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Search Results: 1 - 10 of 32505 matches for " John Schermer "
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The Dynamics of the Treatment-enhancement Distinction: ADHD as a Case Study
Maartje Schermer
Philosophica , 2007,
Abstract: A central issue in the ethical debate on psychopharmacological enhancers concerns the distinction between therapy and enhancement. Although from a theoretical point of view it is difficult to make a clear-cut distinction between treatment (of disease) on the one hand, and enhancement (of normal functioning) on the other, in medical practice and policy debates the counter-positioning of therapy to enhancement is clearly at work. Especially pharmaceutical companies have an interest in occupying the "grey" area between normal and abnormal, treatment and enhancement. This article discusses the dynamics of the treatment-enhancement distinction, and argues that practices that could be labelled "enhancement" can also be understood in terms of medicalisation and "disease mongering". The argument is supported by results from a qualitative empirical study into the experiences and opinions of adults diagnosed with Attention Deficit Hyperactivity Disorder (ADHD). Patients are ambivalent about how to understand ADHD: as a disease, a disorder or a normal variation. Intervention with psychopharmacological means can also be understood in different ways. From an insider perspective it is conceived of as a "normalising" of functioning, whereas from an outsider perspective it can be understood as medicalisation of underperformance, or indeed as performance enhancement. This draws attention to new moral issues which are important but under-recognised in the enhancement debate, and which are related to medicalisation.
Surveillance and Privacy in the Ubiquitous Network Society
Bart Schermer
Amsterdam Law Forum , 2009,
Abstract: Developments in IT will bring us closer to a a€ Ubiquitous Network Societya€ . Ubiquitous networking will become a part of our physical world, linking locations, objects and people. This new technological reality will fundamentally alter our notions of privacy, autonomy and public domain. In this article Bart Schermer describes how developments in IT will enable new surveillance applications; what possible risks these new surveillance applications entail; how the notion of privacy will be influenced by these technologies; and how we can protect ourselves in the future. The author argues that the transformation of the public domain as a result of surveillance will ultimately render the idea of privacy as a a€ physical realitya€ obsolete. Therefore, we need new mechanisms that help ensure privacy and personal autonomy. In these mechanisms notions of trust and transparency should feature more prominently than they do now.
Ethical Issues in Deep Brain Stimulation
Maartje Schermer
Frontiers in Integrative Neuroscience , 2011, DOI: 10.3389/fnint.2011.00017
Abstract: Deep brain stimulation (DBS) is currently used to treat neurological disorders like Parkinson’s disease, essential tremor, and dystonia, and is explored as an experimental treatment for psychiatric disorders like major depression and obsessive compulsive disorder. This mini review discusses ethical issues in DBS treatment and research, as they have been discussed in the medical and ethical literature. With regard to DBS treatment, the most important issues are balancing risks and benefits and ensuring respect for the autonomous wish of the patient. This implies special attention to patient selection, psycho-social impact of treatment, effects on personal identity, and treatment of children. Moreover, it implies a careful informed consent process in which unrealistic expectations of patients and their families are addressed and in which special attention is given to competence. In the context of research, the fundamental ethical challenge is to promote high-quality scientific research in the interest of future patients, while at the same time safeguarding the rights and interests of vulnerable research subjects. Several guidelines have been proposed to ensure this. One of the preconditions to further development of responsible and transparent research practices is the establishment of a comprehensive registry.
Broadband and omnidirectional anti-reflection layer for III/V multi-junction solar cells
Silke L. Diedenhofen,Grzegorz Grzela,Erik Haverkamp,Gerard Bauhuis,John Schermer,Jaime Gómez Rivas
Physics , 2012, DOI: 10.1016/j.solmat.2012.02.022
Abstract: We report a novel graded refractive index antireflection coating for III/V quadruple solar cells based on bottom-up grown tapered GaP nanowires. We have calculated the photocurrent density of an InGaP-GaAs-InGaAsP-InGaAs solar cell with a MgF2/ZnS double layer antireflection coating and with a graded refractive index coating. The photocurrent density can be increased by 5.9 % when the solar cell is coated with a graded refractive index layer with a thickness of 1\mu m. We propose to realize such a graded refractive index layer by growing tapered GaP nanowires on III/V solar cells. For a first demonstration of the feasibility of the growth of tapered nanowires on III/V solar cells, we have grown tapered GaP nanowires on AlInP/GaAs substrates. We show experimentally that the reflection from the nanowire coated substrate is reduced and that the transmission into the substrate is increased for a broad spectral and angular range.
