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

Assessment of genomic instability in Chinese Hamster ovary (CHO) cells

CHO cells are the number one production system for therapeutic proteins due to their ease of handling, their fast growth in suspension culture and their capability to perform complex protein folding and human-like post-translational modifications. This flexibility is in part due to, but at the same time set off by the frequent occurrence of chromosomal rearrangements and other genomic variants, which influences individual cell line performance and the stability of industrial producer cell lines, resulting in prolonged screening phases in order to isolate cells with sufficiently stable properties. Furthermore producer cell properties are also frequently lost again over time and properties within clones derived of the same cell population may vary significantly. The present work focuses on methods for quantification of the rate of chromosomal rearrangements in a given cell line over time in culture. The methods tested include Amplified Fragment Length Polymorphism (AFLP), Chromosome Painting and Chromosome Counting. The principle of AFLP is a restriction enzyme digest of genomic DNA, followed by ligation of the fragments to adapters with a predefined sequence. DNA amplification of restriction fragments is performed using selective AFLP primers complementary to the annealed adapter sequence, but containing extra nucleotides. An initial pattern of bands of digested genomic DNA is defined which allows quantification of chromosomal changes over time using sophisticated statistical techniques. The second technique used is Chromosome Counting of metaphase spreads from a statistically significant number of cells (50-100) in a CHO cell population, with a focus on the spread of counts and ploidy and on how that changes over time. Finally, using chromosome painting, translocations within and across chromosomes and the variation in individual cells within a population can be observed in fine detail. A variety of CHO host cell lines, both pools and subclones were analyzed over a period of six-months in culture. With AFLP we could identify genomic rearrangements for each cell line over time revealing different rates of genomic changes in the analyzed cell lines as well as degrees of relationship between the cell lines and clones at the starting point. Chromosome Counting indicated that the chromosome number and its variation in a CHO cell population differs not only within a population over time, but also between different CHO cell lines. Furthermore the chromosome number of a CHO cell culture changes over time. The older a culture, the more variation and diversity within the population is observed, frequently with a clear tetraploid sub-population appearing after several months in culture. Chromosome painting reveals appearance of new chromosome variants over time, but typically not within the entire population. Overall we can conclude that CHO cells are highly rearranged and that the genomic stability over a production process cannot be guaranteed

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