about its likely impact. Policy and decision makers need to consider how payers and pharmaceutical companies are likely to react to drug price transparency and need to be aware that transparency may produce different effects depending on the country to which it is applied. Even though we believe that full drug price transparency is elusive, various incremental measures can be taken to move toward it.

Simultaneous Enhancement of Thermal Insulation and Impact Resistance in Transparent Bulk Composites

Transparent bulk glass is highly demanded in devices and components of daily life to transmit light and protect against external temperature and mechanical hazards. However, the application of glass is impeded by its poor functional performance, especially in terms of thermal isolation and impact resistance. Here, a glass composite integrating the nacre-inspired structure and shear stiffening gel (SSG) material is proposed. Benefiting from the combination of these two elements, this nacre-inspired SSG/glass composite (NSG) exhibits superior thermal insulation and impact resistance while maintaining transparency simultaneously. Specifically, the low thermal conductivity of the SSG combined with the anisotropic heat transfer capability of the nacre-inspired structure enhances the out-of-plane thermal insulation of NSG. The deformations over large volumes in nacre-inspired facesheets promote the deformation region of the SSG core, synergistic effect of tablet sliding mechanism in nacre-inspired structure and strain-rate enhancement in SSG material cause the superior impact resistance of overall panels in a wide range of impact velocities. NSG demonstrates outstanding properties such as transparency, light weight, impact resistance, and thermal insulation, which are major concerns for the application in engineering fields. In conclusion, this bioinspired SSG/glass composite opens new avenues to achieve comprehensive performance improvements for transparent structural materials.

Increase transparency and reproducibility of real-world evidence in rare diseases through disease-specific Federated Data Networks

PURPOSE

In rare diseases, real-world evidence (RWE) generation is often restricted due to small patient numbers and global geographic distribution. A federated data network (FDN) approach brings together multiple data sources harmonized for collaboration to increase the power of observational research. In this paper, we review how to increase reproducibility and transparency of RWE studies in rare diseases through disease-specific FDNs.

METHOD

To be successful, a multiple stakeholder scientific FDN collaboration requires a strong governance model in place. In such a model, each database owner remains in full control regarding the use of and access to patient-level data and is responsible for data privacy, ethical, and legal compliance. Provided that all this is well documented and good database descriptions are in place, such a governance model results in increased transparency, while reproducibility is achieved through data curation and harmonization, and distributed analytical methods.

RESULTS

Leveraging the OHDSI community set of methods and tools, two rare disease-specific FDNs are discussed in more detail. For multiple myeloma, HONEUR-the Haematology Outcomes Network in Europe-has built a strong community among the data partners dedicated to scientific exchange and research. To advance scientific knowledge in pulmonary hypertension (PH) an FDN, called PHederation, was established to form a partnership of research institutions with PH databases coming from diverse origins.

The majority of observational studies in leading peer-reviewed medicine journals are not registered and do not have a publicly accessible protocol: a scoping review

OBJECTIVES

Observational studies are not subject to the same requirements as randomised controlled trials such as as registration or publishing a protocol. The aim of this scoping review was to estimate the registration rate of observational studies in leading peer-reviewed medicine journals and to evaluate whether protocols were available in the public domain.

STUDY DESIGN AND SETTING

In March 2023, we searched OVID Medline for observational studies published in 2022 in the top five general medicine journals according to impact factor (The Lancet, The British Medical Journal, The Journal of the American Medical Association, The New England Journal of Medicine and Annals of Internal Medicine). We defined an observational study as a cohort study, case-control study, cross-sectional study, or case series. Information on i) the proportion of observational studies that have been registered, and ii) the proportion of observational studies that have a protocol available in the public domain was extracted from a random sample of studies.

RESULTS

Our search identified 699 studies, 290 studies were selected as full text and a random sample of 200 studies were included. For half of the studies, the first author worked in an USA institution. Most studies were cohort studies (n=126, 63.0%) and used administrative healthcare records, electronic healthcare records and registries. Of the 200 observational studies, 20 (10.0%) were registered. Among those, 14 were prospectively registered. Twenty-four studies (12.0%) had a protocol available in the public domain. Studies that were registered or had a protocol, were more frequently published in the BMJ (n=12/28, 42.9%), had a 1st author working in the UK (n=10/28, 35.1%) and used electronic health records (n=13/28, 46.4%) compared to studies with no registration and no protocol.

CONCLUSION

The rate of prospectively registered observational studies is worryingly low. Prospective registration of observational studies should be encouraged and standardized to ensure transparency in clinical research and reduce research wastage.

Requesting conflicts of interest declarations from the European Medicines Agency: 3-year follow-up status

AIMS

We have previously described the European Medicines Agency's (EMA) and the US Food and Drug Administration's guidelines, each for a specific psychiatric indication, on how to design pivotal drug trials used in new drug applications. Here, we report on our efforts over 3 years to retrieve conflicts of interest declarations from EMA. We wanted to assess potential internal industry influence judged as the proportion of guideline committee members with industry conflicts of interest.

METHODS

We submitted Freedom of Information requests in February 2020 to access EMA's lists of committee members (and their declared conflicts of interest) involved in drafting the 13 'Clinical efficacy and safety' guidelines available on EMA's website pertaining to psychiatric indications. In our request, we did not specify the exact EMA committees. Here, we describe the received documents and report the proportion of members with industry interests (i.e. defined as any financial industry relationship). It is a follow-up paper to our first report (http://doi.org/10.1017/S2045796021000147).

RESULTS

After 2 years and 9 months (November 2022), the EMA sent us member lists and corresponding conflicts of interest declarations from the Committee for Medicinal Products for Human use (CHMP) from 2012, 2013 and 2017. These member lists pertained to 3 of the 13 requested guidelines (schizophrenia, depression and autism spectrum disorder). The 10 remaining guidelines were published before 2011 and EMA stated that they needed to require permission from their expert members (with unknown retrieval rate) and foresaw excessive workload and long wait. Therefore, we withdrew our request. The CHMPs from 2012, 2013 and 2017 had from 34 to 36 members; 39%-44% declared any interests and we judged 14%-18% as having industry interests. For the schizophrenia guideline, we identified two members with industry interests to companies who submitted feedback on the guideline. We did not receive declarations from the Central Nervous System (CNS) Working Party, the CHMP appointed expert group responsible for drafting and incorporating feedback into the guidelines.

