ORCID Profile
0000-0002-2956-0883
Current Organisation
University of Twente
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Publisher: BMJ
Date: 09-2022
DOI: 10.1136/BMJOPEN-2021-060326
Abstract: The terms ‘precision medicine’ and ‘personalised medicine’ have become key terms in health-related research and in science-related public communication. However, the application of these two concepts and their interpretation in various disciplines are heterogeneous, which also affects research translation and public awareness. This leads to confusion regarding the use and distinction of the two concepts. Our aim is to provide a snapshot of the current understanding of these concepts. Our study will use Rodgers’ evolutionary concept analysis to systematically examine the current understanding of the concepts ‘precision medicine’ and ‘personalised medicine’ in clinical medicine, biomedicine (incorporating genomics and bioinformatics), health services research, physics, chemistry, engineering, machine learning and artificial intelligence, and to identify their respective attributes (clusters of characteristics) and surrogate and related terms. A systematic search of the literature will be conducted for 2016–2022 using databases relevant to each of these disciplines: ACM Digital Library, CINAHL, Cochrane Library, F1000Research, IEEE Xplore, PubMed/Medline, Science Direct, Scopus and Web of Science. These are among the most representative databases for the included disciplines. We will examine similarities and differences in definitions of ‘precision medicine’ and ‘personalised medicine’ in the respective disciplines and across (sub)disciplines, including attributes of each term. This will enable us to determine how these two concepts are distinguished. Following ethical and research standards, we will comprehensively report the methodology for a systematic analysis following Rodgers’ concept analysis method. Our systematic concept analysis will contribute to the clarification of the two concepts and distinction in their application in given settings and circumstances. Such a broad concept analysis will contribute to non-systematic syntheses of the concepts, or occasional systematic reviews on one of the concepts that have been published in specific disciplines, in order to facilitate interdisciplinary communication, translational medical research and implementation science.
Publisher: Queen's University Library
Date: 09-08-2017
Abstract: Given recognition of widespread state sponsored surveillance programs, are liberal democracies descending into an Orwellian authoritarian nightmare? The realities of the modern surveillance state instead suggest our worries ought to be about Kafkaesque bureaucratic black holes. In this paper we suggest that authoritarianism can be avoided by liberal democracies if they adhere to processes of ensurance and assurance. Moreover, we argue that both of these attributes are instrumentally enabled by transparency.
Publisher: Springer International Publishing
Date: 2021
Publisher: Wiley
Date: 29-06-2019
DOI: 10.1002/9781444367072.WBIEE878
Abstract: Cybersecurity presents numerous points for ethical inquiry. This entry looks at cybersecurity through a number of layers of analysis. Starting with cyberspace's nonphysical and nongeographic nature, it looks at international norms to show that there are norms in cyberspace. It then covers particular ethical issues around cyberwar and matters of state–state conflict in cyberspace that fall short of war. State–citizen relations are explored and, finally, some of the ethical issues concerning in iduals and cybersecurity.
Publisher: Springer Netherlands
Date: 2014
Publisher: Springer Netherlands
Date: 2014
Publisher: Springer International Publishing
Date: 2017
Publisher: Oxford University Press (OUP)
Date: 22-05-2018
DOI: 10.1002/BJS5.53
Publisher: BMJ
Date: 06-2022
DOI: 10.1136/BMJOPEN-2022-061211
Abstract: To explore experiences of women who identified themselves as having a possible breast cancer overdiagnosis. Qualitative interview study using key components of a grounded theory analysis. International interviews with women diagnosed with breast cancer and aware of the concept of overdiagnosis. Twelve women aged 48–77 years from the UK (6), USA (4), Canada (1) and Australia (1) who had breast cancer (ductal carcinoma in situ n=9, (invasive) breast cancer n=3) diagnosed between 2004 and 2019, and who were aware of the possibility of overdiagnosis. Participants were recruited via online blogs and professional clinical networks. Most women (10/12) became aware of overdiagnosis after their own diagnosis. All were concerned about the possibility of overdiagnosis or overtreatment or both. Finding out about overdiagnosis/overtreatment had negative psychosocial impacts on women’s sense of self, quality of interactions with medical professionals, and for some, had triggered deep remorse about past decisions and actions. Many were uncomfortable with being treated as a cancer patient when they did not feel ‘diseased’. For most, the recommended treatments seemed excessive compared with the diagnosis given. Most found that their initial clinical teams were not forthcoming about the possibility of overdiagnosis and overtreatment, and many found it difficult to deal with their set management protocols. The experiences of this small and unusual group of women provide rare insight into the profound negative impact of finding out about overdiagnosis after breast cancer diagnosis. Previous studies have found that women valued information about overdiagnosis before screening and this knowledge did not reduce subsequent screening uptake. Policymakers and clinicians should recognise the ersity of women’s perspectives and ensure that women are adequately informed of the possibility of overdiagnosis before screening.
