Anticipatory governance and moral imagination : methodological insights from a scenario-based public deliberation study

The fields of Responsible Research and Innovation (RRI) and participatory foresight seek to establish, and toinclude publics within, anticipatory governance mechanisms. While scenario-based methods can bring to thepublics’ attention the ethical challenges associated to existing technologies, there has been little empirical re-search examining how, in practice, prospective public deliberative processes should be organized to informanticipatory governance. The goal of this article is to generate methodological insights into the way suchmethods can stimulate the public's moral imagination regarding what may (or may not) happen in the future andwhat should (or should not) happen in the future. Our qualitative analyses draw on a public deliberation studythat included videos and online scenarios to support participants’ (n= 57) deliberations about fictional inter-ventions for genetically at-risk individuals. Our findings clarify how participants: (1) challenged key elements ofour scenarios; (2) extended several of their technical and moral prospects; (3) engaged personally with others,including our scenarios’ characters; and (4) mobilized the past creatively to reason about the future. Ourmethodology enabled participants to creatively and empathetically envision complex sociotechnical futures. Yet,important methodological limits should be acknowledged by those who design, implement and use public en-gagement methods to inform anticipatory governance

Dangerous diagnostics? Regulatory reform in the genomic era

Molecular diagnostics are expanding rapidly yet many have not been externally evaluated. Kelly Holloway and colleagues identify failings in the regulatory system and report on recent efforts at refor

Health Canada needs to act on laboratory-developed diagnostics

An international exposé of flawed regulations for medical implants prompted Canada’s health minister to announce sweeping changes to the regulation of medical devices.1 Yet an important subset of medical devices remains outside the purview of this regulatory overhaul: laboratory-developed tests

Spectral and Timing Properties of IGR J17091-3624 in the Rising Hard State During its 2016 Outburst

We present a spectral and timing study of the NuSTAR and Swift observations of the black hole candidate IGR J17091-3624 in the hard state during its outburst in 2016. Disk reflection is detected in each of the NuSTAR spectra taken in three epochs. Fitting with relativistic reflection models reveals that the accretion disk is truncated during all epochs with $R_{\rm in}>10~r_{\rm g}$, with the data favoring a low disk inclination of $\sim 30^{\circ}-40^{\circ}$. The steepening of the continuum spectra between epochs is accompanied by a decrease in the high energy cut-off: the electron temperature $kT_{\rm e}$ drops from $\sim 64$ keV to $\sim 26$ keV, changing systematically with the source flux. We detect type-C QPOs in the power spectra with frequency varying between 0.131 Hz and 0.327 Hz. In addition, a secondary peak is found in the power spectra centered at about 2.3 times the QPO frequency during all three epochs. The nature of this secondary frequency is uncertain, however a non-harmonic origin is favored. We investigate the evolution of the timing and spectral properties during the rising phase of the outburst and discuss their physical implications.Comment: 11 pages, 9 figures, accepted by Ap

Examining the ethical and social issues of health technology design through the public appraisal of prospective scenarios : a study protocol describing a multimedia-based deliberative method

Background: The design of health technologies relies on assumptions that affect how they will be implemented, such as intended use, complexity, impact on user autonomy, and appropriateness. Those who design and implement technologies make several ethical and social assumptions on behalf of users and society more broadly, but there are very few tools to examine prospectively whether such assumptions are warranted and how the public define and appraise the desirability of health innovations. This study protocol describes a three-year study that relies on a multimedia-based prospective method to support public deliberations that will enable a critical examination of the social and ethical issues of health technology design. Methods: The first two steps of our mixed-method study were completed: relying on a literature review and the support of our multidisciplinary expert committee, we developed scenarios depicting social and technical changes that could unfold in three thematic areas within a 25-year timeframe; and for each thematic area, we created video clips to illustrate prospective technologies and short stories to describe their associated dilemmas. Using this multimedia material, we will: conduct four face-to-face deliberative workshops with members of the public (n = 40) who will later join additional participants (n = 25) through an asynchronous online forum; and analyze and integrate three data sources: observation, group deliberations, and a self-administered participant survey. Discussion: This study protocol will be of interest to those who design and assess public involvement initiatives and to those who examine the implementation of health innovations. Our premise is that using user-friendly tools in a deliberative context that foster participants’ creativity and reflexivity in pondering potential technoscientific futures will enable our team to analyze a range of normative claims, including some that may prove problematic and others that may shed light over potentially more valuable design options. This research will help fill an important knowledge gap; intervening earlier in technological development could help reduce undesirable effects and inform the design and implementation of more appropriate innovations

A NuSTAR observation of the reflection spectrum of the low mass X-ray binary 4U 1728-34

