Biobanks and Electronic Health Records: Ethical and Policy Challenges in the Genomic Age

In this paper we discuss the ethical and policy challenges presented by the construction and use of biobanks and electronic health records systems, with a particular focus on how these resources implicate certain types of security concerns for patients, families, health care providers and institutions. These two technology platforms are selected for special emphasis in this paper for two reasons. First and foremost, there is a close connection between them. Indeed, of the many accepted definitions, this one from the German National Bioethics Commission provides a sense of this close connection and the great power and reflects the great power these two separate platforms provide to probe more deeply the connection between genotype and phenotype: "...[B]iobanks are defined as collections of samples of human bodily substances (e.g., cells, tissues, blood or DNA as the physical medium of genetic information) that are or can be associated with personal data and information on their donors." Second, these two topics implicate both clinical ethics issues (those arising at the bedside for health care providers and patients), and human research ethics issues (issues arising for scientists, research subjects, ethics review bodies and regulatory authorities). Both of these sub-specialty areas confront similar and complementary ethical issues; for example, issues arising from the nature and adequacy of informed consent, the sufficiency of systems to protect personal privacy and confidentiality, or the need to balance concerns relating to data security and the need to know. A growing research base supports calls for more attention to these issues, and yet current professional ethics frameworks and policy consultation methods are poorly organized and ill-equipped to anticipate and fully address ethical issues in health information technology generally, or to provide adequate ethical assessment of the tools that elicit these issues. Our strategy is to orient readers to the history and context of these issues, to frame several key challenges for researchers and policy makers, and then to close with several recommendations for next steps.Richard M. Fairbanks Foundation, Indianapolis; Grant #UL1RR025761-01, NCRR/NIH: Indiana Clinical and Translational Sciences Institut

Morphology and reactivity of size-selected titanium oxide nanoclusters on Au(111).

The morphology and reactivity of mass-selected titania clusters, Ti3O6 and Ti3O5, deposited onto Au(111) were studied by scanning tunneling microscopy and temperature programmed desorption. Despite differing by only one oxygen atom, the stoichiometric Ti3O6 and the sub-stoichiometric ("reduced") Ti3O5 clusters exhibit very different structures and preferred binding sites. The Ti3O6 clusters bind at step edges and form small assemblies (2-4 clusters) on Au terraces, while the "reduced" Ti3O5 clusters form much larger fractal-like assemblies that can extend across step boundaries. Annealing the Ti3O5,6/Au(111) systems to higher temperatures causes changes in the size-distributions of cluster assemblies, but does not lead to the formation of TiOx nanoislands for temperatures ≤700 K. Reactivity studies show that the reduced Ti3O5 cluster has higher activity than Ti3O6 for 2-propanol dehydration, although both clusters exhibit substantial activity for dehydrogenation to acetone. Calculations using DFT+U suggest that the differences in aggregate morphology and reactivity are associated with the number of undercoordinated Ti3c sites in the supported clusters

Deflection-Compensating Beam for use inside a Cylinder

A design concept for a beam for a specific application permits variations and options for satisfying competing requirements to minimize certain deflections under load and to minimize the weight of the beam. In the specific application, the beam is required to serve as a motion-controlled structure for supporting a mirror for optical testing in the lower third portion of a horizontal, cylindrical vacuum chamber. The cylindrical shape of the chamber is fortuitous in that it can be (and is) utilized as an essential element of the deflection-minimizing design concept. The beam is, more precisely, a table-like structure comprising a nominally flat, horizontal portion with vertical legs at its ends. The weights of the beam and whatever components it supports are reacted by the contact forces between the lower ends of the legs and the inner cylindrical chamber wall. Whereas the bending moments arising from the weights contribute to a beam deflection that is concave with its lowest point at midlength, the bending moments generated by the contact forces acting on the legs contribute to a beam deflection that is convex with its highest point at midlength. In addition, the bending of the legs in response to the weights causes the lower ends of the legs to slide downward on the cylindrical wall. By taking the standard beam-deflection equations, combining them with the geometric relationships among the legs and the horizontal portion of the beam, and treating the sliding as a component of deflection, it is possible to write an equation for the net vertical deflection as a function of the load and of position along the beam. A summary of major conclusions drawn from the equation characterization is included