Publisher: Wiley
Date: 19-05-2017
DOI: 10.1111/JAPP.12216
Publisher: Routledge
Date: 30-10-2019
Publisher: Informa UK Limited
Date: 25-07-2017
Publisher: Springer International Publishing
Date: 2017
Publisher: Cambridge University Press (CUP)
Date: 2020
DOI: 10.1017/S0892679420000143
Abstract: The ethics of whistleblowing are complex and challenging. On the one hand, there are a strong set of moral reasons why someone ought to blow the whistle when he or she learns of wrongdoing. On the other hand, such actions typically come at a significant cost to the whistleblower and may not bring about any significant change. Both aspects prompt us to ask, why would I be a whistleblower? Emanuela Ceva and Michele Bocchiola's Is Whistleblowing a Duty? answers that question by arguing that one has an organizational duty to blow the whistle. Kate Kenny's Whistleblowing: Toward a New Theory reframes the question, showing how hard it has been for members of the international financial industry to blow the whistle and bring about any effective change to that industry. In this review essay, I suggest that analyses of whistleblowing need to take into account evolving technologies, the importance of loyalty, and special contexts such as whistleblowing in the national security sector.
Publisher: MDPI AG
Date: 12-08-2021
DOI: 10.3390/JPM11080791
Abstract: There is enormous variation in the manifestations of disease experienced by people with multiple sclerosis (PwMS). While this variation makes personalized medicine an attractive goal, there are many challenges to be overcome before this opportunity can be realized. Personalized medicine often focuses on targeted therapies and detailed monitoring, but we also need to recognize that there will be variation in acceptance of these approaches by different PwMS. In other words, deep personalization of medicine will encompass targeted therapy, precision monitoring, tailored to variation in personal attitudes to these transformations in health care. In order to meet the promise of personalized medicine for MS, understanding the experiences of PwMS is necessary both to aid in the uptake of personalized medicine, and to ensure that personalized approaches to monitoring disease and treatment provide a net benefit to PwMS rather than placing additional burdens and stressors on them. Here, we describe recent research that identified five experiential themes for PwMS, and then interpret these themes according to the foundations of personalized medicine to provide a road map for implementation of personalized medicine solutions for PwMS.
Publisher: Brill
Date: 21-12-2016
DOI: 10.1163/15718158-01702005
Abstract: Before the Al Qaeda attacks in the us , it was hard to find support for torture in the liberal-democratic world. However, post 9/11 torture (or at least something very close to torture) was used by liberal democracies like the United States ( us ). Practices like water-boarding were justified by reference to the war on terror. Underneath this lies a reasoning that we have two options, some large scale act of violence and torture, and that torture is a lesser evil, exemplified by ‘ticking time bomb’ scenarios – if you have two options, both bad, but one is far worse than the other, the lesser evil seems a reasonable decision. This article proposes that there is a moral danger through slippage from recognising torture as a generally justified action. It explains this slippage by reference to the ‘halo effect’: a cognitive bias in which something is judged as permissible or good through association with non-relevant facts. Given the current risks of domestic terrorism, the article argues that we need to learn from the us ex le post 9/11 to ensure that we avoid justifying uses of torture in non-exceptional circumstances.
Publisher: Springer International Publishing
Date: 2022
Publisher: American Medical Association (AMA)
Date: 09-07-2020
Publisher: Routledge
Date: 26-06-2013
Publisher: Springer International Publishing
Date: 2021
DOI: 10.1007/978-3-030-90221-6_11
Abstract: As liberal democracies grapple with the evolution of online political extremism, in addition to governments, social media and internet infrastructure companies have found themselves making more and more decisions about who gets to use their platforms, and what people say online. This raises the question that this paper explores, who should regulate extremist content online? In doing so the first part of the paper examines the evolution of the increasing role that social media and internet infrastructure companies have come to play in the regulating extremist content online, and the ethical challenges this presents. The second part of the paper explores three ethical challenges: i) the moral legitimacy of private actors, ii) the concentration of power in the hands of a few actors and iii) the lack of separation of powers in the content regulation process by private actors.
