The inherent normativity of HTA can be conceptualized as a result of normative commitments, a concept that we further specify to encompass moral, epistemological and ontological commitments at play in the practice of HTA. Based on examples from literature, and an analysis of the example of assessing Non-Invasive Prenatal Testing (NIPT), we will show that inevitable normative decisions in conducting an assessment commits the HTA practitioner to moral (regarding what makes a health technology desirable), ontological (regarding which effects of health technology are conceivable), and epistemological (regarding how to obtain reliable information about health technology) norms. This highlights and supports the need for integrating normative analysis and stakeholder participation, providing guidance to HTA practitioners when making normative choices. This will foster a shared understanding between those who conduct, use, or are impacted by assessments regarding what are conceivable and desirable outcomes of using health technology, and how to collect reliable information to assess whether these outcomes are (going to be) realized. It also provides more insight into the implications of different normative choices.

OBJECTIVE: Our objective was to explore procedures and methods used at health technology assessment (HTA) agencies for assessing medical devices and the underlying views of HTA practitioners about appropriate methodology to identify challenges in adopting new methodologies for assessing devices. We focused on the role of normative commitments of HTA practitioners in the adoption of new methods.
METHODS: An online survey, including questions on procedures, scoping, and assessments of medical devices, was sent to members of the International Network of Agencies for Health Technology Assessment. Interviews were conducted with survey respondents and HTA practitioners involved in assessments of transcatheter aortic valve implantation to gain an in-depth understanding of choices made and views about assessing medical devices. Survey and interview questions were inspired by the \"values in doing assessments of health technologies\" approach towards HTA, which states that HTA addresses value-laden questions and information.
RESULTS: The current practice of assessing medical devices at HTA agencies is predominantly based on procedures, methods, and epistemological principles developed for assessments of drugs. Both practical factors (available time, demands of decision-makers, existing legal frameworks, and HTA guidelines), as well as commitments of HTA practitioners to principles of evidence-based medicine, make the adoption of a new methodology difficult.
CONCLUSIONS: There is a broad recognition that assessments of medical devices may need changes in HTA methodology. In order to realize this, the HTA community may require both a discussion on the role, responsibility, and goals of HTA, and resulting changes in institutional context to adopt new methodologies.

With the swift advancement of cloud computing and the Internet of Things (IoT), to address the issue of massive data storage, IoT devices opt to offload their data to cloud servers so as to alleviate the pressure of resident storage and computation. However, storing local data in an outsourced database is bound to face the danger of tampering. To handle the above problem, a verifiable database (VDB), which was initially suggested in 2011, has garnered sustained interest from researchers. The concept of VDB enables resource-limited clients to securely outsource extremely large databases to untrusted servers, where users can retrieve database records and modify them by allocating new values, and any attempts at tampering will be detected. This paper provides a systematic summary of VDB. First, a definition of VDB is given, along with correctness and security proofs. And the VDB based on commitment constructions is introduced separately, mainly divided into vector commitments and polynomial commitments. Then VDB schemes based on delegated polynomial functions are introduced, mainly in combination with Merkle trees and forward-secure symmetric searchable encryption. We then classify the current VDB schemes relying on four different assumptions. Besides, we classify the established VDB schemes built upon two different groups. Finally, we introduce the applications and future development of VDB. To our knowledge, this is the first VDB review paper to date.

Is there variation across cultures in what counts as a lie? Here we present evidence for a potentially unique conceptualization of lying in Shuar-Achuar communities in Ecuador, contrasting this conceptualization with people in twelve other countries and non-Shuar-Achuar Ecuadorians. In Shuar-Achuar communities, but not others, predictions of the future that turn out to be false are considered lies, even when the events that render them false are unforeseen. Failed commitments, on the other hand, are not seen as lies when unforeseen events prevent them from being kept. To explain this phenomenon, we suggest that there is an epistemic norm that regulates predictive speech acts in Shuar-Achuar communities, linked to the view that the future can be known under certain special circumstances. This norm holds that claiming knowledge of the future is a form of lying when events prove the prediction false. Commitments, on the other hand, do not imply certainty about the future and so are not considered lies when circumstances prevent them from being fulfilled. In addition, we found several other factors that influence whether speech acts are categorized as lies, including the speaker\'s expertise, group membership, and the nature of the outcome.

How should scarce health-related resources be allocated? This paper argues that values that apply to these decisions fail to always fully determine what we should do. Health maximization and allocation-according-to-need are suggested as two values that should be part of a general theory of how to allocate health-related resources. The \"small improvement argument\" is used to argue that it is implausible that one alternative is always better, worse, or equal to another alternative with respect to these values. Approaches that rely on these values are thus incomplete. To deal with this, it is suggested that we ought to use incomplete theories in a two-step process. Such a process first discards ineligible alternatives, and, second, uses reasons grounded in collective commitments to identify a unique, best alternative in the remaining set.

This paper examines the conceptual and terminological overlap between theories and models of practical deliberation developed within the fields of Practical Reasoning (PR) and Practical Argumentation (PA). It carefully delineates the volitional, epistemic, normative, and social commitments invoked and explicates various rationales for attributing the label \'practical\' to instances of reasoning and argumentation. Based on these analyses, the paper develops a new approach to practical deliberation called the Stakeholder Commitment Approach (SCA). By distinguishing between \'problem holder\' and \'problem solver\', and specifying the distributions of attributable commitments among the stakeholders, the SCA introduces an extension and refinement of the grounds for assigning the label \'practical\' that brings PR and PA closer together.

