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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.
After surveying its members on ethical issues (2003), the International Network of Agencies for Health Technology Assessment (INAHTA) mandated its Ethics Working Group (2005) to reflect on the role of health technology assessment (HTA) organizations in meeting social expectations. Some aspects of these have since been clarified by two studies addressing either the official position of INAHTA's members or the publication authors. An international survey was carried out on the perception of HTA professionals’ expectations when producing HTA reports: how to fulfil HTA's social role, which value judgments should be made explicit and what should be the status of ethical analysis.
A twenty-two question, web-based, anonymous survey was devised from our recent systematic review on the integration of ethics into HTA and carried from April to July 2018. The information on 328 HTA agencies/contact persons from seventy-five countries was collected from the website of INAHTA, Health Technology Assessment International (HTAi), the European Network for Health Technology Assessment (EUnetHTA), EuroScan International Network, the HTA Network of the Americas (RedETSA) and the HTA Network of Asia (HTAsiaLink), a 2015 World Health Organization survey, HTAi members, and our local HTA network (Québec, Canada).
Eighty-nine participants completed and submitted a finalized survey for a 27 percent participation rate representing thirty-three countries. Regarding how the HTA reports should fulfil their social role, our results showed that over 84 percent of the respondents agreed upon the necessity to address it to decision makers, patients and citizens. At a lower and more variable level, the same result was found about the necessity to make value judgements explicit in different sections of the report, including ethical analysis. This contrasts with the variability of responses obtained on the status of ethical analysis although an agreement on the expertise required was observed. Variability in the usefulness of patient, public or stakeholder participation was observed.
At the dawn of this decade, this study reveals high expectations on context-dependent decisions in HTA: the necessity to integrate the ‘explicitation’ of value judgements and systematic ethical analysis to fulfil HTA's social role.
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 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.
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.
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.
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.
In particle accelerators, the bending magnets have to be wound with flared ends. This particular shape induces an inhomogeneity in the magnetic field in the ends, which degrades the particle beam stability. This paper proposes a 3D modeling for conductors with rectangular cross-sections. The coil is first divided into blocks (parallelepipeds and arcs). Then the magnetic field is evaluated in every point of space by means of analytical formulas which allow an accurate computation. This method is also faster than numerical integrations of Biot and Savart law. Some optimization examples are finally presented and show that it is possible to minimize, with a few degrees of freedom only, the first field harmonics, integrated along the beam tube.
Monte Carlo simulations are used to perform an atomic scale modelling of the magnetic properties of epitaxial exchange-coupled DyFe2/YFe2 superlattices. These samples, extremely well-researched experimentally, are constituted by a hard ferrimagnet DyFe2 and a soft ferrimagnet YFe2 antiferromagnetically coupled. Depending on the layers and on the temperature, the field dependence of the magnetization depth profile is complex. In this work, we reproduce by Monte Carlo simulations hysteresis loops for the net and compound-specific magnetizations at different temperatures, and assess the quality of the results by a direct comparison to experimental hysteresis loops.
Mass-balance and dynamic behaviour of Chhota Shigri glacier, western Himalaya, India, has been investigated between 2002 and 2010 and compared to data collected in 1987-89. During the period 2002-10, the glacier experienced a negative glacier-wide mass balance of -0.67 ± 0.40 m w.e. a-1. Between 2003 and 2010, elevation and ice-flow velocities slowly decreased in the ablation area, leading to a 24-37% reduction in ice fluxes, an expected response of the glacier dynamics to its recent negative mass balances. The reduced ice fluxes are still far larger than the balance fluxes calculated from the 2002-10 average surface mass balances. Therefore, further slowdown, thinning and terminus retreat of Chhota Shigri glacier are expected over the next few years. Conversely, the 2003/04 ice fluxes are in good agreement with ice fluxes calculated assuming that the glacier-wide mass balance is zero. Given the limited velocity change between 1987−89 and 2003/04 and the small terminus change between 1988 and 2010, we suggest that the glacier has experienced a period of near-zero or slightly positive mass balance in the 1990s, before shifting to a strong imbalance in the 21st century. This result challenges the generally accepted idea that glaciers in the Western Himalaya have been shrinking rapidly for the last few decades.
Les problèmes actuels en mécanique dans le domaine ferroviaire font intervenir de manière
intensive des non-linéarités, que ce soit dans le comportement des composants du système
(ex. ballast...), ou aux interfaces. Par ailleurs, la prise en compte de l’aléatoire dans
la modélisation devient incontournable, tant pour les sollicitations du système que pour
la variabilité de ses caractéristiques. Ces deux tendances sont illustrées sur des
exemples de problématiques actuelles : dynamique des véhicules et de l’infrastructure,
Residual stresses in sputtered ZnO films on Si are investigated and discussed. By means of X-ray diffraction, we show that as-deposited ZnO films encapsulated or not by Si3N4 protective coatings are highly compressively stressed. Moreover, a transition of stress is observed as a function of the post-deposition annealing temperature. After a heat treatment at 800°C, ZnO films are tensily stressed while ZnO films encapsulated by Si3N4 are stress-free. With the aid of in-situ X-ray diffraction, we argue that this thermally-activated stress relaxation can be attributed to a variation of the chemical composition of the ZnO films.
Detailed observations have been performed on the evolution of a viscous catenary, a rope of high-viscosity fluid suspended from two points falling under gravity. Stroboscopic imaging techniques are used to obtain the position and shape of the strand as a function of time. Depending on their initial thickness and profile, the filaments are observed to evolve into either a quasi-catenary, or other, more complex shapes. A conceptually simple, energy-based theory is developed and compared with observations. It is shown to describe reasonably, except for a scaling in the time scale, the catenary-like regime.
Functional hybrid coatings have been elaborated from a polymer matrix incorporating iron oxide nanoparticles. Stable aqueous suspensions of goethite (α-FeOOH) nanorods, obtained by controlled precipitation of Fe3+ ions, were introduced in 2-hydroxyethyl methacrylate (HEMA). The films were spin-coated on glass substrates from the solutions prior to a UV light induced free radical polymerization step. Nanoindentation tests were carried out to investigate the mechanical properties of the hybrid coatings. Swelling measurements and Fourier Transformed Infrared Spectroscopy (FTIR) were used to characterize the interface between the iron oxide nanoparticles and the PHEMA matrix. Cross-sectional scanning electron microscopy (SEM) and transmission electron microscopy (TEM) was performed to evaluate the dispersion state of the iron oxide particles through the matrix. From a mechanical point of view, iron oxide nanorods yield to a strong reinforcement effect of PHEMA (increase in modulus and hardness by a factor 2 with 5%vol goethite nanoparticles). Origins of such reinforcement are attributed to the existence of highly favourable interactions at the goethite-PHEMA interface combined with a homogeneous dispersion of the particles. The nature of these interactions and evidences of there influence on the mechanical behaviour of the nanohybrid coatings are reported.