Publisher: Springer Science and Business Media LLC
Date: 26-08-2017
Publisher: National Institute for Strategic Studies
Date: 08-08-2023
DOI: 10.53679/2616-9460.2.2022.02
Abstract: In recent years, international attention has been turned to the ways that states use disinformation to further their own political ends. Propaganda, information conflict and active measures have long been a tool of statecraft, but the parallel development of information and communication technologies with increased levels of internal discord and social tension within states have made such disinformation c aigns both more effective and more worrying. This paper provides a brief history of Soviet “active measures”, before examining the role of Russian disinformation and cognitive warfare in Russia’s 2022 invasion of Ukraine. The examination of this topic is not solely confined to a description of the methods used it also highlights some of the ethical issues involved in Russia’s use of cognitive warfare and its heavy reliance on disinformation. Whereas information warfare focuses on controlling the flow of information, cognitive warfare instead has a more subtle yet potentially more damaging goal of shaping not simply what people think, but how they think and how they react to information. One of the significant features of the current conflict in Ukraine is the role that disinformation is playing in both driving and describing the conflict, and this paper explores the history and ethical implications of modern cognitive warfare, particularly in relation to the current conflict in Ukraine.
Publisher: Springer Science and Business Media LLC
Date: 25-01-2021
Publisher: Springer Science and Business Media LLC
Date: 25-05-2021
DOI: 10.1038/S41416-021-01440-8
Abstract: The TARGIT-A trial reported risk-adapted targeted intraoperative radiotherapy (TARGIT-IORT) during lumpectomy for breast cancer to be as effective as whole-breast external beam radiotherapy (EBRT). Here, we present further detailed analyses. In total, 2298 women (≥45 years, invasive ductal carcinoma ≤3.5 cm, cN0–N1) were randomised. We investigated the impact of tumour size, grade, ER, PgR, HER2 and lymph node status on local recurrence-free survival, and of local recurrence on distant relapse and mortality. We analysed the predictive factors for recommending supplemental EBRT after TARGIT-IORT as part of the risk-adapted approach, using regression modelling. Non-breast cancer mortality was compared between TARGIT-IORT plus EBRT vs. EBRT. Local recurrence-free survival was no different between TARGIT-IORT and EBRT, in every tumour subgroup. Unlike in the EBRT arm, local recurrence in the TARGIT-IORT arm was not a predictor of a higher risk of distant relapse or death. Our new predictive tool for recommending supplemental EBRT after TARGIT-IORT is at targit.org.uk/addrt . Non-breast cancer mortality was significantly lower in the TARGIT-IORT arm, even when patients received supplemental EBRT, HR 0.38 (95% CI 0.17–0.88) P = 0.0091. TARGIT-IORT is as effective as EBRT in all subgroups. Local recurrence after TARGIT-IORT, unlike after EBRT, has a good prognosis. TARGIT-IORT might have a beneficial abscopal effect. ISRCTN34086741 (21/7/2004), NCT00983684 (24/9/2009).
Publisher: OMICS Publishing Group
Date: 2015
Publisher: Walter de Gruyter GmbH
Date: 04-2020
Abstract: The Internet of Things (IoT) is, in part, an information handling system that can remove humans from the information handling process. The particular problem explored is how we are to understand privacy when considering informational systems that handle personal information in ways that impact people’s lives when there is no human operator in direct contact with that personal information. I argue that these new technologies need to take concepts like privacy into account, but also, that we ought also to take these technologies into account to reconsider and perhaps reconceptualise privacy. This paper argues that while an inhuman system like the IoT does not necessarily violate the interpersonal privacy of people, if the IoT is used as part of a state surveillance program, a political notion of privacy may be violated.
