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During the 2014–2016 Ebola epidemic in West Africa, some communities reacted hostilely to the implementation of quarantine measures. This study's aim was to examine the views of lay people in Guinea on the acceptability of community quarantine. From June to August 2016, 302 adults indicated the acceptability of quarantine in 36 scenarios varying as a function of four factors: the infectious disease's level of contagiousness, its level of lethality, the number of cases in the community and whether persons in quarantine are provided with support services. Five clusters were identified: (1) for 18% of the participants, quarantine is never acceptable; (2) 16% considered, in contrast, that quarantine is always acceptable; (3) for 14%, it depends on the disease's level of contagiousness and lethality; (4) 36% based their judgement not only on the levels of contagiousness and lethality, but also on whether those in quarantine are provided with support services; and (5) 16% had no opinion. Interventions to increase voluntary compliance with community quarantine in Guinea must not be ‘one size fits all’, but must be multifaceted and tailored in design and implementation to match the diversity of people's concerns and needs.
Depositional changes are studied in three sections encompassing the Danian–Selandian transition, Loubieng (France), Zumaia (Spain) and Sidi Nasseur (Tunisia), using magnetic susceptibility as a proxy. Additional rock-magnetic analyses are used to avoid ambiguous interpretation of magnetic susceptibility. The magnetic susceptibility, measured on 90 to 270 samples per section, is mainly controlled by paramagnetic minerals and linked to detrital input. Major increases in the detrital input are correlated to the end of the Latest Danian Event, a hyperthermal, and to the Danian–Selandian boundary. In Loubieng, two gradual increases in magnetic susceptibility within limestones beds precede the major detrital input increases, and start synchronously with the beginning of the Latest Danian Event and the onset of haematite deposition around the Danian–Selandian boundary, respectively. This haematite is suspected to be of primary origin based, among other things, on low magnetic viscosity values, which is used here as an indicator of diagenetic origin in haematite and goethite. The red levels where haematite is interpreted to be of primary origin could be linked to the hyperthermal event previously hypothesized for the basal Selandian. The comparison of the magnetic susceptibility, chemo- and biostratigraphic data between the three sections highlights the condensed nature of the sedimentation around the Danian–Selandian boundary in the sections of the Atlantic realm. The lower part of the Selandian shows a particularly low sedimentation rate at Zumaia compared to Loubieng and Sidi Nasseur. The latter displays the most complete record of the three.
The fact that HTA is a value-laden process is recognized in the literature. This is one of the reasons for promoting a better integration of ethics in HTA processes. Although what is meant by value-judgment (VJ) and how it can be used in HTA is not clear for some authors; others have proposed the elicitation of implicit VJs, to make them more explicit, as one way for clarifying the role ethics may play in HTA. In order to clarify what a VJ is, a conceptual analysis is needed to distinguish it from a factual-judgment and see how they diverge on certain aspects and converge on others.
The distinction between VJs and factual-judgments was debated in the fifties. At the core of the philosophy of language was a distinction between factual-scientific assertions about facts, considered objective, and VJs on what is right/wrong-good/bad, considered subjective. In speech-act theory these distinctions were treated as two different operations: assertive and evaluative. A conceptual analysis of VJs, considering them as specific speech-acts, was used for clarifying/deciphering the role of VJs in HTA.
VJs are intrinsically embedded in decision-making since they are the reasons justifying decisions. This is why implicit VJs can be identified at every decision-step in the HTA process. Assessment is usually considered objective while appraisal seems subjective. Since VJs are entrenched in the decisions taken throughout the assessment process, the results are not completely objective. Ethical analysis also distinguishes two types of VJs, those based on normative criteria and those based on various degrees of value actualization. Furthermore, since evaluation requires criteria based on a rational process, VJs are not totally subjective.
Elicitation of VJs in HTA is one way of integrating ethics in HTA and offers decision-makers a more thorough picture of the ethical issues involved in their decision.