CONCLUSIONS

After almost 3 years, we received information, which only partly addressed our request. We recommend EMA to improve transparency by publishing the author names and their corresponding conflicts of interest declarations directly in the 'Clinical efficacy and safety' guidelines and to not remove conflicts of interest declarations after 1 year from their website to reduce the risk of stealth corporate influence during the development of these influential guidelines.

A paradigm shift?-On the ethics of medical large language models

After a wave of breakthroughs in image-based medical diagnostics and risk prediction models, machine learning (ML) has turned into a normal science. However, prominent researchers are claiming that another paradigm shift in medical ML is imminent-due to most recent staggering successes of large language models-from single-purpose applications toward generalist models, driven by natural language. This article investigates the implications of this paradigm shift for the ethical debate. Focusing on issues like trust, transparency, threats of patient autonomy, responsibility issues in the collaboration of clinicians and ML models, fairness, and privacy, it will be argued that the main problems will be continuous with the current debate. However, due to functioning of large language models, the complexity of all these problems increases. In addition, the article discusses some profound challenges for the clinical evaluation of large language models and threats to the reproducibility and replicability of studies about large language models in medicine due to corporate interests.

Have the non-technical summaries of animal experiments in Europe improved? An update

Following a review of the Directive 2010/63/EU on the protection of animals used for scientific purposes in the European Union (EU), non-technical project summaries (NTS) of all approved projects must be published in a central database using a standard template. Our initial review of the NTS reported in ALTEX in 2018 had found the NTS to be deficient in their accessibility and quality, notably the adverse effects section where the harms to the animals are meant to be described. Here we repeat our review to see if these legislative changes have improved the accessibility and quality of the NTS. As before we focused on the NTS from the United Kingdom (UK) and Germany; even though the UK has left the EU it is using the same template. We found significant improvement in the reporting of five of the six elements we identified as essential to the predicted harms section. However, there was no significant improvement in the reporting of adverse effects. Only 41% of German NTS and 48% of UK NTS are fully reporting this important element of the predicted harms section. In our view, researchers need support in describing the impact of their research on the animals and to assist here we include a checklist for competent authorities and a list of suggested terminology for standard administration and sampling procedures. Unless the NTS improve further, their utility as a tool for sharing of good practices in the 3Rs or to support evidence-based policy making will remain limited.

Perceptions of patient-reported outcome data access and sharing among patients with heart failure: ethical implications for research

AIMS

In the face of growing expectations for data transparency and patient engagement in care, we evaluated preferences for patient-reported outcome (PRO) data access and sharing among patients with heart failure (HF) using an ethical framework.

METHODS AND RESULTS

We conducted qualitative interviews with a purposive sample of patients with HF who participated in a larger 8-week study that involved the collection and return of PROs using a web-based interface. Guided by an ethical framework, patients were asked questions about their preferences for having PRO data returned to them and shared with other groups. Interview transcripts were coded by three study team members using directed content analysis. A total of 22 participants participated in semi-structured interviews. Participants were mostly male (73%), White (68%) with a mean age of 72. Themes were grouped into priorities, benefits, and barriers to data access and sharing. Priorities included ensuring anonymity when data are shared, transparency with intentions of data use, and having access to all collected data. Benefits included: using data as a communication prompt to discuss health with clinicians and using data to support self-management. Barriers included: challenges with interpreting returned results, and potential loss of benefits and anonymity when sharing data.

CONCLUSION

Our interviews with HF patients highlight opportunities for researchers to return and share data through an ethical lens, by ensuring privacy and transparency with intentions of data use, returning collected data in comprehensible formats, and meeting individual expectations for data sharing.

The transparency of quantitative empirical legal research published in highly ranked law journals (2018-2020): an observational study

Background

Scientists are increasingly concerned with making their work easy to verify and build upon. Associated practices include sharing data, materials, and analytic scripts, and preregistering protocols. This shift towards increased transparency and rigor has been referred to as a "credibility revolution." The credibility of empirical legal research has been questioned in the past due to its distinctive peer review system and because the legal background of its researchers means that many often are not trained in study design or statistics. Still, there has been no systematic study of transparency and credibility-related characteristics of published empirical legal research.

Methods

To fill this gap and provide an estimate of current practices that can be tracked as the field evolves, we assessed 300 empirical articles from highly ranked law journals including both faculty-edited journals and student-edited journals.

Results

We found high levels of article accessibility (86%, 95% CI = [82%, 90%]), especially among student-edited journals (100%). Few articles stated that a study's data are available (19%, 95% CI = [15%, 23%]). Statements of preregistration (3%, 95% CI = [1%, 5%]) and availability of analytic scripts (6%, 95% CI = [4%, 9%]) were very uncommon. (i.e., they collected new data using the study's reported methods, but found results inconsistent or not as strong as the original).

Conclusion

We suggest that empirical legal researchers and the journals that publish their work cultivate norms and practices to encourage research credibility. Our estimates may be revisited to track the field's progress in the coming years.

Improved Performance of QDSSCs Can Be Achieved by Constructing a Transparent Anatase TiO2@MWCNT Photoanode Based on the Bionic Mountain Lotus

In this research, the structural characteristics of the mountain holly leaf were emulated. It was observed that after the initially uneven surface of the petals is filled with infiltrated water, it exhibits a distinctive transparent beauty after rainfall. Furthermore, the presence of leaf veins enhances the structural strength of the petals and facilitates nutrient transport. Inspired by previous studies on double-layer spin-coated films, we further developed and designed the TA TiO2@MWCNT photocathode thin film. This innovative film incorporates multiwalled carbon nanotubes (MWCNT) into a previously established TA TiO2 photocathode thin film. The inclusion of MWCNT results in the formation of a three-dimensional highway structure, where MWCNT intertwines within the TA TiO2 film. Under the operational state of immersion in the electrolyte, it maintains a level of transparency similar to that of the TA TiO2 photoanode thin film. The high-temperature sintering process results in the oxidation and depletion of MWCNTs on the surface of the film, leaving behind uniformly dispersed concave defects, thereby greatly enhancing the specific surface area. The findings demonstrate that the optoelectrode of high transparency and high specific surface area, TA TiO2@MWCNT, comprehensively enhances the performance of the solar cells. The transparent QDSSC surpasses its counterparts for the first time, achieving a power conversion efficiency (PCE) of 6.335%. This sets the stage for new materials and innovative approaches in the field of solar cells and other titanium dioxide film-related areas.