Publisher: Wiley
Date: 24-06-2020
DOI: 10.1111/HEX.13093
Publisher: Cambridge University Press
Date: 03-07-2017
Abstract: People increasingly live online, sharing publicly what might have once seemed private, but at the same time are enraged by extremes of government surveillance and the corresponding invasion into our private lives. In this enlightening work, Adam Henschke re-examines privacy and property in the age of surveillance in order to understand not only the importance of these social conventions, but also their moral relevance. By analyzing identity and information, and presenting a case for a relation between the two, he explains the moral importance of virtual identities and offers an ethically robust solution to design surveillance technologies. This book should be read by anyone interested in surveillance technology, new information technology more generally, and social concepts like privacy and property.
Publisher: Elsevier BV
Date: 07-2021
Publisher: Springer Netherlands
Date: 2014
Publisher: Informa UK Limited
Date: 03-05-2020
Publisher: Springer International Publishing
Date: 2021
DOI: 10.1007/978-3-030-90221-6_5
Abstract: In this chapter I present an argument that cyber-terrorism will happen. This argument is premised on the development of a cluster of related technologies that create a direct causal link between the informational realm of cyberspace and the physical realm. These cyber-enabled physical systems fit under the umbrella of the ‘Internet of Things’ (IoT). While this informational hysical connection is a vitally important part of the claim, a more nuanced analysis reveals five further features are central to the IoT enabling cyber-terrorism. These features are that the IoT is radically insecure , that the components of the IoT are in the world , that the sheer numbers of IoT devices mean potential attacks can be intense , that the IoT will likely be powered by a range of Artificial Intelligence aspects, making it inscrutable , and that the IoT is largely invisible . Combining these five factors together, the IoT emerges as a threat vector for cyber-terrorism. The point of the chapter is to go beyond recognising that the IoT is a thing in the world and so can enable physical impacts from cyber-attacks, to offer these five factors to say something more specific about just why the IoT can potentially be used for cyber-terrorism. Having outlined how the IoT can be used for cyber-terrorism, I attend to the question of whether such actions are actually terrorism or not. Ultimately, I argue, as the IoT grows in scope and penetration of our physical worlds and behaviours, it means that cyber-terrorism is not a question of if, but when. This, I suggest, has significant ethical implications as these five features of the IoT mean that we ought to be regulating these technologies.
Publisher: Springer Science and Business Media LLC
Date: 19-03-2009
Publisher: Cambridge University Press (CUP)
Date: 2021
DOI: 10.1017/S0892679421000125
Abstract: It is a long-held belief that states must retain the monopoly over political violence in order to be states, and to survive. However, there are recent criticisms of this view forcing us to consider not just the state's use of political violence but the very nature of the state. Elizabeth Frazer and Kimberly Hutchings's Can Political Violence Ever Be Justified? argues that it cannot. Ned Dobos's Ethics, Security, and the War-Machine raises a series of arguments against states having standing militaries, and Alex Vitale's The End of Policing similarly raises a series of arguments against the institution of the police. In this review essay, I suggest that these arguments all force us to revisit the very nature of the state. There are concerns about simply abolishing these institutions of political violence, but we can indeed conceive of states without the monopoly on violence.
Publisher: JMIR Publications Inc.
Date: 25-01-2023
DOI: 10.2196/43377
Abstract: An important strategy to understand young people’s needs regarding technologies for type 1 diabetes mellitus (T1DM) management is to examine their day-to-day experiences with these technologies. This study aimed to examine young people’s and their caregivers’ experiences with diabetes technologies in an exploratory way and relate the findings to the existing technology acceptance and technology design theories. On the basis of this procedure, we aimed to develop device characteristics that meet young people’s needs. Overall, 16 in-person and web-based face-to-face interviews were conducted with 7 female and 9 male young people with T1DM (aged between 12 and 17 years) and their parents between December 2019 and July 2020. The participants were recruited through a pediatric diabetes clinic based at Canberra Hospital. Data-driven thematic analysis was performed before theory-driven analysis to incorporate empirical data results into the unified theory of acceptance and use of technology (UTAUT) and value-sensitive design (VSD). We used the COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist for reporting our research procedure and findings. In this paper, we summarize the key device characteristics that meet young people’s needs. Summarized interview themes from the data-driven analysis included aspects of self-management, device use, technological characteristics, and feelings associated with device types. In the subsequent theory-driven analysis, the interview themes aligned with all UTAUT and VSD factors except for one (privacy). Privacy concerns or related aspects were not reported throughout the interviews, and none of the participants made any mention of data privacy. Discussions around ideal device characteristics focused on reliability, flexibility, and automated closed loop systems that enable young people with T1DM to lead an independent life and alleviate parental anxiety. However, in line with a previous systematic review by Brew-Sam et al, the analysis showed that reality deviated from these expectations, with inaccuracy problems reported in continuous glucose monitoring devices and technical failures occurring in both continuous glucose monitoring devices and insulin pumps. Our research highlights the benefits of the transdisciplinary use of exploratory and theory-informed methods for designing improved technologies. Technologies for diabetes self-management require continual advancement to meet the needs and expectations of young people with T1DM and their caregivers. The UTAUT and VSD approaches were found useful as a combined foundation for structuring the findings of our study.
