Development and Presentation of an Ethical Framework for Health and Medical Apps

The ubiquity of mobile applications makes it difficult to weigh up opportunities and potential risks. One significant aspect of an ethical assessment regarding the development and use of health and medical apps is the lack of clear and consistent guidelines and measures of value. Aim: The aim of this paper was to identify the main ethical determinants associated in the context of health and medical apps and develop a framework for ethical reflection. Methods: A systematic literature search in the database PubMed was undertaken and the journal Biomed Central Medical Ethics was hand searched and 32 met the review criteria. On this basis of the review an interview guide was developed and five purposively selected experts on the field of payers, science, consumers, medical ethics and society were interviewed regarding health and medical apps. Results: There is a lack of consistent and clear guidelines regarding the use of health and medical apps in literature. Indeed, findings refer to established biomedical principles. The interviews identified that several insecurities related to legal and regulatory issues are common. On the other hand, many advantages of the use of health and medical apps have been pointed out by experts. Conclusion: Debates on ethics and the use of health and medical apps should play a significant role in public discussion. Ethical endpoints cannot be considered isolated from each other, and must be regarded as a complex network of aspects connected with each other. Further research should concentrate on the development of consistent guidelines and a framework for reflection of occurring ethical concerns

Abschlussbericht des Forschungsprojekts "Broker für Dynamische Produktionsnetzwerke"

Der Broker für dynamische Produktionsnetzwerke (DPNB) ist ein vom Bundesministerium für Bildung und Forschung (BMBF) gefördertes und durch den Projektträger Karlsruhe (PTKA) betreutes Forschungsprojekt zwischen sieben Partnern aus Wissenschaft und Wirtschaft mit einer Laufzeit von Januar 2019 bis einschließlich Dezember 2021. Über den Einsatz von Cloud Manufacturing sowie Hard- und Software-Komponenten bei den teilnehmenden Unternehmen, sollen Kapazitätsanbieter mit Kapazitätsnachfrager verbunden werden. Handelbare Kapazitäten sind in diesem Falle Maschinen-, sowie Transport- und Montagekapazitäten, um Supply Chains anhand des Anwendungsfalls der Blechindustrie möglichst umfassend abzubilden. Der vorliegende Abschlussbericht fasst den Stand der Technik sowie die Erkenntnisse aus dem Projekt zusammen. Außerdem wird ein Überblick über die Projektstruktur sowie die Projektpartner gegeben

Peri-operative red blood cell transfusion in neonates and infants: NEonate and Children audiT of Anaesthesia pRactice IN Europe: A prospective European multicentre observational study

BACKGROUND: Little is known about current clinical practice concerning peri-operative red blood cell transfusion in neonates and small infants. Guidelines suggest transfusions based on haemoglobin thresholds ranging from 8.5 to 12 g dl-1, distinguishing between children from birth to day 7 (week 1), from day 8 to day 14 (week 2) or from day 15 (≥week 3) onwards. OBJECTIVE: To observe peri-operative red blood cell transfusion practice according to guidelines in relation to patient outcome. DESIGN: A multicentre observational study. SETTING: The NEonate-Children sTudy of Anaesthesia pRactice IN Europe (NECTARINE) trial recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. PATIENTS: The data included 5609 patients undergoing 6542 procedures. Inclusion criteria was a peri-operative red blood cell transfusion. MAIN OUTCOME MEASURES: The primary endpoint was the haemoglobin level triggering a transfusion for neonates in week 1, week 2 and week 3. Secondary endpoints were transfusion volumes, 'delta haemoglobin' (preprocedure - transfusion-triggering) and 30-day and 90-day morbidity and mortality. RESULTS: Peri-operative red blood cell transfusions were recorded during 447 procedures (6.9%). The median haemoglobin levels triggering a transfusion were 9.6 [IQR 8.7 to 10.9] g dl-1 for neonates in week 1, 9.6 [7.7 to 10.4] g dl-1 in week 2 and 8.0 [7.3 to 9.0] g dl-1 in week 3. The median transfusion volume was 17.1 [11.1 to 26.4] ml kg-1 with a median delta haemoglobin of 1.8 [0.0 to 3.6] g dl-1. Thirty-day morbidity was 47.8% with an overall mortality of 11.3%. CONCLUSIONS: Results indicate lower transfusion-triggering haemoglobin thresholds in clinical practice than suggested by current guidelines. The high morbidity and mortality of this NECTARINE sub-cohort calls for investigative action and evidence-based guidelines addressing peri-operative red blood cell transfusions strategies. TRIAL REGISTRATION: ClinicalTrials.gov, identifier: NCT02350348

Matrix stiffness drives epithelial–mesenchymal transition and tumour metastasis through a TWIST1–G3BP2 mechanotransduction pathway

