Redefining the research hospital

Introduction All medicine was innovation, once. Yet the contemporary notion of medical research is remarkably narrow. While every clinician is encouraged to be aware of the latest advances, only a few are expected to contribute to them. Anyone may be a patient, yet clinical practice is determined by the minority included in research studies. The aim of medicine is to improve the lives of patients, yet knowledge of disease is arbitrarily prioritised as its primary means. The agents of medicine are clinicians, yet new interventions are mostly created by others, within corporate enterprise deliberately kept at arm’s length. We treat the specific, individual patient in front of us, now, yet most research is addressed to faceless, generic groups, to be realised deep into an ill-defined, hypothetical future

The Value of Data: Applying a Public Value Model to the English National Health Service

Research and innovation in biomedicine and health care increasingly depend on electronic data. The emergence of data-driven technologies and associated digital transformations has focused attention on the value of such data. Despite the broad consensus of the value of health data, there is less consensus on the basis for that value; thus, the nature and extent of health data value remain unclear. Much of the existing literature presupposes that the value of data is to be understood primarily in financial terms, and assumes that a single financial value can be assigned. We here argue that the value of a dataset is instead relational; that is, the value depends on who wants to use it and for what purposes. Moreover, data are valued for both nonfinancial and financial reasons. Thus, it may be more accurate to discuss the values (plural) of a dataset rather than the singular value. This plurality of values opens up an important set of questions about how health data should be valued for the purposes of public policy. We argue that public value models provide a useful approach in this regard. According to public value theory, public value is created, or captured, to the extent that public sector institutions further their democratically established goals, and their impact on improving the lives of citizens. This article outlines how adopting such an approach might be operationalized within existing health care systems such as the English National Health Service, with particular focus on actionable conclusions

Is It Rational to Assume that Infants Imitate Rationally? A Theoretical Analysis and Critique

It has been suggested that preverbal infants evaluate the efficiency of others' actions (by applying a principle of rational action) and that they imitate others' actions rationally. The present contribution presents a conceptual analysis of the claim that preverbal infants imitate rationally. It shows that this ability rests on at least three assumptions: that infants are able to perceive others' action capabilities, that infants reason about and conceptually represent their own bodies, and that infants are able to think counterfactually. It is argued that none of these three abilities is in place during infancy. Furthermore, it is shown that the idea of a principle of rational action suffers from two fallacies. As a consequence, is it suggested that it is not rational to assume that infants imitate rationally. Copyright (C) 2012 S. Karger AG, Base

Genetic and neurological foundations of customer orientation: field and experimental evidence

We explore genetic and neurological bases for customer orientation (CO) and contrast them with sales orientation (SO). Study 1 is a field study that establishes that CO, but not SO, leads to greater opportunity recognition. Study 2 examines genetic bases for CO and finds that salespeople with CO are more likely to have the 7R variant of the DRD4 gene. This is consistent with basic research on dopamine receptor activity in the brain that underlies novelty seeking, the reward function, and risk taking. Study 3 examines the neural basis of CO and finds that salespeople with CO, but not SO, experience greater activation of their mirror neuron systems and neural processes associated with empathy. Managerial and research implications are discussed

Enrolment in clinical research at UCLH and geographically distributed indices of deprivation [version 1; peer review: awaiting peer review]

Healthcare should be judged by its equity as well as its quality. Both aspects depend not only on the characteristics of service delivery but also on the research and innovation that ultimately shape them. Conducting a fully-inclusive evaluation of the relationship between enrolment in primary research studies at University College London Hospitals NHS Trust and indices of deprivation, here we demonstrate a quantitative approach to evaluating equity in healthcare research and innovation. We surveyed the geographical locations, aggregated into Lower Layer Super Output Areas (LSOAs), of all England-resident UCLH patients registered as enrolled in primary clinical research studies. We compared the distributions of ten established indices of deprivation across enrolled and non-enrolled areas within Greater London and within a distance-matched subset across England. Bayesian Poisson regression models were used to examine the relation between deprivation and the volume of enrolment standardized by population density and local disease prevalence. A total of 54593 enrolments covered 4401 LSOAs in Greater London and 10150 in England, revealing wide geographical reach. The distributions of deprivation indices were similar between enrolled and non-enrolled areas, exhibiting median differences from 0.26% to 8.73%. Across Greater London, enrolled areas were significantly more deprived on most indices, including the Index of Multiple Deprivation; across England, a more balanced relationship to deprivation emerged. Regression analyses of enrolment volumes yielded weak biases, in favour of greater deprivation for most indices, with little modulation by local disease prevalence. Primary clinical research at UCLH has wide geographical reach. Areas with enrolled patients show similar distributions of established indices of deprivation to those without, both within Greater London, and across distance-matched areas of England. We illustrate a robust approach to quantifying an important aspect of equity in clinical research and provide a flexible set of tools for replicating it across other institutions

Penetration Problem for Infrastructe Stability in Conditions of Offshore Fields Development