Publisher: Informa UK Limited
Date: 02-01-2016
Publisher: Palgrave Macmillan US
Date: 10-12-2016
Publisher: Philosophy Documentation Center
Date: 2012
Publisher: Informa UK Limited
Date: 08-03-2021
Publisher: Oxford University Press
Date: 03-2016
Publisher: Cold Spring Harbor Laboratory
Date: 12-01-2022
DOI: 10.1101/2022.01.12.22269125
Abstract: Introduction. The terms "precision medicine" and "personalised medicine" have become key terms in health-related research, and in science-related public communication. However, the application of these two concepts and their interpretation in various disciplines are heterogeneous, which also affects research translation and public awareness. This leads to confusion regarding the use and distinction of the two concepts. Methods and analysis. Our study aims at using Rodger's concept analysis method to systematically examine and distinguish the current understanding of the concepts "precision medicine" and "personalised medicine" in clinical medicine, biomedicine (incorporating genomics and bioinformatics), health services research physics, chemistry, engineering machine learning, and artificial intelligence, and to identify their respective attributes (clusters of characteristics) and surrogate and related terms. We will analyse similarities and differences in definitions in the respective disciplines and across different (sub)disciplines. The analysis procedure will include (1) a concept identification, (2) a setting, s le, and data source selection, (3) data collection, (4) data analysis and data summary, (5) identification of ex les, and (6) identification of implications for further concept development. Ethics and dissemination. Following ethical and research standards, we will comprehensively report the methodology for a systematic analysis following Roger's[1] concept analysis method. Our systematic concept analysis will contribute to the clarification of the two concepts and distinction in their application in given settings and circumstances. Such a broader concept analysis will contribute to non-systematic syntheses of the concepts, or occasional systematic reviews on one of the concepts that have been published in specific disciplines, in order to facilitate interdisciplinary communication, translational medical research, and implementation science.
Publisher: Springer Science and Business Media LLC
Date: 13-04-2018
Publisher: Edward Elgar Publishing
Date: 27-07-2021
Publisher: MDPI AG
Date: 03-08-2020
DOI: 10.3390/PHILOSOPHIES5030013
Abstract: Technological advancements have provided militaries with the possibility to enhance human performance and to provide soldiers with better warfighting capabilities. Though these technologies hold significant potential, their use is not without cost to the in idual. This paper explores the complexities associated with using human cognitive enhancements in the military, focusing on how the purpose and context of these technologies could potentially undermine a soldier’s ability to say no to these interventions. We focus on cognitive enhancements and their ability to also enhance a soldier’s autonomy (i.e., autonomy-enhancing technologies). Through this lens, we explore situations that could potentially compel a soldier to accept such technologies and how this acceptance could impact rights to in idual autonomy and informed consent within the military. In this examination, we highlight the contextual elements of vulnerability—institutional and differential vulnerability. In addition, we focus on scenarios in which a soldier’s right to say no to such enhancements can be diminished given the special nature of their work and the significance of making better moral decisions. We propose that though in some situations, a soldier may be compelled to accept said enhancements with their right to say no diminished, it is not a blanket rule, and safeguards ought to be in place to ensure that autonomy and informed consent are not overridden.
Publisher: Edward Elgar Publishing
Date: 27-07-2021
Publisher: Springer Science and Business Media LLC
Date: 04-2012
Publisher: Cambridge University Press
Date: 15-04-2010
Publisher: Springer Science and Business Media LLC
Date: 02-02-2021
DOI: 10.1038/S41416-020-01233-5
Abstract: In the randomised TARGIT-A trial, risk-adapted targeted intraoperative radiotherapy (TARGIT-IORT) during lumpectomy was non-inferior to whole-breast external beam radiotherapy, for local recurrence. In the long-term, no difference was found in any breast cancer outcome, whereas there were fewer deaths from non-breast-cancer causes. TARGIT-IORT should be included in pre-operative consultations with eligible patients.