We report on a simultaneous NuSTAR and Swift observation of the neutron star low-mass X-ray binary 4U 1728-34. We identified and removed four Type I X-ray bursts during the observation in order to study the persistent emission. The continuum spectrum is hard and well described by a black body with $kT=$ 1.5 keV and a cutoff power law with $\Gamma=$ 1.5 and a cutoff temperature of 25 keV. Residuals between 6 and 8 keV provide strong evidence of a broad Fe K$\alpha$ line. By modeling the spectrum with a relativistically blurred reflection model, we find an upper limit for the inner disk radius of $R_{\rm in}\leq2 R_{\rm ISCO}$. Consequently we find that $R_{\rm NS}\leq23$ km, assuming M=1.4{\mbox{\rm\,M_{\mathord\odot}}} and $a=0.15$. We also find an upper limit on the magnetic field of $B\leq2\times10^8$ G.Comment: 9 pages, 8 figure

NuSTAR and Swift observations of the black hole candidate XTE J1908+094 during its 2013 outburst

The black hole candidate XTE J1908+094 went into outburst for the first time since 2003 in October 2013. We report on an observation with the Nuclear Spectroscopic Telescope Array (NuSTAR) and monitoring observations with Swift during the outburst. NuSTAR caught the source in the soft state: the spectra show a broad relativistic iron line, and the light curves reveal a ~40 ks flare with the count rate peaking about 40% above the non-flare level and with significant spectral variation. A model combining a multi-temperature thermal component, a power-law, and a reflection component with an iron line provides a good description of the NuSTAR spectrum. Although relativistic broadening of the iron line is observed, it is not possible to constrain the black hole spin with these data. The variability of the power-law component, which can also be modeled as a Comptonization component, is responsible for the flux and spectral change during the flare, suggesting that changes in the corona (or possibly continued jet activity) are the likely cause of the flare.Comment: 9 pages, 6 figures, 3 tables, accepted for publication in Ap

The Broadband XMM-Newton and NuSTAR X-ray Spectra of Two Ultraluminous X-ray Sources in the Galaxy IC 342

We present results for two Ultraluminous X-ray Sources (ULXs), IC 342 X-1 and IC 342 X-2, using two epochs of XMM-Newton and NuSTAR observations separated by $\sim$7 days. We observe little spectral or flux variability above 1 keV between epochs, with unabsorbed 0.3--30 keV luminosities being $1.04^{+0.08}_{-0.06} \times 10^{40}$ erg s$^{-1}$ for IC 342 X-1 and $7.40\pm0.20 \times 10^{39}$ erg s$^{-1}$ for IC 342 X-2, so that both were observed in a similar, luminous state. Both sources have a high absorbing column in excess of the Galactic value. Neither source has a spectrum consistent with a black hole binary in low/hard state, and both ULXs exhibit strong curvature in their broadband X-ray spectra. This curvature rules out models that invoke a simple reflection-dominated spectrum with a broadened iron line and no cutoff in the illuminating power-law continuum. X-ray spectrum of IC 342 X-1 can be characterized by a soft disk-like black body component at low energies and a cool, optically thick Comptonization continuum at high energies, but unique physical interpretation of the spectral components remains challenging. The broadband spectrum of IC 342 X-2 can be fit by either a hot (3.8 keV) accretion disk, or a Comptonized continuum with no indication of a seed photon population. Although the seed photon component may be masked by soft excess emission unlikely to be associated with the binary system, combined with the high absorption column, it is more plausible that the broadband X-ray emission arises from a simple thin blackbody disk component. Secure identification of the origin of the spectral components in these sources will likely require broadband spectral variability studies.Comment: 12 pages, 11 figures, 5 Tables, Accepted for publication in The Astrophysical Journa

Providing Value to New Health Technology: The Early Contribution of Entrepreneurs, Investors, and Regulatory Agencies

Background: New technologies constitute an important cost-driver in healthcare, but the dynamics that lead to their emergence remains poorly understood from a health policy standpoint. The goal of this paper is to clarify how entrepreneurs, investors, and regulatory agencies influence the value of emerging health technologies. Methods: Our 5-year qualitative research program examined the processes through which new health technologies were envisioned, financed, developed and commercialized by entrepreneurial clinical teams operating in Quebec’s (Canada) publicly funded healthcare system. Results: Entrepreneurs have a direct influence over a new technology’s value proposition, but investors actively transform this value. Investors support a technology that can find a market, no matter its intrinsic value for clinical practice or healthcare systems. Regulatory agencies reinforce the “double” value of a new technology—as a health intervention and as an economic commodity—and provide economic worth to the venture that is bringing the technology to market. Conclusion: Policy-oriented initiatives such as early health technology assessment (HTA) and coverage with evidence may provide technology developers with useful input regarding the decisions they make at an early stage. But to foster technologies that bring more value to healthcare systems, policy-makers must actively support the consideration of health policy issues in innovation polic