Design of an Optical Device Based on Kirigami Approach

The aim of this work was to design a kirigami-based metamaterial with optical properties. This idea came from the necessity of a study that can improve common camouflage techniques to yield a product that is cheap, light, and easy to manufacture and assemble. The author investigated the possibility of exploiting a rotation to achieve transparency and color changing. One of the most important examples of a kirigami structure is a geometry based on rotating squares, which is a one-degree-of-freedom mechanism. In this study, light polarization and birefringence were exploited to obtain transparency and color-changing properties using two polarizers and common cellophane tape. These elements were assembled with a rotating-square structure that allowed the rotation of a polarizer placed on the structure with respect to a fixed polarizer equipped with cellophane layers.

More Is Not Always Better: Impacts of AI-Generated Confidence and Explanations in Human-Automation Interaction

OBJECTIVE

The study aimed to enhance transparency in autonomous systems by automatically generating and visualizing confidence and explanations and assessing their impacts on performance, trust, preference, and eye-tracking behaviors in human-automation interaction.

BACKGROUND

System transparency is vital to maintaining appropriate levels of trust and mission success. Previous studies presented mixed results regarding the impact of displaying likelihood information and explanations, and often relied on hand-created information, limiting scalability and failing to address real-world dynamics.

METHOD

We conducted a dual-task experiment involving 42 university students who operated a simulated surveillance testbed with assistance from intelligent detectors. The study used a 2 (confidence visualization: yes vs. no) × 3 (visual explanations: none, bounding boxes, bounding boxes and keypoints) mixed design. Task performance, human trust, preference for intelligent detectors, and eye-tracking behaviors were evaluated.

RESULTS

Visual explanations using bounding boxes and keypoints improved detection task performance when confidence was not displayed. Meanwhile, visual explanations enhanced trust and preference for the intelligent detector, regardless of the explanation type. Confidence visualization did not influence human trust in and preference for the intelligent detector. Moreover, both visual information slowed saccade velocities.

CONCLUSION

The study demonstrated that visual explanations could improve performance, trust, and preference in human-automation interaction without confidence visualization partially by changing the search strategies. However, excessive information might cause adverse effects.

APPLICATION

These findings provide guidance for the design of transparent automation, emphasizing the importance of context-appropriate and user-centered explanations to foster effective human-machine collaboration.

A trustworthy AI reality-check: the lack of transparency of artificial intelligence products in healthcare

Trustworthy medical AI requires transparency about the development and testing of underlying algorithms to identify biases and communicate potential risks of harm. Abundant guidance exists on how to achieve transparency for medical AI products, but it is unclear whether publicly available information adequately informs about their risks. To assess this, we retrieved public documentation on the 14 available CE-certified AI-based radiology products of the II b risk category in the EU from vendor websites, scientific publications, and the European EUDAMED database. Using a self-designed survey, we reported on their development, validation, ethical considerations, and deployment caveats, according to trustworthy AI guidelines. We scored each question with either 0, 0.5, or 1, to rate if the required information was "unavailable", "partially available," or "fully available." The transparency of each product was calculated relative to all 55 questions. Transparency scores ranged from 6.4% to 60.9%, with a median of 29.1%. Major transparency gaps included missing documentation on training data, ethical considerations, and limitations for deployment. Ethical aspects like consent, safety monitoring, and GDPR-compliance were rarely documented. Furthermore, deployment caveats for different demographics and medical settings were scarce. In conclusion, public documentation of authorized medical AI products in Europe lacks sufficient public transparency to inform about safety and risks. We call on lawmakers and regulators to establish legally mandated requirements for public and substantive transparency to fulfill the promise of trustworthy AI for health.

Pristine Ti3C2Tx MXene Enables Flexible and Transparent Electrochemical Sensors

In the era of the internet of things, there exists a pressing need for technologies that meet the stringent demands of wearable, self-powered, and seamlessly integrated devices. Current approaches to developing MXene-based electrochemical sensors involve either rigid or opaque components, limiting their use in niche applications. This study investigates the potential of pristine Ti3C2Tx electrodes for flexible and transparent electrochemical sensing, achieved through an exploration of how material characteristics (flake size, flake orientation, film geometry, and uniformity) impact the electrochemical activity of the outer sphere redox probe ruthenium hexamine using cyclic voltammetry. The optimized electrode made of stacked large Ti3C2Tx flakes demonstrated excellent reproducibility and resistance to bending conditions, suggesting their use for reliable, robust, and flexible sensors. Reducing electrode thickness resulted in an amplified faradaic-to-capacitance signal, which is advantageous for this application. This led to the deposition of transparent thin Ti3C2Tx films, which maintained their best performance up to 73% transparency. These findings underscore its promise for high-performance, tailored sensors, marking a significant stride in advancing MXene utilization in next-generation electrochemical sensing technologies. The results encourage the analytical electrochemistry field to take advantage of the unique properties that pristine Ti3C2Tx electrodes can provide in sensing through more parametric studies.

Fear of Missing Out: Constrained Trial of Blockchain in Supply Chain

Blockchain's potential to revolutionize supply chain and logistics with transparency and equitable stakeholder engagement is significant. However, challenges like scalability, privacy, and interoperability persist. This study explores the scarcity of real-world blockchain implementations in supply chain and logistics since we have not witnessed many real-world deployments of blockchain-based solutions in the field. Puzzled by this, we integrate technology, user experience, and operational efficiency to illuminate the complex landscape of blockchain integration. We present blockchain-based solutions in three use cases, comparing them with alternative designs and analyzing them in terms of technical, economic, and operational aspects. Insights from a tailored questionnaire of 50 questions addressed to practitioners and experts offer crucial perspectives on blockchain adoption. One of the key findings from our work shows that half of the companies interviewed agree that they will miss the potential for competitive advantage if they do not invest in blockchain technology, and 61% of the companies surveyed claimed that their customers ask for more transparency in supply chain-related transactions. However, only one-third of the companies were aware of the main features of blockchain technology, which shows a lack of knowledge among the companies that may lead to a weaker blockchain adaption in supply chain use cases. Our readers should note that our study is specifically contextualized in a Netherlands-funded national project. We hope that researchers as well as stakeholders in supply chain and logistics can benefit from the insights of our work.