Publisher: Philosophy Documentation Center
Date: 2012
Publisher: Informa UK Limited
Date: 26-10-2016
Publisher: Project MUSE
Date: 2014
Publisher: BMJ
Date: 13-02-2019
DOI: 10.1136/JRAMC-2018-001140
Abstract: This article argues that there is a duty of care held by the State to military veterans who have been technologically enhanced as part of their military service. It suggests that enhancements may be permanent, persistent or protracted and demonstrates how enhancements generate additional moral responsibilities from the chain of command. The paper concludes by demonstrating how this institutional duty of care relates to issues such as informed consent.
Publisher: Elsevier BV
Date: 09-2018
Publisher: Oxford University Press
Date: 19-10-2017
DOI: 10.1093/OSO/9780190652951.001.0001
Abstract: As a game-changing technology, robotics naturally will create ripple effects through society. Some of them may become tsunamis. So it’s no surprise that “robot ethics”—the study of these effects on ethics, law, and policy—has caught the attention of governments, industry, and the broader society, especially in the past several years. Since our first book on the subject in 2012, a groundswell of concern has emerged, from the C aign to Stop Killer Robots to the C aign Against Sex Robots. Among other bizarre events, a robot car has killed its driver, and a kamikaze police robot bomb has killed a sniper. Given these new and evolving worries, we now enter the second generation of the debates— robot ethics 2.0 . This edited volume is a one-stop authoritative resource for the latest research in the field, which is often scattered across academic journals, books, media articles, reports, and other channels. Without presuming much familiarity with either robotics or ethics, this book helps to make the discussion more accessible to policymakers and the broader public, as well as academic audiences. Besides featuring new use-cases for robots and their challenges—not just robot cars, but also space robots, AI, and the internet of things (as massively distributed robots)—we also feature one of the most erse group of researchers on the subject for truly global perspectives.
Publisher: BMJ
Date: 19-08-2020
DOI: 10.1136/BMJ.M2836
Abstract: To determine whether risk adapted intraoperative radiotherapy, delivered as a single dose during lumpectomy, can effectively replace postoperative whole breast external beam radiotherapy for early breast cancer. Prospective, open label, randomised controlled clinical trial. 32 centres in 10 countries in the United Kingdom, Europe, Australia, the United States, and Canada. 2298 women aged 45 years and older with invasive ductal carcinoma up to 3.5 cm in size, cN0-N1, eligible for breast conservation and randomised before lumpectomy (1:1 ratio, blocks stratified by centre) to either risk adapted targeted intraoperative radiotherapy (TARGIT-IORT) or external beam radiotherapy (EBRT). Random allocation was to the EBRT arm, which consisted of a standard daily fractionated course (three to six weeks) of whole breast radiotherapy, or the TARGIT-IORT arm. TARGIT-IORT was given immediately after lumpectomy under the same anaesthetic and was the only radiotherapy for most patients (around 80%). TARGIT-IORT was supplemented by EBRT when postoperative histopathology found unsuspected higher risk factors (around 20% of patients). Non-inferiority with a margin of 2.5% for the absolute difference between the five year local recurrence rates of the two arms, and long term survival outcomes. Between 24 March 2000 and 25 June 2012, 1140 patients were randomised to TARGIT-IORT and 1158 to EBRT. TARGIT-IORT was non-inferior to EBRT: the local recurrence risk at five year complete follow-up was 2.11% for TARGIT-IORT compared with 0.95% for EBRT (difference 1.16%, 90% confidence interval 0.32 to 1.99). In the first five years, 13 additional local recurrences were reported (24/1140 v 11/1158) but 14 fewer deaths (42/1140 v 56/1158) for TARGIT-IORT compared with EBRT. With long term follow-up (median 8.6 years, maximum 18.90 years, interquartile range 7.0-10.6) no statistically significant difference was found for local recurrence-free survival (hazard ratio 1.13, 95% confidence interval 0.91 to 1.41, P=0.28), mastectomy-free survival (0.96, 0.78 to 1.19, P=0.74), distant disease-free survival (0.88, 0.69 to 1.12, P=0.30), overall survival (0.82, 0.63 to 1.05, P=0.13), and breast cancer mortality (1.12, 0.78 to 1.60, P=0.54). Mortality from other causes was significantly lower (0.59, 0.40 to 0.86, P=0.005). For patients with early breast cancer who met our trial selection criteria, risk adapted immediate single dose TARGIT-IORT during lumpectomy was an effective alternative to EBRT, with comparable long term efficacy for cancer control and lower non-breast cancer mortality. TARGIT-IORT should be discussed with eligible patients when breast conserving surgery is planned. ISRCTN34086741 , NCT00983684 .
