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"Organisational Ethics Policies; A Primer"

I regret that it took me so long to find an essay on "Organisational Ethics Policies" by Howard Whitton, available <a href="http://www.cmi.no/publications/file/?3344=organisational-ethics-policies-a-primer">from the European U4 Anti-Corruption Resource Center</a>. While it was written with international non-governmental organisations (NGOs) who "administer aid programs" in mind, it seems applicable to all kinds of NGOs and not-for-profit organizations, including those in health care. In the US, most medical schools and their parent universities, most hospitals and academic medical centers, essentially all medical societies and disease advocacy groups, and some insurance companies and managed care organizations are not-for-profit. The main points of the paper are its summaries of the basic elements of "effective ethics policies." First, such a policy <blockquote> - must first have unequivocal authority and the endorsement of boards and senior management, and must be: o founded on the organisation’s core values, mandate, and ethical principle o developed in consultation with those affected by it o realistically achievable o written in plain language, coherent with other policies, and easily available o clearly understood by staff, and by other stakeholders o consistent with the organisation’s policies on rewards and sanctions o regularly reviewed and evaluated with all stakeholders o universally applied, and transparently enforced. </blockquote> The main content areas might include such "major areas of ethical risk" as: <blockquote>o financial management and accountability standards o internal and external audit processes o professional ethics, conduct, and conflict of interest standards o fair treatment rules for staff and clients o processes for the prevention of fraud and other abuse of trust o integrity mechanisms governing proper decision-making o provision of transparent information to stakeholders o complaints and whistleblower disclosure processes o principled policy dispute processes o transparent and objective evaluation mechanisms. </blockquote> So, specific policies should include the following functional elements: <blockquote> o a code of conduct/ethics based on the organisation’s core values o professional practice standards interpreting the code’s principles o procedures for managing conflict of interest situations (including the registration of relevant interests and assets of decision makers) o procedures for offering and accepting gifts and business courtesies o criteria for the proper use of organisational assets and authority o prohibition of harassment and discrimination in the workplace o criteria for protected reporting of unethical or illegal behaviour o rights of clients to obtain service, including complaint procedures for failure to meet standards o obligations for accountability and transparency,and information provision o standards for dealing with confidential and privileged information o constraints on ancillary and post-separation employment o standards for providing reasons for administrative decisions. </blockquote> Also the policies should include: <blockquote> • A commitment to training staff in the full range of ethics-related activities. Training will improve personal awareness and strengthen the ability to define and manage improper conduct, whether by co-workers, managers, or external stakeholders. The range of training themes should include the organisation’s integrity system, specific anticorruption measures, harassment-free workplaces, non-discrimination principles, financial management and audit, integrity in procurement practices, donor relations, personal and institutional conflict of interest, accountability, responsibility, procedural fairness, and strategic problem-solving. • Policies and procedures for regular management reporting to boards and executives, in particular to enable monitoring of matters which may be of particular concern from time to time. • Independent, external scrutiny of policies provide an important resource for boards and executives for ensuring that espoused core values and actual behaviours are aligned, and to identify areas of policy and management practice requiring improvement. • Policies and procedures for protected reporting of improper conduct, both to enhance worker and stakeholder confidence in the integrity of an organisation, and to provide avenues for early detection of inappropriate behaviour. Genuine whistleblowing must be effectively endorsed, and effectively protected, to ensure the organisation’s credibility. • Procedures for the sanctioning of improper conduct and failure to meet relevant standards by staff, structured so as to enhance management’s capacity to deal effectively with ethical issues in the workplace. </blockquote> Such policies cannot be considered ethical panaceas, but in my humble opinion (and based, I believe, on at least a little cognitive psychology), visible, reasonable, clear ethics policies could reduce the sort of bad behavior that Health Care Renewal often discusses on the part of leaders of major health care not-for-profit organizations and NGOs. So, those of you who work for or are otherwise affiliated with a not-for-profit university, medical school, hospital, academic medical center, medical organization, disease advocacy organization, or insurance company/ managed care organization might want to go through the exercise of answering these questions: 1 - Does your organization have anything that resembles an ethics policy? 2 - If so, which of the characteristics listed above does it have? 3 - Which of the content areas listed above does it include? 4 - Which of the functional and additional elements listed above does it include? If much is missing, is there an obvious reason for what was omitted? If the policy seems poorly characterized or incomplete, why should it not be improved? Would you feel comfortable suggesting improvements? If not, why not, and what does that say about the organization?