Eliciting implicit value-judgments (VJs) in the HTA process is one way of integrating ethics in HTA since the latter is recognized as a value-laden process. An analysis of the diversity of opinions on implicit VJs in HTA and of their role, highlights the connection there exists between VJs and the different decisions involved in the whole HTA process. Such a link is corroborated by a conceptual analysis of VJ using a speech-act philosophical approach grounded in the philosophy of language, since VJs are linked with normative speech-acts such as commands, recommendations and advices.
We propose an analysis of the published citations mentioning VJs, extracted from our systematic review on the challenges of integrating ethics in HTA. In order to do so, those quotes were categorized in a chart, the latter of which presents: (i) the different steps of decision-making in the HTA process, (ii) the description of the implicit VJ(s) and (iii) the criteria involved. This chart was elaborated with the participation of the HTA local evaluators involved as co-investigators in our research group. The final version was discussed, debated and validated by the entire research group.
The chart shows 18 decision-making steps in the HTA process in which twenty-three implicit VJs can be observed. The range of such VJs encompasses the whole HTA process from the initial mandate to the agency presenting the decisional issues, to the dissemination of the final report. The published citations gathered for each category compile different expectations on the elicitation of the implicit VJs, thus making the latter VJs more explicit.
This chart allows a better understanding of the expectations that are at the core of the appeal for more transparency in the HTA process, since stakeholders need to understand which value-judgments the final conclusion of a report is relying on.
Integration of ethics into health technology assessment (HTA) remains challenging for HTA practitioners. We conducted a systematic review on social and methodological issues related to ethical analysis in HTA. We examined: (1) reasons for integrating ethics (social needs); (2) obstacles to ethical integration; (3) concepts and processes deployed in ethical evaluation (more specifically value judgments) and critical analyses of formal experimentations of ethical evaluation in HTA.
Search criteria included “ethic,” “technology assessment,” and “HTA”. The literature search was done in Medline/Ovid, SCOPUS, CINAHL, PsycINFO, and the international HTA Database. Screening of citations, full-text screening, and data extraction were performed by two subgroups of two independent reviewers. Data extracted from articles were grouped into categories using a general inductive method.
A list of 1,646 citations remained after the removal of duplicates. Of these, 132 were fully reviewed, yielding 67 eligible articles for analysis. The social need most often reported was to inform policy decision making. The absence of shared standard models for ethical analysis was the obstacle to integration most often mentioned. Fairness and Equity and values embedded in Principlism were the values most often mentioned in relation to ethical evaluation.
Compared with the scientific experimental paradigm, there are no settled proceedings for ethics in HTA nor consensus on the role of ethical theory and ethical expertise hindering its integration. Our findings enable us to hypothesize that there exists interdependence between the three issues studied in this work and that value judgments could be their linking concept.
The ‘open approach’ is rooted in the open-source and free-software movements. Its application has spread to more fields than computer engineering. Product design is impacted as well: we observe new stakeholders and practices challenging current structured design processes and leading to industrial successes. Open-design appears to be promising yet disruptive. Moreover, its distinctive features remain unclear.
This paper aims to popularize this new concept, as well as to give both researchers and practitioners an overview of current research on open-design, and its consequences on design. For this, we conducted a systematic quantitative bibliometric analysis of 624 entries corresponding to the keyword ‘open-design’ in the Scopus database. This supports a qualitative synthesis of scientific literature, enabling us to summarize practices falling under the umbrella term ‘open-design’. As such, this paper traces the evolution of product design and the open approach. It also analyzes the impact of open-design on the design process as presented in the scientific literature. Finally, this paper develops a typology of open-design of tangible artifacts that distinguishes among three currently reported varieties of practice: do-it-yourself, meta-design, and industrial ecosystems. As the major contribution of this paper, this typology is developed as a final discussion.
One of the barriers of integrating ethics in Health Technology Assessment (HTA) relates to the social role of HTA (1). The aim of this study is to provide a better understanding of the way by which law circumscribes the social role of HTA. Our hypothesis: HTA's social role is embedded within a mixed governance based on hard law and soft law.
