Improving access to prosthetic limbs in Germany: An explorative review

Background: Meeting the needs of users when it comes to accessing prosthetic limbs is an important factor in the acceptance and use of a prosthesis; the cost of such prosthetics also constitutes a potential financial challenge. Objectives: The aim of this study was to investigate potential hurdles to accessing limb prosthetics in the German health care system, including organizational, social, economic, and regulatory issues, and to provide food for thought about ethical implications. Methods: Sixteen German users of limb prosthetics with upper-limb and/or lower-limb amputation were recruited by means of purposive sampling. Semistructured interviews were performed, with the guiding question being as follows: “What were your experiences with the German prosthetic care and reimbursement system?” Ten stakeholders (insurance representatives, prosthetic technicians, medical service representatives, a law expert, and a lawyer) were asked about the issues they encounter in their work related to prosthetic care and reimbursement, and about ways to ameliorate these issues. A qualitative content analysis method was used to analyze the data. Results: Half of the interviewed service users experienced hurdles to gaining a suitable prosthetic device, such as waiting times and pressure to negotiate their need for a certain prosthesis. Some of the views expressed about the issues relating to prosthetic reimbursement in Germany were common to all stakeholders, whereas some conflicted with the views of others

Weighting factor elicitation for sustainability assessment of energy technologies

In this paper, an approach for sustainability assessment of innovative energy technologies is expanded by multi-criteria decision analysis (MCDA) methods to aggregate indicator results and support decision-making. One of the most important steps for MCDA is to determine weighting factors for individual indicators. Thus, a workshop was performed to elicit weighting factors for sustainability assessments of energy technologies from developers of such technologies and energy system modellers from academia. These stakeholders expressed their preferences with respect to sustainability criteria using the Simple Multi Attribute Rating Technique (SMART). A triple bottom line approach of sustainable development was used as the basis for the aggregation of indicator results. This approach is based on Life Cycle Costing, Life Cycle Assessment and social indicators. Obtained weighting factors were applied to an integrative sustainability assessment with the aggregation method Preference Ranking Organization METHod for Enrichment of Evaluations (PROMETHEE). Hydrogen-based mobility as an important technology to foster decarbonization in the transport sector is used as a case study for the application of the derived weighting factors. A conventional vehicle, powered by fossil fuel, is compared with a fuel cell electric vehicle (FCEV) for the year 2050. Different options (pipeline, compressed gaseous hydrogen, liquid hydrogen, liquid organic hydrogen carrier) are discussed for the supply of hydrogen. The results for this weighting factor set are compared with an equal weighting scenario of the three sustainability dimensions and indicators within one sustainability dimension. The FCEV, using pipelines for hydrogen supply, came out first in the assessment as well as in all sensitivity analyses

AI models and the future of genomic research and medicine: True sons of knowledge? Artificial intelligence needs to be integrated with causal conceptions in biomedicine to harness its societal benefits for the field

The increasing availability of large-scale, complex data has made research into how human genomes determine physiology in health and disease, as well as its application to drug development and medicine, an attractive field for artificial intelligence (AI) approaches. Looking at recent developments, we explore how such approaches interconnect and may conflict with needs for and notions of causal knowledge in molecular genetics and genomic medicine. We provide reasons to suggest that—while capable of generating predictive knowledge at unprecedented pace and scale—if and how these approaches will be integrated with prevailing causal concepts will not only determine the future of scientific understanding and self-conceptions in these fields. But these questions will also be key to develop differentiated policies, such as for education and regulation, in order to harness societal benefits of AI for genomic research and medicine

Obstacles to Prosthetic Care - Legal and Ethical Aspects of Access to Upper and Lower Limb Prosthetics in Germany and the Improvement of Prosthetic Care from a Social Perspective

This article belongs to the Special Issue Socio-technical Approaches for Assistive Technologies and People with Disabilitie