"Organisational Ethics Policies; A Primer"

I regret that it took me so long to find an essay on "Organisational Ethics Policies" by Howard Whitton, available from the Europe...

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Academic Freedom Curtailed: Censorship Down Under On EHR's for the Emergency Department?

In a stunning development: The essay on Emergency Department electronic health record (EHR) problems in the Australian state of New South Wales (NSW) by medical informatics professor Dr. Jon Patrick, Health Information Technologies Research Laboratory (HITRL), University of Sydney, that I referenced in my posts "<a href="http://hcrenewal.blogspot.com/2009/10/from-down-under-story-of-deployment-of.html">The Story of the Deployment of an ED Clinical Information System ‐ Systemic Failure or Bad Luck</a>" and "<a href="http://hcrenewal.blogspot.com/2009/10/nsw-nightmare-and-overuse-of-computers.html">NSW Nightmare and Overuse of Computers</a>" appears to have been censored. This apparently occurred at the level of the the government. The essay was available as item 6 at <a href="http://www.it.usyd.edu.au/%7Ehitru/index.php?option=com_content&task=view&id=91&Itemid=146">http://www.it.usyd.edu.au/~hitru/index.php?option=com_content&task=view&id=91&Itemid=146</a> . Attempts to download now provide a message "This document is not currently available." I do not know if the vendor was involved. (A copy of vers. 3 of Professor Patrick's report is still available <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/ed3.pdf">here</a> in PDF; it was a work in progress when it was pulled.) [Oct. 24 - see addendum below - ed.] This appears to be an overt example of suppression of academic freedom that I believe should receive widespread attention, most especially if there is retaliation of any kind against the professor. I also believe censorship of a document such as this could escalate to a human rights issue regarding what appears to be deliberate censorship of critical information about IT systems that could possibly be putting large numbers of patients at risk. Imagine if this was a report about potentially defective nuclear reactor control systems or containment processes at biological hazards research sites. I believe addressing the issues raised in the report would have been a far more responsible approach than censorship. -- SS Addendum 10/24: The author of the paper asked me to remove it from my server as well. It is currently unavailable. This situation is in flux and hopefully will be resolved soon. Hopefully, the issues in the report will be addressed.

Academic Freedom Curtailed: Censorship Down Under On EHR's for the Emergency Department?

In a stunning development: The essay on Emergency Department electronic health record (EHR) problems in the Australian state of New South Wa...

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Celebrating free expression 20 years after the fall of the Berlin Wall