Three HTA agencies were conveniently selected for our study: Haute Autorité de santé (HAS) (France), National Institute for Health and Care Excellence (NICE) (United Kingdom) and Institut national d'excellence en santé et en services sociaux (INESSS) (Québec, Canada). Our analysis of the legal, administrative and procedural documents relating to the existence and assessment processes of these three agencies is guided by the following criteria:
1.The normative strength of the documents (categories of hard law or soft law) (2)
2.The definition of the agencies’ social role (1)
3.The integration of ethics in the agencies’ mandate.
Hard law contributes to establish a general mandate and some legal legitimacy for these agencies. Soft law, grounded in the HTA producers' practices, plays a major role in the legal governance of HTA. Our results demonstrate that these agencies existing practices seem to circumscribe their social role further than their constitutive laws. In this context, social actors become responsible to define, structure and operationalize the implementation of HTA.
In addition, the legal framework (hard law) through which HTA unfolds does not clearly support its structural and social role. Despite existing legal frameworks, the normative legitimacy of HTA is not entirely established, as it depends on soft law. Taken altogether, this maintains a persisting conceptual vagueness in HTA governance.
The social role of HTA should be defined either through modifying existing legislations (hard law) or through harmonization of the agencies internal policies and regulations (soft law). Such legal initiatives would help clarify the aims of HTA evaluations: assessments (scientific) or appraisal (value-laden), and therefore give a clearer indication on how best to integrate ethics in HTA.
The main difficulties encountered in the integration of ethics in Health Technology Assessment (HTA) were identified in our systematic review. In the process of analyzing these difficulties we then addressed the question of the diversity of ethical approaches (1) and the difficulties in their operationalization (2,3).
Nine ethical approaches were identified: principlism, casuistry, coherence analysis, wide reflexive equilibrium, axiology, socratic approach, triangular method, constructive technology assessment and social shaping of technology. Three criteria were used to clarify the nature of each of these approaches:
1.The characteristics of the ethical evaluation
2.The disciplinary foundation of the ethical evaluation
3.The operational process of the ethical evaluation in HTA analysis.
In HTA, both norm-based ethics and value-based ethics are mobilized. This duality is fundamental since it proposes two different ethical evaluations: the first is based on the conformity to a norm, whereas the second rests on the actualization of values. The disciplinary foundation generates diversity as philosophy, sociology and theology propose different justifications for ethical evaluation. At the operational level, ethical evaluation's characteristics are applied to the case at stake by specific practical reasoning. In a norm-based practical reasoning, one must substantiate the facts that will be correlated to a moral norm for clearly identifying conformity or non-conformity. In value-based practical reasoning, one must identify the impacts of the object of assessment that will be subject to ethical evaluation. Two difficulties arise: how to apply values to facts and prioritize amongst conflicting ethical evaluations of the impacts?
Applying these three criteria to ethical approaches in HTA helps understanding their complexity and the difficulty of operationalizing them in HTA tools. The choice of any ethical evaluations is never neutral; it must be justified by a moral point of view. Developing tools for ethics in HTA is operationalizing a specific practical reasoning in ethics.
The objective was to identify the conceptual and methodological issues surrounding integration of ethics in Health Technology Assessment (HTA). We conducted a systematic review examining: (i) social needs, (ii) methodological and procedural barriers, (iii) concepts or processes of ethics assessment used and (iv) results of experimentations for integrating ethics in HTA.
Search criteria included ‘ethic’, ‘technology assessment’ and ‘HTA’. The literature search was done up to 21 November 2016 in Medline/Ovid, SCOPUS, CINAHL, PsycINFO and international HTA Database. Screening of citations, screening of full-text and data extraction were performed by two subgroups of two independent reviewers. The first group was constituted of HTA experts, and the second of ethics and philosophy experts. Data extracted from articles were regrouped in categories for each objective.