Publisher: Informa UK Limited
Date: 19-02-2015
Publisher: Oxford University Press
Date: 03-2016
Publisher: United States Army War College Press
Date: 03-03-2023
Publisher: Springer International Publishing
Date: 06-09-2014
Publisher: Informa UK Limited
Date: 03-04-2017
Publisher: Springer International Publishing
Date: 29-09-2021
Publisher: Springer Science and Business Media LLC
Date: 19-11-2020
Publisher: Cold Spring Harbor Laboratory
Date: 10-11-2021
DOI: 10.1101/2021.11.08.21265793
Abstract: An important strategy to understand young people’s needs regarding technologies for Type 1 Diabetes Mellitus (T1DM) management is to examine their day-to-day experiences with these technologies. This study aimed to describe T1DM youth and their caregivers’ experiences and preferences regarding insulin pumps, sensor technologies, and related communication technologies based on a hybrid theoretical foundation, as well as to describe derived ideal device characteristics. Sixteen face-to-face interviews were conducted with young people and their parents. Data analysis included data-driven thematic analysis followed by theory-driven analysis (Unified Theory of Acceptance and Use of Technology value sensitive design). Initial themes derived from the interviews included aspects of self-management, device use, technological characteristics, and feelings associated with device types. Interview findings were congruent with factors from the two theories. Discussions around ideal devices focused on reliability, flexibility, and automated closed loop systems that enabled an independent life for young people and alleviated parental anxiety. Reality deviated from expectations, with inaccuracy problems and technical failures reported. Technologies for diabetes self-management require continual advancement to meet the needs of young people with T1DM and their caregivers. Understanding experiences and challenges with devices enabled us to identify theory-supported device characteristics useful for the designing of improved technologies. An important strategy to understand young people’s needs and preferences regarding technologies for Type 1 Diabetes Mellitus (T1DM) management is to examine their day-to-day experiences with these technologies. This study aimed to describe T1DM youth and their caregivers’ experiences and preferences regarding insulin pumps, sensor technologies, and related communication technologies based on a hybrid theoretical foundation, as well as to describe derived ideal device characteristics. Sixteen face-to-face interviews were conducted with young people with T1DM and their parents about their diabetes technology use. A combination of data-driven thematic analysis in a first stage, and theory-driven analysis in a second stage was used to incorporate in-depth study analysis and existing theoretical literature. Relevant literature included technology adoption (Unified Theory of Acceptance and Use of Technology/UTAUT) and value sensitive design (VSD) models. Based on this approach ideal device characteristics for young people with T1DM were summarized. Initial themes derived from the interviews included aspects of diabetes self-management, device use, and specific device-related technological characteristics and feelings associated with the specific device types (continuous glucose monitoring, insulin pump, flash glucose monitoring). The interview data delivered information congruent with all UTAUT and VSD factors except for one (privacy). Discussions around ideal diabetes devices focused on reliability, flexibility, and automated closed loop systems that enabled an independent and normal life for adolescents, and alleviated parental anxiety. However, in line with the previous systematic review, the interview analysis showed that reality deviated from these expectations, with inaccuracy problems reported for continuous glucose monitoring devices, and technical failures occurring in both continuous glucose monitoring devices and insulin pumps. UTAUT and VSD approaches were found useful as a combined foundation for structuring our study findings. Technologies for diabetes self-management require continual advancement to meet the needs and expectations of young people with T1DM and their caregivers. Understanding their experiences, as well as challenges with the devices, enabled us to identify theory-supported ideal device characteristics that can be useful in the designing and developing of improved technologies.
Start Date: 2018
End Date: 2021
Funder: Australian Research Council
View Funded Activity