(Cross-posted from the <a href="http://youtube-global.blogspot.com/2009/10/celebrating-free-expression-20-years.html" style="font-style: italic;">YouTube Blog</a>) In 1989, the fall of the Berlin Wall became a striking symbol for free expression far beyond the borders of Germany. Just 20 years later, Iranian citizens used online tools like YouTube and Twitter to share <a href="http://www.youtube.com/watch?v=EUMVwkf2tEY">firsthand accounts</a> of the brutal government crackdown waged against protesters disputing the country's election results. <a href="http://www.citizentube.com/2009/06/violence-breaks-out-in-streets-of.html">Many Iranians risked their lives</a> to document the violence, despite the government's attempts to expel journalists and stifle any voices of dissent. The democratizing power of the Internet has enabled individuals to share their stories with a global audience in ways never before possible, and given a voice to those who wouldn't otherwise be heard. To commemorate the twentieth anniversary of the fall of the Berlin Wall, we're launching a YouTube channel — <a href="http://youtube.com/googlefreeexpression">youtube.com/GoogleFreeExpression</a> — to highlight and celebrate free expression around the world, and we want to hear from you. This channel is designed to feature your stories and reflections on free expression. Tell us about how you or someone you know has taken a stand for free expression. Perhaps you've <a href="http://www.youtube.com/googlefreeexpression#p/c/31A28F774BE309E2/11/SDAPbRZmT6g">protested against</a> something you didn't agree with, <a href="http://www.youtube.com/googlefreeexpression#p/c/31A28F774BE309E2/8/BNf8a0fjnn8">taken action</a> when someone else's free speech was being suppressed or <a href="http://www.youtube.com/googlefreeexpression#p/c/31A28F774BE309E2/14/KVqj5lcEkBk">been inspired</a> by someone who has stood up for the right to speak out. Make a short video sharing your experience, upload it to YouTube, and add it as a reply to this one: <object height="340" width="560"><param name="movie" value="http://www.youtube.com/v/NBirQbsWXw0&hl=en&fs=1&"><param name="allowFullScreen" value="true"><param name="allowscriptaccess" value="always"><embed src="http://www.youtube.com/v/NBirQbsWXw0&hl=en&fs=1&" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" width="560" height="340"></embed></object> We'll be featuring the best submissions on the <a href="http://www.youtube.com/user/GoogleFreeExpression">Google Free Expression channel</a>, so be sure to check back in the weeks to come. We look forward to hearing from you. Posted by Annette Kroeber-Riel, Senior European Policy Counsel

Celebrating free expression 20 years after the fall of the Berlin Wall

(Cross-posted from the YouTube Blog ) In 1989, the fall of the Berlin Wall became a striking symbol for free expression far beyond the borde...

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Reading gets personal with Popular items and Personalized ranking

<div>(Cross-posted from the <a href="http://googlereader.blogspot.com/2009/10/reading-gets-personal-with-popular.html">Official Google Reader Blog</a>)</div><div> </div>Today, we're launching two changes to <a href="http://reader.google.com/">Google Reader</a> to help you discover more interesting content faster. Just as the launch of <a href="http://googleblog.blogspot.com/2005/06/search-gets-personal.html">Personalized Search</a> improved search results based on your search history, these changes use your Reader Trends to improve your reading experience. <ul><li>Explore section - We're always trying to help you discover new stuff in Reader, and today we're introducing Popular items and Recommended sources, two ways to find interesting content from all over the Internet. We use algorithms to find top-rising images, videos and pages from anywhere (not just your subscriptions), collect them in the new Popular items section and order them by what we think you'll like best. Now you don't have to be embarrassed about missing that hilarious video everyone is talking about — it should show up in your Popular items feed automatically. And to make it easier to find interesting feeds, we're moving <a href="http://googlereader.blogspot.com/2007/11/attack-of-interns-recommendations-and.html">Recommendations</a> into the new Explore section and giving it a new name — Recommended sources. Like always, it uses your <a href="http://www.google.com/reader/view/#trends-page">Reader Trends</a> and <a href="http://www.google.com/history/">Web History</a> (if you're opted into Web History) to generate a list of feeds we think you might like.</li></ul><ul><li><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgbsZ6ttkLzpwHvZSeHQn5513pMX4gFce7bt8NWpBZc8j7BEDt2yjcX3pUFQZ0iGwZIpoiDGLAlbZ3N0BSJjB4IHG3dxfJM3gWRfWtUKvLkcCh0_dd8hJVxthGfzxWkq9wHRoX4RcI8D-xT/s1600-h/explore.png" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5395560149323462850" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgbsZ6ttkLzpwHvZSeHQn5513pMX4gFce7bt8NWpBZc8j7BEDt2yjcX3pUFQZ0iGwZIpoiDGLAlbZ3N0BSJjB4IHG3dxfJM3gWRfWtUKvLkcCh0_dd8hJVxthGfzxWkq9wHRoX4RcI8D-xT/s400/explore.png" style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 260px; height: 168px;" /></a>Personalized ranking - Only have a 10-minute coffee break and want to see the best items first? All feeds now have a new sort option called "magic" that re-orders items in the feed based on your personal usage, and overall activity in Reader, instead of default chronological order. Click "Sort by magic" under the Folder Settings menu of your feed to switch to personalized ranking. Unlike the old "auto" ranking, this new ranking is personalized for you, and gets better with time as we learn what you like best — the more you "like" and "share" stuff, the better your magic sort will be. Give it a try on a high-volume feed folder or All items and see for yourself!</li></ul><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgFxPahh5xbE9CNQQgPZZZGlTGQFV5kMI24lJxe61Ng1mUWJC2qn4C-3QgkIAFY468N3VAf2Gv5KFRjO8ckU-Seg7Ur_tz-IMPuBd1KEUHP3TJsx_I72EvlThyphenhyphen1dkboNd6wWoStmLGeMlrr/s1600-h/magic.png" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5395560153703883890" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgFxPahh5xbE9CNQQgPZZZGlTGQFV5kMI24lJxe61Ng1mUWJC2qn4C-3QgkIAFY468N3VAf2Gv5KFRjO8ckU-Seg7Ur_tz-IMPuBd1KEUHP3TJsx_I72EvlThyphenhyphen1dkboNd6wWoStmLGeMlrr/s400/magic.png" style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 191px; height: 134px;" /></a>The goal of personalization at Google remains the same as ever: to help you find the best content on the web. We hope these new features help you do just that — go <a href="http://www.google.com/reader/view/#stream/pop/explore">Explore</a> for yourself. Finally, we'd love to hear your feedback — share your thoughts on <a href="http://www.google.com/support/forum/p/reader?hl=en">our help group</a>, <a href="http://twitter.com/googlereader">Twitter</a> or the Reader section of <a href="http://getsatisfaction.com/google/products/google_google_reader">Get Satisfaction</a>, a third party support community. Posted by Beverly Yang, Software Engineer, Search Quality