A list of 2,420 citations was obtained while 1,646 remained after the removal of duplicates. Of these, 132 were fully reviewed, yielding 67 eligible articles for analysis. Eight categories were identified within the social needs. The mostly evoked were ‘Informed policy decision making’ (n = 16) and 'Informed public/patient decision making’ (n = 12). Ten categories of methodological and procedural barriers were identified. The most mentioned were 'Lack of standardized and recognized proceedings for ethical analysis’ (n = 28) and ‘Lack of shared consensus on the role of ethical theory and ethical expertise’ (n = 17). Within the concepts or processes of ethics assessment, thirteen categories were identified. The most mentioned were ‘Fairness and Equity’ (n = 12), ‘Beneficence and Non-maleficence’ (n = 10) and, ‘Autonomy’ (n = 10). Within results of experimentations, five categories were identified. The most mentioned was ‘Usefulness of ethics for identifying relevant problems’ (n = 3). While few experimentations were identified, no clear operational method was found in our research.
This study confirms the necessity to design an operational method integrating ethics and addressing social needs of HTA. Our results constitute the basis for developing a new theoretical and practical method.
Local glacial fluctuations and flood occurrences were investigated in the sediment sequence of proglacial Lake Muzelle. Based on geochemical analysis and organic matter content established using loss on ignition and reflectance spectroscopy, we identified six periods of increased glacial activity over the last 1700 yr. Each is in accordance with records from reference glaciers in the Alps. A total of 255 graded layers were identified and interpreted as flood deposits. Most of these occurred during glacial advances such as the Little Ice Age period and exhibit thicker deposits characterized by an increase in the fine grain-size fraction. Fine sediment produced by glacial activity is transported to the proglacial lake during heavy rainfall events. The excess of glacial flour during these periods seems to increase the watershed’s tendency to produce flood deposits in the lake sediment, suggesting a strong influence of the glacier on flood reconstruction records. Thus, both flood frequency and intensity, which is estimated based on layer thickness as a proxy, cannot be used in reconstruction of past extreme events because of their variability. There is a need to take into account changes in sediment supply in proglacial areas that could preclude satisfactory interpretation of floods in terms of past climate variability.
This paper proposes a Bayesian approach to estimating a factor-augmented GDP per capita equation. We exploit the panel dimension of our data and distinguish between individual-specific and time-specific factors. On the basis of 21 technology, infrastructure, and institutional indicators from 82 countries over a 19-year period (1990 to 2008), we construct summary indicators of each of these three components in the cross-sectional dimension and an overall indicator of all 21 indicators in the time-series dimension and estimate their effects on growth and international differences in GDP per capita. For most countries, more than 50% of GDP per capita is explained by the four common factors we have introduced. Infrastructure is the greatest contributor to total factor productivity, followed by technology and institutions.
The best strategy for controlling extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) transmission in intensive care units (ICUs) remains elusive.
We developed a stochastic transmission model to quantify the effectiveness of interventions aimed at reducing the spread of ESBL-PE in an ICU.
We modeled the evolution of an outbreak caused by the admission of a single carrier in a 10-bed ICU free of ESBL-PE. Using data obtained from recent muticenter studies, we studied 26 strategies combining different levels of the following 3 interventions: (1) increasing healthcare worker compliance with hand hygiene before and after contact with a patient; (2) cohorting; (3) reducing antibiotic prevalence at admission with or without reducing antibiotherapy duration.
Improving hand hygiene compliance from 55% before patient contact and 60% after patient contact to 80% before and 80% after patient contact reduced the nosocomial incidence rate of ESBL-PE colonization by 91% at 90 days. Adding cohorting to hand hygiene improvement intervention decreased the proportion of ESBL-PE acquisitions by an additional 7%. Antibiotic restriction had the lowest impact on the epidemic. When combined with other interventions, it only marginally improved effectiveness, despite strong hypotheses regarding antibiotic impact on transmission.
Our results suggest that hand hygiene is the most effective intervention to control ESBL-PE transmission in an ICU.