Trials and tribulations of transparency related to inconsistencies between plan and conduct in peer-reviewed physiotherapy publications: A methodology review

RATIONALE

The physiotherapy profession strives to be a leader in providing quality care and strongly recognizes the value of research to guide clinical practice. Adherence to guidelines for research reporting and conduct is a significant step towards high-quality, transparent and reproducible research.

AIM/OBJECTIVE

Assess integrity between planned and conducted methodology in randomized controlled trials (RCTs) and systematic reviews (SRs) published in physiotherapy journals.

METHODS

Eighteen journals were manually searched for RCTs and SRs published from 1 July 2021 through 31 December 2021. Studies were included if the journal or specific study was indexed in PubMed and published/translated in English. Descriptive statistics determined congruence between preregistration data and publication.

RESULTS

Forty RCTs and 68 SRs were assessed. Forty-three SRs included meta-analysis (MA). Of the 34 registered RCTs, 7 (20.6%) had no discrepancy between the registration and publication. Two trials (5.9%) addressed all discrepancies, 4 (11.8%) addressed some and 21 (61.8%) did not address any discrepancies. Of the 36 registered MAs, 33 (91.7%) had discrepancies between the registration and publication. Two (5.6%) addressed all discrepancies and three (8.3%) had no discrepancies. Eight SRs without MA published information not matching their registration, and none provided justification for the discrepancies.

CONCLUSION

Most RCTs/SRs were registered; the majority had discrepancies between preregistration and publication, potentially influencing the outcomes and interpretations of findings. Journals should require preregistration and compare the submission with the registration information when assessing publication suitability. Readers should be aware of these inconsistencies and their implications when interpreting and translating results into practice.

Country of Origin of Medical Products and Risk of Labour Rights Abuse: A Cross-Sectional Analysis Using Four Procurement Datasets

Background Case studies have highlighted labour rights abuse in the manufacture of several healthcare products, but little is known about the scale of the problem or the specific products involved. We aimed to quantify and compare the overall and product-specific risks of labour rights abuse in the manufacture of healthcare products supplied to high-income settings using multiple datasets on the product country of origin (COO). Methods Public procurement data from South-Eastern Norway (n=23,972 products) were compared to datasets from three other high-income settings: procurement data from Cambridge University Hospitals, trade data from UN Comtrade, and registry data from the US Food and Drug Administration (FDA). In each dataset, the product COO was matched to the International Trade Union Confederation risk rating for labour abuse and deemed high-risk when rated 4, 5, or 5+. Results In the Norway data, 55.4% of products by value had a COO declared, 49.1% of which mapped as high-risk of labour rights abuses. COO was identified for 70/100 products in the Cambridge data, with COO matching high-risk at 59.9% by value. The level of risk for specific medical product categories varied between the Norway, US FDA, and UN Comtrade datasets, but those with higher proportional risk included medical/surgical gloves and electrosurgical products. Conclusion Evidence of high-risk of labour rights abuse in the manufacture of healthcare products present in these data indicates a likely high level of risk across the sector. There is an urgent need for global legislative and political reform, with a particular focus on supply chain transparency as a key mechanism for tackling this issue.

Scalable Photochromic Film for Solar Heat and Daylight Management

The adaptive control of sunlight through photochromic smart windows could have a huge impact on the energy efficiency and daylight comfort in buildings. However, the fabrication of inorganic nanoparticle and polymer composite photochromic films with a high contrast ratio and high transparency/low haze remains a challenge. Here, a solution method is presented for the in situ growth of copper-doped tungsten trioxide nanoparticles in polymethyl methacrylate, which allows a low-cost preparation of photochromic films with a high luminous transparency (luminous transmittance Tlum = 91%) and scalability (30 × 350 cm2 ). High modulation of visible light (ΔTlum = 73%) and solar heat (modulation of solar transmittance ΔTsol = 73%, modulation of solar heat gain coefficient ΔSHGC = 0.5) of the film improves the indoor daylight comfort and energy efficiency. Simulation results show that low-e windows with the photochromic film applied can greatly enhance the energy efficiency and daylight comfort. This photochromic film presents an attractive strategy for achieving more energy-efficient buildings and carbon neutrality to combat global climate change.

Morphological and taxonomic diversity of mesozooplankton is an important driver of carbon export fluxes in the ocean

Mesozooplankton is a very diverse group of small animals ranging in size from 0.2 to 20 mm not able to swim against ocean currents. It is a key component of pelagic ecosystems through its roles in the trophic networks and the biological carbon pump. Traditionally studied through microscopes, recent methods have been however developed to rapidly acquire large amounts of data (morphological, molecular) at the individual scale, making it possible to study mesozooplankton using a trait-based approach. Here, combining quantitative imaging with metabarcoding time-series data obtained in the Sargasso Sea at the Bermuda Atlantic Time-series Study (BATS) site, we showed that organisms' transparency might be an important trait to also consider regarding mesozooplankton impact on carbon export, contrary to the common assumption that just size is the master trait directing most mesozooplankton-linked processes. Three distinct communities were defined based on taxonomic composition, and succeeded one another throughout the study period, with changing levels of transparency among the community. A co-occurrences' network was built from metabarcoding data revealing six groups of taxa. These were related to changes in the functioning of the ecosystem and/or in the community's morphology. The importance of Diel Vertical Migration at BATS was confirmed by the existence of a group made of taxa known to be strong migrators. Finally, we assessed if metabarcoding can provide a quantitative approach to biomass and/or abundance of certain taxa. Knowing more about mesozooplankton diversity and its impact on ecosystem functioning would allow to better represent them in biogeochemical models.