Reading gets personal with Popular items and Personalized ranking

(Cross-posted from the Official Google Reader Blog ) Today, we're launching two changes to Google Reader to help you discover more inte...

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Note to readers referred here from the Oct. 20 NY Times

Note to readers referred here from the Oct. 20 NY Times

Note to readers referred here from the Oct. 20 NY Times story "Steps to Greater Accountability in Medical Education" by Duff Wilso...

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Medical Informatics, Pharma, Health IT, and Golden Advice That Sits Sadly Unused

In recent correspondences with colleagues I was reminded of a letter I wrote seven years ago that was published in Bio-IT World, a journal about biomedicine focusing mainly on pharma, bioinformatics and related fields. As the sole formally-trained Medical Informatics specialist at Merck, I wrote: <blockquote><a href="http://www.bio-itworld.com/archive/081302/letters.html">Medical Informatics MIA</a> [Missing in Action - ed.] Bio-IT World August 13, 2002 Dear Bio-IT World: I enjoyed reading the article "Informatics Moves to the Head of the Class" (June Bio·IT World). Thank you for spotlighting the National Library of Medicine (NLM) training programs in medical informatics and bioinformatics, of which I am a graduate (Yale, 1994). Bioinformatics appears to receive more media attention and offer more status, career opportunities, and compensation than the less-prestigious medical informatics. This disparity, however, may impede the development of next-generation medicines. Bioinformatics discoveries may be more likely to result in new medicines, for example via pharmacogenomics, when they are coupled with large-scale, concurrent, ongoing clinical data collection. At the same time, applied medical informatics, as a distinct specialty, is essential to the success of extensive clinical data collection efforts, especially at the point of care. Hospital and provider MIS personnel are best equipped for implementing business-oriented IT, not clinical IT. Implementing clinical IT in patient-care settings constitutes one of the core competencies of applied medical informaticists. Informatics specialists with a bioinformatics focus — even those coming from the new joint programs — usually are not proficient in hospital business and management issues that impede adoption of clinical IT in patient care settings. Such organizational and territorial issues are in no small way responsible for the low utilization of clinical IT in patient care settings. It will be important for medical informaticists focused in the clinical domain and bioinformaticists specializing in the molecular domain to collaborate with other specialists in order to best integrate clinical and genomic data. Further information on these issues can be found in the book Organizational Aspects of Health Informatics: Managing Technological Change, by Nancy M. Lorenzi and Robert T. Riley (Springer-Verlag, 1995). Various publications from the medical informatics community, such as the American Medical Informatics Association (<a href="https://exchangeweb.drexel.edu/owa/redir.aspx?C=3d51436b9a224f06be16751d1de7e240&URL=http%3a%2f%2fwww.amia.org" target="_blank">www.amia.org</a>) and the International Medical Informatics Association (<a href="https://exchangeweb.drexel.edu/owa/redir.aspx?C=3d51436b9a224f06be16751d1de7e240&URL=http%3a%2f%2fwww.imia.org" target="_blank">www.imia.org</a>), are also useful. Scot Silverstein, MD Director, Published Information Resources & The Merck Index Merck Research Laboratories </blockquote>I was also responsible for the entry of the term "Medical Informatics" into the controlled vocabulary pool used for various purposes at Merck. As far as I can tell, the Medical Informatics talent gap still exists in all major pharmas despite writings on the topic from colleagues as well as myself. With the present turmoil including declining pipelines, mergers and mass layoffs pending in many large pharmas, and even despite Medical Informatics on a fast path to being declared a full medical subspecialty, it is likely this gap will persist for years longer. This is a shame. The field offers insights that can help R&D substantially, and I speak from direct experience from my time in that domain. I am reminded via all this of another industry that seems to hurt itself via ignoring the advice of Medical Informatics professionals, the health IT industry. Healthcare IT is actually the core competence of Medical Informatics professionals, but those people are under-represented in the higher ranks of the health IT industry as well. Many