Infect. Control Hosp. Epidemiol. 2016;37(3):272–280
The effect of electron beam irradiation of stoichiometric hydroxyapatite (Ca10(PO4)6(OH)2, HAP) is investigated using electron energy loss spectroscopy (EELS) in the scanning transmission electron microscope (STEM) mode equipped with a LaB6 gun. Initial irradiation at 160 A cm−2 dose rate shows no modification of the low loss spectra. No difference of mass loss for Ca, O and P is observed for two different probe diameters: 4 nm (dose rate = 160 A cm−2) and 24 nm (dose rate = 70 A cm−2). Furthermore no formation of CaO is observed for both experimental conditions. It is proposed that the low values of both electron dose rates and doses (from 350 to 2400 C cm−2) avoid mass loss. At the higher dose rate obtained with a field emission gun (FEG), transformations are observed for the lowloss signal as well as for the Ca, P and O signals. These results might be very useful for the future studies of apatite particles at the nanoscale.
Through the experiments presented here we wanted to test whether egg production of the
black-chinned tilapia Sarotherodon melanotheron heudelotii under
experimental conditions varies as a function of ambient salinity (fresh waters vs.
sea waters vs. hypersaline waters, 0, 35 and 70, respectively)
and whether these responses differ between fish acclimated within a few weeks from fresh
water to saline and hypersaline environments (experiments E1 and E2, monitoring over 10
and 18 weeks), and individuals born and raised all life long at the experimental
salinities (E3, monitoring over 18 weeks). In total, 233 spawns were collected. In each of
the three experiments, the reproductive investment (gram of egg per gram of female over 2
weeks) did not differ between salinities of 0 and 35, whereas it was 2–3 times lower at 70
than at 0–35, because of lower spawning frequency (E1-E3), smaller clutch size (E1) and
lower spawn mass (E1-E3). Finally, fish acclimated to salinity from fresh water over a few
weeks and those maintained at a particular salinity all life long showed similar
reproductive traits, thereby emphasizing the remarkable physiological plasticity of this
Social statuses existed before the social sciences. When scholars began to develop this concept in the nineteenth century, they were drawing on the juridical writings of the seventeenth and eighteenth centuries and, more broadly, the vocabulary used by social groups to define themselves across time and space. From this moment forward, social statuses occupied a central position in the work of historians, sociologists, and anthropologists. These scholars were aiming to describe and explain the dynamics of human societies, but they also participated in framing the debates at the heart of the social sciences—as attested by the recurrent disputes between a Marxian notion of class and a Weberian conception of status groups, particularly among readers with tacit political motivations. Max Weber played a fundamental part in the success of the concept, taking the juridical aspect and the idea of society as a body, inherited from the ancien régime, and adding a specifically sociological content relating to the hierarchy of social prestige, which is neither directly inherited (as with castes) nor purely economic (as with classes). In truth, this definition was rarely applied stricto sensu by historians, sociologists, and anthropologists, but it did allow for the elaboration of a concept that could delimit groups of individuals sharing legal and symbolic characteristics within a given society, and that could incorporate the categories used by social actors themselves into historical analysis. Thus, during the 1960s, it was around the notion of status that interpretations of the ancien régime as a society of orders or a society of classes took shape, while anthropologists began to consider notions of emic and etic. From the 1980s, however, the concept of social status receded into the background as the idea of a global interpretation of society by the social sciences was called into question.