Human movement modifications induced by different levels of transparency of an active upper limb exoskeleton

Active upper limb exoskeletons are a potentially powerful tool for neuromotor rehabilitation. This potential depends on several basic control modes, one of them being transparency. In this control mode, the exoskeleton must follow the human movement without altering it, which theoretically implies null interaction efforts. Reaching high, albeit imperfect, levels of transparency requires both an adequate control method and an in-depth evaluation of the impacts of the exoskeleton on human movement. The present paper introduces such an evaluation for three different "transparent" controllers either based on an identification of the dynamics of the exoskeleton, or on force feedback control or on their combination. Therefore, these controllers are likely to induce clearly different levels of transparency by design. The conducted investigations could allow to better understand how humans adapt to transparent controllers, which are necessarily imperfect. A group of fourteen participants were subjected to these three controllers while performing reaching movements in a parasagittal plane. The subsequent analyses were conducted in terms of interaction efforts, kinematics, electromyographic signals and ergonomic feedback questionnaires. Results showed that, when subjected to less performing transparent controllers, participants strategies tended to induce relatively high interaction efforts, with higher muscle activity, which resulted in a small sensitivity of kinematic metrics. In other words, very different residual interaction efforts do not necessarily induce very different movement kinematics. Such a behavior could be explained by a natural human tendency to expend effort to preserve their preferred kinematics, which should be taken into account in future transparent controllers evaluation.

Strategies for Traceability to Prevent Unauthorised GMOs (Including NGTs) in the EU: State of the Art and Possible Alternative Approaches

The EU's regulatory framework for genetically modified organisms (GMOs) was developed for "classical" transgenic GMOs, yet advancements in so-called "new genomic techniques (NGTs)" have led to implementation challenges regarding detection and identification. As traceability can complement detection and identification strategies, improvements to the existing traceability strategy for GMOs are investigated in this study. Our results are based on a comprehensive analysis of existing traceability systems for globally traded agricultural products, with a focus on soy. Alternative traceability strategies in other sectors were also analysed. One focus was on traceability strategies for products with characteristics for which there are no analytical verification methods. Examples include imports of "conflict minerals" into the EU. The so-called EU Conflict Minerals Regulation requires importers of certain raw materials to carry out due diligence in the supply chain. Due diligence regulations, such as the EU's Conflict Minerals Regulation, can legally oblige companies to take responsibility for certain risks in their supply chains. They can also require the importer to prove the regional origin of imported goods. The insights from those alternative traceability systems are transferred to products that might contain GMOs. When applied to the issue of GMOs, we propose reversing the burden of proof: All companies importing agricultural commodities must endeavour to identify risks of unauthorised GMOs (including NGTs) in their supply chain and, where appropriate, take measures to minimise the risk to raw material imports. The publication concludes that traceability is a means to an end and serves as a prerequisite for due diligence in order to minimise the risk of GMO contamination in supply chains. The exemplary transfer of due diligence to a company in the food industry illustrates the potential benefits of mandatory due diligence, particularly for stakeholders actively managing non-GMO supply chains.

Social and Ethical Implications of Digital Crisis Technologies: Case Study of Pandemic Simulation Models During the COVID-19 Pandemic

BACKGROUND

Responses to public health crises are increasingly technological in nature, as the prominence of COVID-19-related statistics and simulations amply demonstrates. However, the use of technologies is preconditional and has various implications. These implications can not only affect acceptance but also challenge the acceptability of these technologies with regard to the ethical and normative dimension.

OBJECTIVE

This study focuses on pandemic simulation models as algorithmic governance tools that played a central role in political decision-making during the COVID-19 pandemic. To assess the social implications of pandemic simulation models, the premises of data collection, sorting, and evaluation must be disclosed and reflected upon. Consequently, the social construction principles of digital health technologies must be revealed and examined for their effects with regard to social, ethical, and ultimately political issues.

METHODS

This case study starts with a systematization of different simulation approaches to create a typology of pandemic simulation models. On the basis of this, various properties, functions, and challenges of these simulation models are revealed and discussed in detail from a socioscientific point of view.

RESULTS

The typology of pandemic simulation methods reveals the diversity of model-driven handling of pandemic threats. However, it is reasonable to assume that the use of simulation models could increasingly shift toward agent-based or artificial intelligence models in the future, thus promoting the logic of algorithmic decision-making in response to public health crises. As algorithmic decision-making focuses more on predicting future dynamics than statistical practices of assessing pandemic events, this study discusses this development in detail, resulting in an operationalized overview of the key social and ethical issues related to pandemic crisis technologies.

CONCLUSIONS

This study identifies 3 major recommendations for the future of pandemic crisis technologies.

Beyond Animal Testing Index: Benchmarking tool for a world beyond animal testing

While the original definition of replacement focuses on the replacement of the use of animals in science, a more contemporary definition focuses on accelerating the development and use of predictive and robust models, based on the latest science and technologies, to address scientific questions without the use of animals. The transition to animal free innovation is on the political agenda in and outside the European Union. The Beyond Animal Testing Index (BATI) is a benchmarking instrument designed to provide insight into the activities and contributions of research institutes to the transition to animal free innovation. The BATI allows participating organizations to learn from each other and stimulates continuous improvement. The BATI was modelled after the Access to Medicine Index, which benchmarks pharmaceutical companies on their efforts to make medicines widely available in developing countries. A prototype of the BATI was field-tested with three Dutch aca­demic medical centers and two universities in 2020-2021. The field test demonstrated the usability and effectiveness of the BATI as a benchmarking tool. Analyses were performed across five different domains. The participating institutes concluded that the BATI served as an internal as well as an external stimulus to share, learn, and improve institutional strategies towards the transition to animal free innovation. The BATI also identified gaps in the development and implementation of 3R technologies. Hence, the BATI might be a suitable instrument for monitoring the effectiveness of policies. BATI version 1.0 is ready to be used for benchmarking at a larger scale.

Transparency as a Means to Analyse the Impact of Inertial Sensors on Users during the Occupational Ergonomic Assessment: A Systematic Review

The literature has yielded promising data over the past decade regarding the use of inertial sensors for the analysis of occupational ergonomics. However, despite their significant advantages (e.g., portability, lightness, low cost, etc.), their widespread implementation in the actual workplace has not yet been realized, possibly due to their discomfort or potential alteration of the worker's behaviour. This systematic review has two main objectives: (i) to synthesize and evaluate studies that have employed inertial sensors in ergonomic analysis based on the RULA method; and (ii) to propose an evaluation system for the transparency of this technology to the user as a potential factor that could influence the behaviour and/or movements of the worker. A search was conducted on the Web of Science and Scopus databases. The studies were summarized and categorized based on the type of industry, objective, type and number of sensors used, body parts analysed, combination (or not) with other technologies, real or controlled environment, and transparency. A total of 17 studies were included in this review. The Xsens MVN system was the most widely used in this review, and the majority of studies were classified with a moderate level of transparency. It is noteworthy, however, that there is a limited and worrisome number of studies conducted in uncontrolled real environments.