Hammerman's Hill the land, people and industry of the Titterstone Clee Hill area of Shropshire from the sixteenth to the eighteenth centuries

This thesis attempts to trace the major changes, during a period of about three hundred years, in the Titterstone Glee Hill area of south Shropshire Its main objective is to see to what extent developments over a long period of time provided conditions which prepared the way-for the great increase in industrial activity that occurred in the second half of the eighteenth century. The underlying geology, the general geography and an outline of the earlier history of the area have been examined to provide a background to the changes that occurred in agriculture, settlements, population, and in industry, where the emergence and expansion of the iron and coal industries have received close attention. The thesis, which reveals that the area was very poor, studies the possible causes and the impacts of developments which include changes in landholding patterns and in land management, the polarization of society, the attitudes of manor lords and of industrial entrepreneurs, increases and other movements in population, and alterations in settlements. During this period industrial activity passed through three distinct stages. The first, which began before the middle of the sixteenth century, was encouraged by the growth in local demand for raw iron, particularly between 1580 and about 1630, but during the second the progress of the iron industry was restricted by the slower growth of the local market and by limited success in acquiring a share of the West Midland market. The third stage differed greatly from the earlier stages and was far more active for the area adopted a new role as the major supplier of ironstone and, later, of coal to the ironworks at Bringewood and Charlcott. As a result the district became involved closely with the main movements and the fortunes of the Midland and national iron markets although it played merely a subsidiary or supplementary part in industrial innovations and changes. However, the increase in coal production was encouraged further by the growth of a wider local market as roads were improved and by 1783, when the area's close connection with the major iron markets was severed, the coal industry was able to replace the large-scale mining of ironstone and to support the great increases in population that had taken place

Ethical, legal and social issues for personal health records and applications

AbstractRobert Wood Johnson Foundation’s Project HealthDesign included funding of an ethical, legal and social issues (ELSI) team, to serve in an advisory capacity to the nine design projects. In that capacity, the authors had the opportunity to analyze the personal health record (PHR) and personal health application (PHA) implementations for recurring themes. PHRs and PHAs invert the long-standing paradigm of health care institutions as the authoritative data-holders and data-processors in the system. With PHRs and PHAs, the individual is the center of his or her own health data universe, a position that brings new benefits but also entails new responsibilities for patients and other parties in the health information infrastructure. Implications for law, policy and practice follow from this shift. This article summarizes the issues raised by the first phase of Project HealthDesign projects, categorizing them into four topics: privacy and confidentiality, data security, decision support, and HIPAA and related legal-regulatory requirements. Discussion and resolution of these issues will be critical to successful PHR/PHA implementations in the years to come

Population Variation In and Selection For Resistance to Pyrethroid-Neonicotinoid Insecticides in the Bed Bug

Pyrethroid resistance in bed bugs, Cimex lectularius, has prompted a change to combination products that include a pyrethroid and a neonicotinoid. Ten populations of bed bugs were challenged with two combination products (Temprid SC and Transport GHP). Susceptibility of these populations varied, with the correlated response of the two products indicating cross resistance. We imposed selection on three populations using label rate Temprid, and then reared progeny from unselected and selected strains. All selected strains were significantly less susceptible to Temprid SC than unselected strains. Temprid selected strains were also less susceptible to Transport. The pyrethroid component of Temprid showed a significantly higher LD50 in selected strains, but susceptibility to the neonicotinoid remained unchanged. Taken together these results indicate resistance to combination insecticides is present in field populations at levels that should be of concern, and that short-term selection affecting existing variance in susceptibility can quickly increase resistance