Matrix stiffness potently regulates cellular behavior in various biological contexts. In breast tumours, the presence of dense clusters of collagen fibrils indicates increased matrix stiffness and correlates with poor survival. It is unclear how mechanical inputs are transduced into transcriptional outputs to drive tumour progression. Here we report that TWIST1 is an essential mechano-mediator that promotes epithelial-mesenchymal transition (EMT) in response to increasing matrix stiffness. High matrix stiffness promotes nuclear translocation of TWIST1 by releasing TWIST1 from its cytoplasmic binding partner G3BP2. Loss of G3BP2 leads to constitutive TWIST1 nuclear localization and synergizes with increasing matrix stiffness to induce EMT and promote tumour invasion and metastasis. In human breast tumours, collagen fiber alignment, a marker of increasing matrix stiffness, and reduced expression of G3BP2 together predict poor survival. Our findings reveal a TWIST1-G3BP2 mechanotransduction pathway that responds to biomechanical signals from the tumour microenvironment to drive EMT, invasion, and metastasis

The Crowdsourced Replication Initiative: Investigating Immigration and Social Policy Preferences. Executive Report.

In an era of mass migration, social scientists, populist parties and social movements raise concerns over the future of immigration-destination societies. What impacts does this have on policy and social solidarity? Comparative cross-national research, relying mostly on secondary data, has findings in different directions. There is a threat of selective model reporting and lack of replicability. The heterogeneity of countries obscures attempts to clearly define data-generating models. P-hacking and HARKing lurk among standard research practices in this area.This project employs crowdsourcing to address these issues. It draws on replication, deliberation, meta-analysis and harnessing the power of many minds at once. The Crowdsourced Replication Initiative carries two main goals, (a) to better investigate the linkage between immigration and social policy preferences across countries, and (b) to develop crowdsourcing as a social science method. The Executive Report provides short reviews of the area of social policy preferences and immigration, and the methods and impetus behind crowdsourcing plus a description of the entire project. Three main areas of findings will appear in three papers, that are registered as PAPs or in process

Health and prostitution in Germany: requirements for prevention based on a systematic literature review

Eger H, Fischer F. Gesundheit und Prostitution in Deutschland: Anforderungen an die Präventionsarbeit auf Basis eines systematischen Reviews. PRAVENTION UND GESUNDHEITSFORDERUNG. 2019;14(4):414-420.Zusammenfassung Hintergrund Die Gesundheit von Sexarbeiter*innen in Deutschland steht in unmittelbarem Zusammenhang mit ihrer Berufsausübung. Aus den prekären Lebensbedingungen resultiert allgemein ein schlechterer Gesundheitszustand unter den Prostituierten gegenüber der Allgemeinbevölkerung. Ziel der Arbeit Fokus dieser Ausarbeitung ist die Darstellung der aktuellen Forschungslage zur gesundheitlichen Situation von Prostituierten in Deutschland. Ferner soll ermittelt werden, welche Faktoren ursächlich für die Herausforderungen bei der gesundheitlichen Versorgung sind und welche Zielgruppen eine erhöhte Vulnerabilität aufweisen. Material und Methoden Mithilfe eines systematischen Reviews wurden 13 relevante Studien ermittelt, die gesundheitsbezogene Aspekte von Sexarbeiter*innen in Deutschland thematisieren. Die Recherche wurde im Februar 2018 in PubMed durchgeführt und schließt alle Studien ein, die seit 2002 publiziert wurden. Ergebnisse Der Gesundheitszustand von Sexarbeiter*innen weicht insgesamt negativ von dem der Allgemeinbevölkerung ab, jedoch ist diese Aussage nicht für alle gesundheitsbezogenen Aspekte generalisierbar. Bisherige Studien untersuchten insbesondere die Prävalenzen von sexuell übertragbaren Infektionen (STI). Als vulnerable Gruppen wurden Sexarbeiter*innen mit Migrationshintergrund sowie männliche Sexarbeiter identifiziert, welche über einen eingeschränkten Zugang zur Gesundheitsversorgung verfügen. Diskussion Die Ergebnisse zeigen einen besonderen Bedarf für Prävention in der Gruppe der Prostituierten auf. Dieser resultiert aus dem allgemein schlechteren Gesundheitszustand von Sexarbeiter*innen, den mit der Tätigkeit in der Prostitution verbundenen Herausforderungen sowie rechtlichen Aspekten. Während bisher hauptsächlich das Vorkommen von STI untersucht wurde, sollten auch Gewalterfahrungen sowie damit einhergehende gesundheitliche Beeinträchtigungen zukünftig stärker adressiert werden.Background. The health of sex workers in Germany is closely associated to their profession. Due to the precarious living conditions, prostitutes suffer in general from a worse health status compared to the general population. Objectives. The aim of this paper is to present the current state of research regarding the health situation of sex workers in Germany. Which factors are the cause of challenges concerning health care and which target groups are predominantly vulnerable are also determined. Materials and methods. Through a systematic review, 13 publications were identified which discuss health-related issues related to sex workers in Germany. The research was conducted in February 2018 in PubMed and includes all studies published since 2002. Results. Overall, the health status of sex workers is worse than the health status of the general population. However, this cannot be generalized for all health-related aspects. Previous studies investigated in particular the prevalence of sexually transmitted infections (STI). Sex workers with a migrant background and male prostitutes were identified as vulnerable groups which suffer from a restricted access to health care. Conclusions. The results indicate a special need for prevention among prostitutes. Underlying causes are the generally poorer state of health of sex workers, the challenges associated with the work as a prostitute as well as legal aspects. So far mainly the occurrence of STI has been investigated; therefore, experiences of violence as well as associated health impairments should be addressed in the future