L’existence des « statuts sociaux » précède celle des sciences sociales, qui s’en sont emparés au XIXe siècle en puisant d’abord dans les écrits des juristes des XVIIe et XVIIIe siècles et, plus largement, dans le vocabulaire par lequel les groupes sociaux se désignent à travers le temps et l’espace. Dès cette époque, ils occupent une place centrale dans les travaux des historiens, des sociologues et des anthropologues, qui tentent de décrire et d’expliquer les dynamiques des sociétés humaines et participent à la structuration des débats au sein des sciences sociales, comme en témoignent les jeux et rejeux de l’opposition entre les classes de Karl Marx et les statuts de Max Weber, en particulier chez des lecteurs parfois guidés par des arrières pensées politiques. M. Weber a considérablement contribué au succès de la notion en ajoutant à une dimension juridique et à une conception de la société comme corps, héritées de l’Ancien Régime, un contenu proprement sociologique, lié à la hiérarchisation selon une échelle du prestige social qui n’est ni directement héréditaire, comme dans les castes, ni purement économique, comme dans les classes. Si cette définition a rarement été utilisée de manière stricte par les histo- riens, les sociologues et les anthropologues, elle a permis de proposer un concept délimitant, au sein d’une société donnée, des groupes d’individus dotés de carac- téristiques juridiques mais aussi symboliques communes, en intégrant à l’analyse historique des catégories maniées par les acteurs. Ainsi, durant les années 1960, c’est autour des statuts que se cristallisent les interprétations de l’Ancien Régime comme société d’ordres ou de classes, alors qu’émergent les discussions entre emic et etic parmi les anthropologues. Pourtant, à partir des années 1980, au moment où l’idée d’une interprétation globale des sociétés humaines par les sciences sociales est remise en cause, la question des statuts sociaux semble passer au second plan.
The thermal transport in amorphous/crystalline silicon superlattices with means of molecular dynamics is presented in the current study. The procedure used to build such structures is discussed. Then, thermal conductivity of various samples is studied as a function of the periodicity of regular superlattices and of the applied temperature. Preliminarily results show that for regular amorphous/crystalline superlattices, the amorphous regions control the heat transfer within the structures. Secondly, in the studied cases thermal conductivity weakly varies with the temperature. This, points out the presence of a majority of non-propagating vibrational modes in such systems.
In the framework of the study of long-term storage of the spent nuclear fuel, polycrystalline UO2 samples have been implanted with He ions. The thin implanted layer, close to the free surface is subjected to elastic stresses which are studied by x-ray diffraction (micro Laue diffraction) and a mechanical modeling. A simple expression of the displacement gradient tensor has been evidenced; it concerns only three terms (ε3, ε4 and ε5) which strongly evolve with considered grain orientations. Finally, we show that results obtained with micro diffraction are in very good agreement with conventional x-ray diffraction measurements done in laboratory at macro scale.
Meal frequency is a key parameter in fish larviculture, especially in highly
cannibalistic species. Knowledge of the biological bases of cannibalism (growth capacity
of cannibals, morphological constraints on cannibalism, prey size preference) can help
predicting the risks of cannibalism for different feeding schedules under culture
conditions. This study relied on the day-by-day analysis of prey size preference and
bioenergetics of individual cannibals of the catfish Pseudoplatystoma punctifer
(8–65 mm standard length, SL, 0.5–400 mg dry mass,
DM) at 28.5 °C under 12L:12D. The results were equated with the
ontogenetic variations of morphological factors (head and mouth width) and feed efficiency
of larvae feeding on Artemia nauplii, in order to calculate the risks of
cannibalism among fish fed 2–7 daily meals. The predation capacities of P.
punctifer were highest at 8 mm SL and decreased in larger fish
(largest prey = 86% and 70% SL in fish of 8 and >30 mm
SL, respectively). Cannibals of increasing size preferred increasingly
smaller prey relative to their own size, but also to their predation capacities. These
morphological and behavioural constraints were largely compensated for by bioenergetics
performance. Cannibals consumed high daily food rations (as high as 171 and 29%
DM in fish <1 and >300 mg DM,
respectively), exhibited high gross conversion efficiencies (0.50–0.55 and about 0.70, in
fish <1 and >30 mg DM, respectively), and grew rapidly
(90 and 18% DM day-1 in fish <1 and >300 mg
DM, respectively). The growth advantage of cannibals over siblings fed
Artemia nauplii was decisive, except for high meal frequencies (6–7
daily meals). This study supports the view that the risk of cannibalism and adequate
feeding strategies can be largely predicted in a particular fish species if the
morphological, behavioural and bioenergetics bases of cannibalism are examined altogether
in an ontogenetic perspective.