Ethical Challenges of Advances in Vaccine Delivery Technologies

Strategies to address misinformation and hesitancy about vaccines, including the fear of needles, and to overcome obstacles to access, such as the refrigeration that some vaccines demand, strongly suggest the need to develop new vaccine delivery technologies. But, given widespread distrust surrounding vaccination, these new technologies must be introduced to the public with the utmost transparency, care, and community involvement. Two emerging technologies, one a skin-patch vaccine and the other a companion dye and detector, provide excellent examples of greatly improved delivery technologies for which such a careful approach should be developed in order to increase vaccine uptake. Defusing fears and conspiracy mongering must be a key part of their rollout.

Open Science Considerations for Descriptive Research in Developmental Science

Descriptive developmental research seeks to document, describe, and analyze the conditions under which infants and children live and learn. Here, we articulate how open-science practices can be incorporated into descriptive research to increase its transparency, reliability, and replicability. To date, most open-science practices have been oriented toward experimental rather than descriptive studies, and it can be confusing to figure out how to translate open-science practices (e.g., preregistration) for research that is more descriptive in nature. We discuss a number of unique considerations for descriptive developmental research, taking inspiration from existing open-science practices and providing examples from recent and ongoing studies. By embracing a scientific culture where descriptive research and open science coexist productively, developmental science will be better positioned to generate comprehensive theories of development and understand variability in development across communities and cultures.

The FAIRification of research in real-world evidence: A practical introduction to reproducible analytic workflows using Git and R

Transparency and reproducibility are major prerequisites for conducting meaningful real-world evidence (RWE) studies that are fit for decision-making. Many advances have been made in the documentation and reporting of study protocols and results, but the principles for version control and sharing of analytic code in RWE are not yet as established as in other quantitative disciplines like computational biology and health informatics. In this practical tutorial, we aim to give an introduction to distributed version control systems (VCS) tailored toward the FAIR (Findable, Accessible, Interoperable, and Reproducible) implementation of RWE studies. To ease adoption, we provide detailed step-by-step instructions with practical examples on how the Git VCS and R programming language can be implemented into RWE study workflows to facilitate reproducible analyzes. We further discuss and showcase how these tools can be used to track changes, collaborate, disseminate, and archive RWE studies through dedicated project repositories that maintain a complete audit trail of all relevant study documents.

Data-Sharing Across Otolaryngology: Comparing Journal Policies and Their Adherence to the FAIR Principles

OBJECTIVE

Data-sharing plays an essential role in advancing scientific understanding. Here, we aim to identify the commonalities and differences in data-sharing policies endorsed by otolaryngology journals and to assess their adherence to the FAIR (findable, accessible, interoperable, reusable) principles.

METHODS

Data-sharing policies were searched for among 111 otolaryngology journals, as listed by Scimago Journal & Country Rank. Policy extraction of the top biomedical journals as ranked by Google Scholar metrics were used as a comparison. The FAIR principles for scientific data management and stewardship were used for the extraction framework. This occurred in a blind, masked, and independent fashion.

RESULTS

Of the 111 ranked otolaryngology journals, 100 met inclusion criteria. Of those 100 journals, 79 provided data-sharing policies. There was a clear lack of standardization across policies, along with specific gaps in accessibility and reusability which need to be addressed. Seventy-two policies (of 79; 91%) designated that metadata should have globally unique and persistent identifiers. Seventy-one (of 79; 90%) policies specified that metadata should clearly include the identifier of the data they describe. Fifty-six policies (of 79; 71%) outlined that metadata should be richly described with a plurality of accurate and relevant attributes.

CONCLUSION

Otolaryngology journals have varying data-sharing policies, and adherence to the FAIR principles appears to be moderate. This calls for increased data transparency, allowing for results to be reproduced, confirmed, and debated.

Pitfalls and potentials in simulation studies: Questionable research practices in comparative simulation studies allow for spurious claims of superiority of any method

Comparative simulation studies are workhorse tools for benchmarking statistical methods. As with other empirical studies, the success of simulation studies hinges on the quality of their design, execution, and reporting. If not conducted carefully and transparently, their conclusions may be misleading. In this paper, we discuss various questionable research practices, which may impact the validity of simulation studies, some of which cannot be detected or prevented by the current publication process in statistics journals. To illustrate our point, we invent a novel prediction method with no expected performance gain and benchmark it in a preregistered comparative simulation study. We show how easy it is to make the method appear superior over well-established competitor methods if questionable research practices are employed. Finally, we provide concrete suggestions for researchers, reviewers, and other academic stakeholders for improving the methodological quality of comparative simulation studies, such as preregistering simulation protocols, incentivizing neutral simulation studies, and code and data sharing.

Selection of Medical Teachers: An Initiative for Ensuring a Fair and Transparent Selection Process

BACKGROUND

The first step towards creating a sound educational environment and healthcare in a medical institute is employing medical teachers who maintain ethical behavior in their professional practice. A method where bias and subjectivity can be minimized is by making the recruitment process objective.

MATERIAL AND METHODS

The recruitment started as an offline process and was soon converted into an online form incorporating parameters for scoring. A total of 1,151 medical teachers had submitted their applications for posts in various departments, and 778 candidates were shortlisted and called for an interview. After the interview process, a unique symposium on the selection of medical teachers was organized. The feedback was incorporated into the online application that was released for the subsequent phases of recruitment.

RESULTS

The response rate of the study was 96.55%. Analysis of the feedback by the applicants showed that 47.59% of the applicants were of the opinion that the prevailing selection process in the country needs a change; 84.14% felt that the inclusion of objective criteria would make the selection process more transparent; and 91.03% were happy with the stratification of marks; 82.75% of the applicants and experts felt that knowledge of statistics for quality research and publications in indexed and institutional journals may be considered for the selection process; and 52.41% thought that all authors of an article should be given equal weightage. Adopting a fairly new concept of workplace-based assessment (WPBA) in India was acceptable to 83.45%.

CONCLUSIONS

Parameter-based, objective selection reduces bias, and merit alone is recognized.