The paper is generally devoted to the problem of offshore oil and gas fields' development. The main focus of the study is mechanical behavior of seafloor sediments and stability of infrastructure objects' supporting constructions. We study the problem of estimating the effective mechanic properties of seafloor sediments. To solve the problem, we propose the usage of gravity corer of bottom sediments. These corers make it possible to study dynamic elastic properties at the ship laboratory conditions. We study the sampling process itself as a tool to estimate the rheological properties of seafloor sediments. In the current study, we propose a specific analysis of the samples and sampling process. The sampling corer is equipped with tools providing an opportunity to measure its acceleration at each moment during the sampling process. This acceleration depends on controllable sampling process conditions and mechanical properties of seafloor sediments being sampled. A corresponding contact problem is considered using the finite-element method. It is shown that there is an opportunity to evaluate some (but not all) parameters for visco-elasto-plastic rheology of the sediments from a known acceleration of the sampling tube. The obtained results make it possible to improve the quality of model of mechanical properties of the seafloor sediments. This improvement provides the corresponding increase in mechanical modeling of infrastructure stability and decreases the risks accompanying offshore field development

Analyzing European Union Politics

The speed and depth with which the European Communities/ European Union has evolved is breathtaking and has radically shaped the life of the continent. Ever since the beginning of this ambitious economic and political project, scholars around the world have tried to explain the underlying logic behind it and the mechanisms of its functioning. Thus, a plethora of studies developed alongside the evolution of the EU. SENT (Network of European Studies) is an innovative and ambitious project which brought together about 100 partners from the EU member states, candidate and associated countries, and other parts of the world. It was a far reaching project aimed to overcome disciplinary and geographical- linguistic boundaries in order to assess the state of EU studies today, as well as the idea of Europe as transmitted by schools, national politicians, the media, etc. SENT’s main goal was to map European studies, in order to get a comprehensive picture of the evolution of European studies over the last decades in different disciplines and countries. This approach permitted to achieve a better understanding of the direction these studies are now taking. Five disciplines were identified where EU studies have particularly evolved: law, politics, economics, history, and social and cultural studies. The mapping of EU studies thus includes a review of the most studied issues in EU studies today, the main academic schools, the most influential journals and books published, but it also shows how local realities and national identities affect the study and teaching of Europe around the world. In addition, an important work was done in mapping and discussing teaching methodologies in relation to European studies with the aim of introducing and diffusing the most up-to-date techniques

Long-latency modulation of motor cortex excitability by ipsilateral posterior inferior frontal gyrus and pre-supplementary motor area

The primary motor cortex (M1) is strongly influenced by several frontal regions. Dual-site transcranial magnetic stimulation (dsTMS) has highlighted the timing of early (<40 ms) prefrontal/premotor influences over M1. Here we used dsTMS to investigate, for the first time, longer-latency causal interactions of the posterior inferior frontal gyrus (pIFG) and pre-supplementary motor area (pre-SMA) with M1 at rest. A suprathreshold test stimulus (TS) was applied over M1 producing a motor-evoked potential (MEP) in the relaxed hand. Either a subthreshold or a suprathreshold conditioning stimulus (CS) was administered over ipsilateral pIFG/pre-SMA sites before the TS at different CS-TS inter-stimulus intervals (ISIs: 40-150 ms). Independently of intensity, CS over pIFG and pre-SMA (but not over a control site) inhibited MEPs at an ISI of 40 ms. The CS over pIFG produced a second peak of inhibition at an ISI of 150 ms. Additionally, facilitatory modulations were found at an ISI of 60 ms, with supra-but not subthreshold CS intensities. These findings suggest differential modulatory roles of pIFG and pre-SMA in M1 excitability. In particular, the pIFG-but not the pre-SMA-exerts intensity-dependent modulatory influences over M1 within the explored time window of 40-150 ms, evidencing fine-tuned control of M1 output

Deep forecasting of translational impact in medical research.

The value of biomedical research-a $1.7 trillion annual investment-is ultimately determined by its downstream, real-world impact, whose predictability from simple citation metrics remains unquantified. Here we sought to determine the comparative predictability of future real-world translation-as indexed by inclusion in patents, guidelines, or policy documents-from complex models of title/abstract-level content versus citations and metadata alone. We quantify predictive performance out of sample, ahead of time, across major domains, using the entire corpus of biomedical research captured by Microsoft Academic Graph from 1990-2019, encompassing 43.3 million papers. We show that citations are only moderately predictive of translational impact. In contrast, high-dimensional models of titles, abstracts, and metadata exhibit high fidelity (area under the receiver operating curve [AUROC] > 0.9), generalize across time and domain, and transfer to recognizing papers of Nobel laureates. We argue that content-based impact models are superior to conventional, citation-based measures and sustain a stronger evidence-based claim to the objective measurement of translational potential

Neural correlates of evidence accumulation during value-based decisions revealed via simultaneous EEG-fMRI

Current computational accounts posit that, in simple binary choices, humans accumulate evidence in favour of the different alternatives before committing to a decision. Neural correlates of this accumulating activity have been found during perceptual decisions in parietal and prefrontal cortex; however the source of such activity in value-based choices remains unknown. Here we use simultaneous EEG–fMRI and computational modelling to identify EEG signals reflecting an accumulation process and demonstrate that the within- and across-trial variability in these signals explains fMRI responses in posterior-medial frontal cortex. Consistent with its role in integrating the evidence prior to reaching a decision, this region also exhibits task-dependent coupling with the ventromedial prefrontal cortex and the striatum, brain areas known to encode the subjective value of the decision alternatives. These results further endorse the proposition of an evidence accumulation process during value-based decisions in humans and implicate the posterior-medial frontal cortex in this process