Tech-Wise:ethical deliberation about the impact of technology through practical working methods

In deze publicatie beschrijven we de aanpak ‘Wijs met techniek’ die is ontwikkeld voor docenten in het mbo-, hbo- en wo-onderwijs. De aanpak bevat werkvormen voor toepassing in een les of werksessie om studenten te helpen ethisch na te denken over de impact van techniek.In het eerste deel vind je informatie over de impact en ethiek van techniek.In het tweede deel vind je de volgende praktische werkvormen die de theorie over ethiek en techniek in kleine stukjes toegankelijk en toepasbaar maken:• Ethical Readiness Check• Ethische stakeholder-dialoog• Product Impact Tool• Tegeltje Wijs met techniekPer werkvorm lees je hoe ethische reflectie helpt om tot een rijker ontwerp te komen. We lichten dit toe aan de hand van voorbeelden uit de praktijk: ethische reflectie en ideeën van studenten en anderen rondom de casus van elektrische deelscooters

Comparison of Parametric Survival Extrapolation Approaches Incorporating General Population Mortality for Adequate Health Technology Assessment of New Oncology Drugs

Objectives: Survival extrapolation of trial outcomes is required for health economic evaluation. Generally, all-cause mortality (ACM) is modeled using standard parametric distributions, often without distinguishing disease-specific/excess mortality and general population background mortality (GPM). Recent National Institute for Health and Care Excellence guidance (Technical Support Document 21) recommends adding GPM hazards to disease-specific/excess mortality hazards in the log-likelihood function ("internal additive hazards"). This article compares alternative extrapolation approaches with and without GPM adjustment. Methods: Survival extrapolations using the internal additive hazards approach (1) are compared to no GPM adjustment (2), applying GPM hazards once ACM hazards drop below GPM hazards (3), adding GPM hazards to ACM hazards (4), and pro-portional hazards for ACM versus GPM hazards (5). The fit, face validity, mean predicted life-years, and corresponding uncertainty measures are assessed for the active versus control arms of immature and mature (30-and 75-month follow-up) multiple myeloma data and mature (64-month follow-up) breast cancer data. Results: The 5 approaches yielded considerably different outcomes. Incremental mean predicted life-years vary most in the immature multiple myeloma data set. The lognormal distribution (best statistical fit for approaches 1-4) produces survival increments of 3.5 (95% credible interval: 1.4-5.3), 8.5 (3.1-13.0), 3.5 (1.3-5.4), 2.9 (1.1-4.5), and 1.6 (0.4-2.8) years for approaches 1 to 5, respectively. Approach 1 had the highest face validity for all data sets. Uncertainty over parametric distributions was comparable for GPM-adjusted approaches 1, 3, and 4, and much larger for approach 2. Conclusion: This study highlights the importance of GPM adjustment, and particularly of incorporating GPM hazards in the log-likelihood function of standard parametric distributions

Wijs met techniek: Met praktische werkvormen ethisch reflecteren over de impact van techniek

In deze publicatie beschrijven we de aanpak ‘Wijs met techniek’ die is ontwikkeld voor docenten in het mbo-, hbo- en wo-onderwijs. De aanpak bevat werkvormen voor toepassing in een les of werksessie om studenten te helpen ethisch na te denken over de impact van techniek. In het eerste deel vind je informatie over de impact en ethiek van techniek. In het tweede deel vind je de volgende praktische werkvormen die de theorie over ethiek en techniek in kleine stukjes toegankelijk en toepasbaar maken: • Ethical Readiness Check • Ethische stakeholder-dialoog • Product Impact Tool • Tegeltje Wijs met techniek Per werkvorm lees je hoe ethische reflectie helpt om tot een rijker ontwerp te komen. We lichten dit toe aan de hand van voorbeelden uit de praktijk: ethische reflectie en ideeën van studenten en anderen rondom de casus van elektrische deelscooters

Ethics, design, and creativity: A fruitful combination

In the context of the designers responsibility for the impact of technology, ethical considerations are important. However, these considerations are often seen as limiting innovation and the freedom of the designer. Is it possible, on the contrary, that ethics can also foster creativity in design? The research project Tech-Wise is about a practice oriented approach in ethics; developing tools to engage people with ethical deliberation on the impact of technology. One result of the project is a workshop format for stimulating ethical deliberation that can be tailored to particular technologies and design disciplines. We argue from the results of one particular instance of this workshop format that such an approach to ethics has a fruitful reciprocal effect. It can stimulate creativity in design by enriching the question about the purpose of an innovation, and the other way around enrich ethical reasoning by opening up to often surprising impacts of technologies

Glucose intolerance and the amount of visceral adipose tissue contribute to an increase in circulating triglyceride concentrations in Caucasian obese females.

CONTEXT: Lipotoxicity is a risk factor for developing obesity-related metabolic complications, including non-alcoholic fatty liver disease, type 2 diabetes (DM2), cardiovascular disease and stroke. Yet, the mechanisms underlying the development of lipotoxicity itself remain poorly understood. Here, we investigated whether glucose intolerance aggravates lipotoxicity by evaluating the association between triglyceride (TG) concentrations and glucose tolerance status in a cross-sectional study on obese Caucasian women at risk for DM2. METHODS: 913 obese females unknown to have diabetes were recruited (mean age: 41.2 ± SD 12.3; median BMI: 36.2, IQR 32.9-40.2). Visceral (VAT) and subcutaneous abdominal adipose tissue volumes were quantified with computed tomography. Glucose, insulin, and triglyceride concentrations were determined in fasting state and following a 75 gram oral glucose tolerance test. RESULTS: Based on fasting and 2 h post-load glucose levels, 27% of the women had impaired glucose tolerance (IGT), and 8% had newly diagnosed DM2. Fasting TG concentrations were similar between the IGT- and DM2-groups, and increased as compared to women with normal glucose tolerance (NGT). Even when adjusting for age, hip circumference and VAT, fasting TG concentrations remained elevated as compared to NGT. Mixed modelling analysis of post-load responses showed that TG concentrations declined more slowly in the DM2-group as compared to IGT and NGT. However, when adjusting for VAT the difference in decline between the glucose tolerance groups disappeared. CONCLUSIONS: Glucose intolerance associates with elevated fasting TG concentrations in obese Caucasian women. We propose that glucose intolerance and increased VAT reduce lipid disposal mechanisms and may accelerate lipotoxicity