Fast-Crosslinking Enabled Self-Roughed Polydimethylsiloxane Transparent Superhydrophobic Coating and Its Application in Anti-Liquid-Interference Electrothermal Device

Polydimethylsiloxane (PDMS)-based transparent and superhydrophobic coatings have important applications, such as anti-icing, corrosion resistance, self-cleaning, etc. However, their applications are limited by the inevitable introduction of nanoparticles/high-temperature/segmented PDMS to facilitate a raspy surface. In this study, a self-roughed, neat PDMS superhydrophobic coating with high transparency is developed via a one-step spray-coating technique. PDMS suspensions with various droplet sizes are synthesized and used as building blocks for raspy surface formation by controlled curing on the warm substrate. The optimal coating exhibits a large water contact angle of 155.4° and transparency (T550 = 82.3%). Meanwhile, the employed spray-coating technique is applicable to modify a plethora of substrates. For proof-of-concept demonstrations, the use of the PDMS hydrophobic coating for anti-liquid-interference electrothermal devices and further transparent observation window for long-term operation in a sub-zero environment is shown successful. The proposed facile synthesis method of hydrophobic PDMS coating is expected to have great potential for a broad range of applications in the large-scale fabrication of fluorine-free, eco-friendly superhydrophobic surfaces.

Electron-Beam-Initiated Crosslinking of Methacrylated Alginate and Diacrylated Poly(ethylene glycol) Hydrogels

An ideal wound dressing not only needs to absorb excess exudate but should also allow for a moist wound-healing environment as well as being mechanically strong. Such a dressing can be achieved by combining both a natural (alginate) and synthetic (poly(ethylene glycol) polymer. Interestingly, using an electron beam on (meth)acrylated polymers allows their covalent crosslinking without the use of toxic photo-initiators. The goal of this work was to crosslink alginate at different methacrylation degrees (26.1 and 53.5% of the repeating units) with diacrylated poly(ethylene glycol) (PEGDA) using electron-beam irradiation at different doses to create strong, transparent hydrogels. Infrared spectroscopy showed that both polymers were homogeneously distributed within the irradiated hydrogel. Rheology showed that the addition of PEGDA into alginate with a high degree of methacrylation and a polymer concentration of 6 wt/v% improved the storage modulus up to 15,867 ± 1102 Pa. Gel fractions > 90% and swelling ratios ranging from 10 to 250 times its own weight were obtained. It was observed that the higher the storage modulus, the more limited the swelling ratio due to a more crosslinked network. Finally, all species were highly transparent, with transmittance values > 80%. This may be beneficial for the visual inspection of healing progression. Furthermore, these polymers may eventually be used as carriers of photosensitizers, which is favorable in applications such as photodynamic therapy.

Animal Ghosts at Canadian Universities: The Politics of Concealment and Transparency

For many years, the lives of animals used for research in Canadian universities have been hidden from public view due both to physical concealment (e.g., security procedures and impenetrable labs) and administrative concealment (non-disclosure of information). Their lives unfold out of sight both physically and discursively, unavailable to the Canadian public for ethical consideration and democratic oversight. Recently, in response to calls by the public to end this secrecy, Canadian universities and the Canadian Council on Animal Care have embraced the language of "transparency" and have begun releasing documentation about animal research practices and procedures. This paper argues that this new "transparency" acts as its own kind of concealment practice, obscuring and displacing meaningful information while constructing highly selective ways of seeing animals in science, and manufacturing acquiescence/consent on the part of the public.

Ownership Beneath: Transparency of Land Ownership in Times of Economic Crime

This article considers 'ownership beneath' in light of the Economic Crime (Transparency and Enforcement) Act 2022, which has introduced a new Schedule 4A into the Land Registration Act 2002. The legislation, with notable exceptions, requires overseas entities to publicly reveal their beneficial owners, with criminal and land law consequences if transparency requirements are not met. The article explores how ownership beneath operates and can be made more transparent, noting the three different forms of beneficial ownership employed: as control, behind a trust and as a consequence. Emphasising the distinctive nature of beneficial ownership of land, the analysis recommends amending ECTEA 2022 to focus on land ownership, not merely landowning overseas entities, facilitating greater transparency by expanding the definition of registrable beneficial owners, closing the loophole where information is not available and requiring public disclosure of most trust information.

Reason Defaults: Presenting Defaults With Reasons for Choosing Each Option Helps Decision-Makers With Minority Interests

Defaults are powerful tools for nudging individuals toward potentially beneficial options. However, defaults typically guide all decision-makers toward the same option and, consequently, may misguide individuals with minority interests. We test whether presenting defaults with information about heterogeneity can help individuals with minority interests select alternative options, and we dub this intervention a "reason default." Reason defaults preselect the option that is best for most individuals (like standard defaults) but also explain (a) why the default was selected and (b) who should opt for an alternative. In five preregistered studies using online convenience samples of adults (N = 4,210), we find that reason defaults can improve decision-makers' outcomes over standard defaults and forced choices by guiding most individuals toward the default option while helping individuals with minority interests select an alternative. Further, participants reported that reason defaults enhance transparency, decision ease, and understanding of the choice relative to standard defaults and forced choices.

Artificial intelligence in medicine - is too much transparency a good thing?

Some encouraging uses for AI in medicine will lead to potentially novel legal liability issues. Complex algorithms involve an opacity that creates problems for the medical and legal professions alike. As iatrogenic injury is common in medical malpractice, the medical profession is understandably concerned when AI is introduced in diagnostic and therapeutic devices and events and outcome cannot be fully explained due to the "black box" effect.A concern about machine learning algorithms is the black box issue and understanding how conclusions or outcomes are reached. The deployment of AI devices in healthcare will require an increase in a clinician's understanding of AI to increase the transparency of their use.An important aspect of medical treatment is the notion of "therapeutic privilege". This will only arise in limited circumstances and requires the clinician to make a judgment, based on reasonable grounds, that the patient's physical or mental health might be seriously harmed by providing the information.Given the complexity of AI and the black box effect, could too much AI transparency possibly overwhelm a patient, such that it may dissuade them from giving consent in circumstances where treatment is necessary and essential? In other words, too much AI transparency and information may inadvertently hinder treatment and progress.