job postings seek such people, but for lower level roles (as I've posted here in the past), and/or conflate formal training with informal experience and with those who qualify for the title of Medical Informaticist like I qualify (being an amateur radio licensee, extra class) as a professional RF engineer. The irony is this: the wisdom of the Medical Informatics field on health IT goes back not years, but decades. It is advice that could have made the vendors much higher margins, allowed them to produce better products, avoid the government regulation that is now nearly inevitable (in some EU countries, clinical IT has already been determined to be a medical device requiring regulation), and in many cases, enabled corporate longevity. Yet the teachings and accumulated wisdom of the field were, and largely still are, ignored, making books such as the new "<a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=cases&sloc=hitormiss">H.I.T. or Miss: Lessons Learned from Health Information Technology Implementations</a>" necessary even in 2009. Here is just a small sampling of that wisdom: <blockquote style="font-family:arial;">Dr. Donald A. B. Lindberg (now Director of the U.S. National Library of Medicine at NIH), 1969: "Computer engineering experts per se have virtually no idea of the real problems of medical or even hospital practice, and furthermore have consistently underestimated the complexity of the problems…in no cases can [building appropriate clinical information systems] be done, simply because they have not been defined with the physician as the continuing major contributor and user of the information." Dr. Octo Barnett's [Harvard] health IT Ten Commandments, 1970: 1. Thou shall know what you want to do 2. Thou shall construct modular systems - given chaotic nature of hospitals 3. Thou shall build a computer system that can evolve in a graceful fashion 4. Thou shall build a system that allows easy and rapid programming development and modification 5. Thou shall build a system that has consistently rapid response time and is easy for the non-computernik to use 6. Thou shall have duplicate hardware systems 7. Thou shall build and implement your system in a joint effort with real users in a real situation with real problems 8. Thou shall be concerned with realities of the cost and projected benefit of the computer system 9. Innovation in computer technology is not enough; there must be a commitment to the potentials of radical change in other aspects of healthcare delivery, particularly those having to do with organization and manpower utilization 10. Be optimistic about the future, supportive of good work that is being done, passionate in your commitment, but always guided by a fundamental skepticism. [Dr. Barnett played a key role in the 2009 National Research Council report about current approaches to health IT being inadequate, Press Release at <a href="http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=12572" style="font-style: italic;">http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=12572</a>, and full report "<a href="http://www.nap.edu/catalog.php?record_id=12572">COMPUTATIONAL TECHNOLOGY FOR EFFECTIVE HEALTH CARE: IMMEDIATE STEPS AND STRATEGIC DIRECTIONS</a>. - ed.] Dr. Morris Collen's Five Rules, 1972 Most common causes of health IT failure: <ul><li>Suboptimal mix of medical and computer specialists … resulting in communications difficulties and in the computer staff underestimating the vast medical needs</li><li>Gross underestimation of the large amounts of money needed</li><li>Suboptimal systems approach with serious incompatibilities between modules</li><li>Unacceptable terminals</li><li>Inadequate management organization and poor judgment </li></ul> Dr. R. Friedman, Reasons for slow spread of EMR, 1977: <ul><li>Poor engineering and unreliability</li><li>Physicians not provided with computer-based applications that exceeded their own capability!</li><li>Inability to prove a positive effect on patient care</li><li>Difficulty transferring one application from one institution to another </li></ul></blockquote> (All taken from Collen's "<a href="http://www.amazon.com/History-Medical-Informatics-United-States/dp/0964774305">A history of Medical Informatics in the United States, 1950-1990</a>".) I might add that the PC did not even exist in 1977, unless you consider the Altair and Heathkit H8 "personal computers." Four-decades-old wisdom like this, and much more, sits out there in the ether and in the Medical Informatics field's professionals like a pot of gold, but is apparently considered as valuable as lead by the HIT - and pharma - industries. I find this amazing - and a pity. -- SS