Creating and Sustaining Service Industry Relationships and Families: Theorizing How Personal Workplace Relationships Both Build Community and Perpetuate Organizational Violence

Service industry workers experience challenging labor conditions in the United States, including pay below the minimum wage, expected emotional labor, and harassment. Additionally, in part because they work long shifts in high stress environments in restaurants and bars, many build and form personal workplace relationships (PWRs). In 2021, we interviewed 38 service industry workers and managers during the COVID-19 pandemic where we examined occupational challenges they faced in the state of Texas, USA. Through our interpretive research, this essay showcases our inductive findings on how service industry workers and managers utilize communication to create and sustain PWRs. We identified how some PWRs are sustained through a unique form of occupational identification that cultivates a “service industry family”, which we term familial personal workplace relationships (familial PWRs). This extends past organizational communication scholarship on family to consider occupational identification. Furthermore, our research reveals that while PWRs may build communities through care and support, they also perpetuate organizational violence, like sexual harassment and bullying

Disparities in COVID-19 vaccine hesitancy among a diverse community-based sample in Connecticut, United States

Though vaccination is among our strongest tools to prevent COVID-19 infections, its delivery has proven challenging. At a time when COVID-19 cases were rapidly increasing in the Northeast, we examined the role of sociodemographic factors, social determinants of health (SDOH), and health-related beliefs, including conspiracy theories, in influencing COVID-19 vaccine hesitancy among a diverse sample of Connecticut (United States) residents. Between August and December 2020, utilizing community partners and advertisements via social media, we surveyed communities known to be most impacted by COVID-19. We used descriptive analysis and multivariable logistic regression to examine vaccine hesitancy. Among 252 participants, most were female (69.8%) and under the age of 55 (62.7%). Approximately one-third reported household incomes less than $30,000 per year and 23.5% were non-Hispanic Black and 17.5% were Hispanic/Latinx. While 38.9% of participants were vaccine hesitant, non-Hispanic Black and Hispanic/Latinx participants were more vaccine hesitant (adjusted odds ratio [AOR] = 3.62; 95% CI 1.77, 7.40) compared to non-Hispanic Whites/Others. Additional factors associated with vaccine hesitancy after adjustment for socioeconomic status and barriers related to SDOH included low perceived risk of COVID-19 and not receiving COVID-19 information from medical institutions and community health workers (p < 0.05). Race/ethnicity, perceived risk, sources of health information, and conspiracy beliefs played a significant role in vaccine hesitancy among this diverse sample. Interventions to promote vaccination should include trusted messengers and sources of information, while long term efforts should focus on addressing the social conditions that deter confidence in scientific data, vaccine efficacy, and the healthcare system

Towards a Feminist Global Health Policy: Power, intersectionality, and transformation

Eger H, Chacko S, El-Gamal S, et al. Towards a Feminist Global Health Policy: Power, intersectionality, and transformation. PLOS Global Public Health. 2024;4(3): e0002959.In the realm of global health policy, the intricacies of power dynamics and intersectionality have become increasingly evident. Structurally embedded power hierarchies constitute a significant concern in achieving health for all and demand transformational change. Adopting intersectional feminist approaches potentially mitigates health inequities through more inclusive and responsive health policies. While feminist approaches to foreign and development policies are receiving increasing attention, they are not accorded the importance they deserve in global health policy. This article presents a framework for a Feminist Global Health Policy (FGHP), outlines the objectives and underlying principles and identifies the actors responsible for its meaningful implementation. Recognising that power hierarchies and societal contexts inherently shape research, the proposed framework was developed via a participatory research approach that aligns with feminist principles. Three independent online focus groups were conducted between August and September 2022 with 11 participants affiliated to the global-academic or local-activist level and covering all WHO regions. The qualitative content analysis revealed that a FGHP must be centred on considerations of intersectionality, power and knowledge paradigms to present meaningful alternatives to the current structures. By balancing guiding principles with sensitivity for context-specific adaptations, the framework is designed to be applicable locally and globally, whilst its adoption is intended to advance health equity and reproductive justice, with communities and policymakers identified as the main actors. This study underscores the importance of dismantling power structures by fostering intersectional and participatory approaches for a more equitable global health landscape. The FGHP framework is intended to initiate debate among global health practitioners, policymakers, researchers and communities. Whilst an undeniably intricate and time-consuming process, continuous and collaborative work towards health equity is imperative to translate this vision into practice