Prior beliefs and the interpretation of scientific results

How do prior beliefs affect the interpretation of scientific results? I discuss a hypothetical scenario where researchers publish results that could either support a theory they believe in, or refute that theory, and ask if the two instances carry the same weight. More colloquially, I ask if we should overweigh scientific results supporting a given theory and reported by a researcher, or a team, that initially did not support that theory. I illustrate the challenge using two examples from psychology: evidence accumulation models, and extra sensory perception.

Recasting the gold standard - part II of II: communicating healthcare options along a continuum of care

SERIES OUTLINE

This is the second part of a two-part series on spectrum of care that encourages practitioners to tailor case management to the patient along a continuum of acceptable options. Part I defined the spectrum of care and broadened its approach beyond initial cost-of-care considerations. This second article introduces strategies for initiating conversations with clients about their needs, wants and expectations specific to healthcare options and case management decisions. It will explore how open inquiry, reflective listening, transparency and unconditional positive regard facilitate dialogue between providers and their clients as they collaborate on decision-making along a spectrum of care.

RELEVANCE

Contextual case management prioritizes interventions that are appropriate for both the patient and the client. To identify and explore which healthcare options represent the best fit for those impacted most by medical decisions, veterinarians need to make space for clients to feel comfortable sharing their perspectives. Clients are more likely to be engaged in decision-making when their insight is actively solicited. They have much to share with us as experts about their cat's overall health and wellness needs. Inviting clients to contribute to the consultation and being receptive to hearing what motivates their choices helps us to structure conversations around healthcare options. The ability to communicate healthcare options is as vital as the provision of healthcare, if not more so.

Prosocial motives underlie scientific censorship by scientists: A perspective and research agenda

Science is among humanity's greatest achievements, yet scientific censorship is rarely studied empirically. We explore the social, psychological, and institutional causes and consequences of scientific censorship (defined as actions aimed at obstructing particular scientific ideas from reaching an audience for reasons other than low scientific quality). Popular narratives suggest that scientific censorship is driven by authoritarian officials with dark motives, such as dogmatism and intolerance. Our analysis suggests that scientific censorship is often driven by scientists, who are primarily motivated by self-protection, benevolence toward peer scholars, and prosocial concerns for the well-being of human social groups. This perspective helps explain both recent findings on scientific censorship and recent changes to scientific institutions, such as the use of harm-based criteria to evaluate research. We discuss unknowns surrounding the consequences of censorship and provide recommendations for improving transparency and accountability in scientific decision-making to enable the exploration of these unknowns. The benefits of censorship may sometimes outweigh costs. However, until costs and benefits are examined empirically, scholars on opposing sides of ongoing debates are left to quarrel based on competing values, assumptions, and intuitions.

Eleven strategies for making reproducible research and open science training the norm at research institutions

Reproducible research and open science practices have the potential to accelerate scientific progress by allowing others to reuse research outputs, and by promoting rigorous research that is more likely to yield trustworthy results. However, these practices are uncommon in many fields, so there is a clear need for training that helps and encourages researchers to integrate reproducible research and open science practices into their daily work. Here, we outline eleven strategies for making training in these practices the norm at research institutions. The strategies, which emerged from a virtual brainstorming event organized in collaboration with the German Reproducibility Network, are concentrated in three areas: (i) adapting research assessment criteria and program requirements; (ii) training; (iii) building communities. We provide a brief overview of each strategy, offer tips for implementation, and provide links to resources. We also highlight the importance of allocating resources and monitoring impact. Our goal is to encourage researchers - in their roles as scientists, supervisors, mentors, instructors, and members of curriculum, hiring or evaluation committees - to think creatively about the many ways they can promote reproducible research and open science practices in their institutions.

Mohs Surgery Price Transparency and Variability at Academic Hospitals After the Implementation of the Federal Price Transparency Final Rule

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Procedural fairness and the resilience of health financing reforms in Ukraine

In 2017, Ukraine's Parliament passed legislation establishing a single health benefit package for the entire population called the Programme of Medical Guarantees,‎ financed through general taxes and administered by a single national purchasing agency. This legislation was in line with key principles for financing universal health coverage. However, health professionals and some policymakers have been critical of elements of the reform, including its reliance on general taxes as the source of funding. Using qualitative methods and drawing on deliberative democratic theory and criteria for procedural fairness, this study argues that the acceptance and sustainability of these reforms could have been strengthened by making the decision-making process fairer. It suggests that three factors limited the extent of stakeholders' participation in this process: first, a perception among reformers that fast-paced decision-making was required because there was only a short political window for much needed reforms; second, a lack of trust among reformers in the motives, representativeness, and knowledge of some stakeholders; and third, an under-appreciation of the importance of dialogic engagement with the public. These findings highlight a profound challenge for policymakers. In retrospect, some of those involved in the reform's design and implementation believe that a more meaningful engagement with the public and stakeholders who opposed the reform might have strengthened its legitimacy and durability. At the same time, the study shows how difficult it is to have an inclusive process in settings where some actors may be driven by unconstrained self-interest or lack the capacity to be representative or knowledgeable interlocutors. It suggests that investments in deliberative capital (the attitudes and behaviours that facilitate good deliberation) and in civil society capacity may help overcome this difficulty.

Report on Proceedings of the Fifteenth Annual European CME Forum, Barcelona, Spain, November 2022

In a welcome return to a live, in person, same space meeting, albeit with some participants joining virtually, the Fifteenth Annual European Continuing Medical Education (CME) Forum (#15ECF) was hosted in Barcelona, Spain,2-4 November 2022. The meeting began with sessions conducted by three special interest groups affiliated with the European CME Forum, but open to all registrants. The main part of the meeting comprised interactive discussion sessions conducted by presenters from North and South America, Europe, India, and Australia, which were interspersed with breakout workshops that tackled three themes, Innovation and Impact, Attitudes and Culture, and Environment and Community. A featured topic was the patient voice in education and insights were provided by the international delegates on their local frameworks for CME/CPD. Updates were also provided on harmonisation among international accreditors, and an important change to the Journal of European CME, that is closely linked to the European CME Forum, was announced. An oral presentation was made by one of the poster authors, and the perennial favourites "Lunch with the Learners" and the "CME Unsession" werealso included. The level of engagement displayed by the participants would seem to suggest that much of the recent fatigue associated with virtual meetings was mitigated by this live event.