Medical Informatics, Pharma, Health IT, and Golden Advice That Sits Sadly Unused

In recent correspondences with colleagues I was reminded of a letter I wrote seven years ago that was published in Bio-IT World, a journal a...

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Art meets engineering with Google Chrome Artist Themes

A couple of weeks ago we <a href="http://googleblog.blogspot.com/2009/10/fast-simple-and-now-stylish-google.html">introduced</a> Artist Themes for Google Chrome. We asked leading designers, artists, illustrators and musicians to use the browser as their personal canvas for designing interesting themes. Since then, we've enjoyed hearing <a href="http://twitter.com/#search?q=google%20chrome%20themes">your thoughts</a> on these designs and how you've used them to personalize your browser. We've also been intrigued by the ways in which these themes have had <a href="http://chrome.blogspot.com/2009/10/from-anime-to-animation-google-chrome.html">interesting and unusual</a> cultural resonance with people around the world. To continue celebrating this collaboration of engineering and art, we've joined forces with our friends at YouTube to launch a new video (with a surprise ending) that we hope showcases the full beauty of these themes. Check it out at <a href="http://youtube.com/googlechromethemes">youtube.com/googlechromethemes</a> or by clicking on the image below. <a href="http://www.youtube.com/googlechromethemes" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5395441379586553090" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj0A5KE5nhkG3IaGHk3UTXwpiqN8VlXI_g3Y0kycM3B9sddPEET-8HbJm6JMoMguFWvqjN4Nvo8wzKKonxQwVk_jPD48kyio7m7zkyDAiE6FOdX6jtQZOhl_idzN6Y3lug7ys0vSnZFVx-m/s400/GoogleChromeThemes-YouTube.png" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 206px;" /></a> Posted by Jeff Gillette, Google Creative Lab

Art meets engineering with Google Chrome Artist Themes

A couple of weeks ago we introduced Artist Themes for Google Chrome. We asked leading designers, artists, illustrators and musicians to use...

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