Promises are voluntary commitments to perform a future action and are often thought to be powerful levers for behavioral change. Here we studied the effectiveness of promises in two preregistered, incentivized field experiments with German students (N = 406) on the premises of a cafeteria. In Experiment 1, the majority of participants (63%) kept their promise to pay back at least half of a € 4-endowment, even though there was no foreseeable cost of breaking the promise, reputational or otherwise. Significantly fewer participants (22%) paid back money in a control group that faced a simple decision to return money or not. In Experiment 2, the majority of participants (54%) kept their promise to add a provided stamp to a postcard and mail it back (anonymously) within a week. We found similar return rates (52%) for a second group for which the word \"promise\" was omitted from the commitment. Our findings show that participants kept their word outside the laboratory while pursuing everyday activities even when there were no foreseeable negative consequences for breaking them, demonstrating that promises are effective levers for behavioral change.

The European Union promotes high-quality food products and protects agricultural traditions. With that vision, Regulation (EU) 1151/2012 defines quality schemes such as protected designations of origin, protected geographical indications and optional quality terms that link quality and tradition to legal labels. These quality schemes are completed by national initiatives. Label Rouge is an official regulated sign of premium quality in France that explicitly aims at higher product quality. Each Label Rouge product has to comply with production and processing conditions stated in its published specifications. Here, we analyse commitments made under Label Rouge books of specifications for beef to show how the Label Rouge quality-sign constructs quality. In order to provide a frame, product quality has been broken down into a set of seven quality attributes: commercial, organoleptic, nutritional, safety, technological, convenience and image-value, where image-value quality attributes encompass the ethical, cultural and environmental dimensions associated with how a food is produced and processed, and its origin. The specifications highlight \'communicative certified characteristics\' (characteristics set out in the specifications that are certified and communicated to the public) and specify how the meat needs to be farmed and processed to attain superior quality. Analysis of all 16 Label Rouge books of specifications for beef, based on scientific expertise and the literature, showed that commitments in these specifications are linked to the seven groups of quality attributes and that they concern the whole continuum of the chain, from animal type to on-farm conditions, transport to slaughter and through to meat ageing. Commitments concerning the whole herd and the selection of label-eligible animals, carcasses and meat particularly enhance organoleptic and image-value attributes. Label Rouge builds quality through commitments on the production, transport and beef ageing conditions, and offers a strong referent for the beef sector on how to better meet more qualitative consumers\' expectations.

The resilience of communities and nations is a necessary condition for sustainable development. Building resilience, however, is not always a straightforward process and requires joint efforts, an all-of-society approach. Thus, the commitment, goodwill, knowledge, experience, and resources of all stakeholders contributing to disaster risk reduction (DRR) are crucial. In UNDRR\'s Sendai Framework Voluntary Commitments online platform, the work of all stakeholders can be showcased and tracked. Using novel data from this platform, this article presents descriptive information about the types of commitments made by stakeholders working on landslides. Results suggest that landslide is the third most covered hazard. Commitments working on this hazard have a more balanced distribution of global, regional, and local actions as compared with the whole sample. Also, landslide commitments tend to display higher levels of collaboration (as measured by the number of organizations involved) and longer duration (a commitment will last 7.6 years on average). Common issues being addressed include capacity development, risk management, and community-based DRR. When looking at specific regions and countries, there are opportunities for increased partnerships and effectiveness in topics such as knowledge sharing and technology solutions. The systemic nature of risks is increasingly apparent, and this article may stimulate further studies analyzing complexity and the joint action of all stakeholders committed to accelerate the implementation of the Sendai Framework.

The aim of this study was to assess the commitments of food companies in Malaysia to improving population nutrition using the Business Impact Assessment on population nutrition and obesity (BIA-Obesity) tool and process, and proposing recommendations for industry action in line with government priorities and international norms.
BIA-Obesity good practice indicators for food industry commitments across a range of domains (n = 6) were adapted to the Malaysian context. Euromonitor market share data was used to identify major food and non-alcoholic beverage manufacturers (n = 22), quick service restaurants (5), and retailers (6) for inclusion in the assessment. Evidence of commitments, including from national and international entities, were compiled from publicly available information for each company published between 2014 and 2017. Companies were invited to review their gathered evidence and provide further information wherever available. A qualified Expert Panel (≥5 members for each domain) assessed commitments and disclosures collected against the BIA-Obesity scoring criteria. Weighted scores across domains were added and the derived percentage was used to rank companies. A Review Panel, comprising of the Expert Panel and additional government officials (n = 13), then formulated recommendations.
Of the 33 selected companies, 6 participating companies agreed to provide more information. The median overall BIA-Obesity score was 11% across food industry sectors with only 8/33 companies achieving a score of > 25%. Participating (p < 0.001) and global (p = 0.036) companies achieved significantly higher scores than non-participating, and national or regional companies, respectively. Corporate strategy related to population nutrition (median score of 28%) was the highest scoring domain, while product formulation, accessibility, and promotion domains scored the lowest (median scores < 10%). Recommendations included the establishment of clear targets for product formulation, and strong commitments to reduce the exposure of children to promotion of unhealthy foods.
This is the first BIA-Obesity study to benchmark the population nutrition commitments of major food companies in Asia. Commitments of companies were generally vague and non-specific. In the absence of strong government regulation, an accountability framework, such as provided by the BIA-Obesity, is essential to monitor and benchmark company action to improve population nutrition.