Photo-generated THz antennas: All-optical control of plasmonic materials
Giorgos Georgiou,Hemant K. Tyagi,Peter Mulder,Gerard J. Bauhuis,John J. Schermer,Jaime Gómez Rivas
Physics , 2013,
Abstract: Localized surface plasmon polaritons in conducting structures give rise to enhancements of electromagnetic local fields and extinction efficiencies. Resonant conducting structures are conventionally fabricated with a fixed geometry that determines their plasmonic response. Here, we challenge this conventional approach by demonstrating the photo-generation of plasmonic materials (THz plasmonic antennas) on a flat semiconductor layer by the structured optical illumination through a spatial light modulator. Free charge carriers are photo-excited only on selected areas, which enables the definition of different plasmonic antennas on the same sample by simply changing the illumination pattern, thus without the need of physically structuring the sample. These results open a wide range of possibilities for an all-optical spatial and temporal control of resonances on plasmonic surfaces and the concomitant control of THz extinction and local field enhancements.
The role of disease characteristics in the ethical debate on personal genome testing
Eline M Bunnik, Maartje HN Schermer, A Cecile JW Janssens
BMC Medical Genomics , 2012, DOI: 10.1186/1755-8794-5-4
Abstract: In this paper, we identify and discuss four disease characteristics - severity, actionability, age of onset, and the somatic/psychiatric nature of disease - and show how these lead to specific ethical issues. By way of illustration, we apply this framework to genetic susceptibility testing for three diseases: type 2 diabetes, age-related macular degeneration and clinical depression. For these three diseases, we point out the ethical issues that are relevant to the question whether it is morally justifiable to offer genetic susceptibility testing to adults or to children or minors, and on what conditions.We conclude that the ethical evaluation of personal genome tests is challenging, for the ethical issues differ with the diseases tested for. An understanding of the ethical significance of disease characteristics will improve the ethical, legal and societal debate on personal genome testing.A growing number of personal genome testing services are presently available that estimate genetic susceptibility to multifactorial diseases [1]. Unlike genetic tests for monogenic diseases, susceptibility tests for multifactorial diseases can be obtained almost exclusively on the direct-to-consumer market. Personal genome tests are non-targeted: they determine a person's risk for a multitude of multifactorial diseases simultaneously [2-5], including cardiovascular disease, Alzheimer's disease, osteoporosis, type 2 diabetes, schizophrenia, and many types of cancer. One of the leading personal genome testing companies is currently estimating personal risks for over two hundred diseases and other phenotypic traits in one single test [2]. The large quantity of test results will have limited clinical significance for and varying emotional impact on consumers, which are in part connected with differences between the diseases tested for.Differences between diseases may have important implications for the ethical, legal and societal debate on genetic susceptibility testing for multifacto
Personal genome testing: Test characteristics to clarify the discourse on ethical, legal and societal issues
Eline M Bunnik, Maartje HN Schermer, A Cecile JW Janssens
BMC Medical Ethics , 2011, DOI: 10.1186/1472-6939-12-11
Abstract: This paper addresses four test characteristics of personal genome testing: its being a non-targeted type of testing, its high analytical validity, low clinical validity and problematic clinical utility. These characteristics raise their own specific ELSI, for example: non-targeted genetic profiling poses serious problems for information provision and informed consent. Questions about the quantity and quality of the necessary information, as well as about moral responsibilities with regard to the provision of information are therefore becoming central themes within ELSI-discussions of personal genome testing. Further, the current low level of clinical validity of genetic profiles raises questions concerning societal risks and regulatory requirements, whereas simultaneously it causes traditional ELSI-issues of clinical genetics, such as psychological and health risks, discrimination, and stigmatization, to lose part of their relevance. Also, classic notions of clinical utility are challenged by the newer notion of 'personal utility.'Consideration of test characteristics is essential to any valuable discourse on the ELSI of personal genome testing for multifactorial diseases. Four key characteristics of the test - targeted/non-targeted testing, analytical validity, clinical validity and clinical utility - together determine the applicability and the relevance of ELSI to specific tests. The paper identifies and discusses four areas of interest for the ELSI-debate on personal genome testing: informational problems, risks, regulatory issues, and the notion of personal utility.In discussions on ethical, legal and societal issues (ELSI) surrounding genetic testing, there is no longer any single satisfying definition of what constitutes 'a genetic test'. Practices of genetic testing are becoming more and more heterogeneous, not only with regard to the setting and purpose of testing, but also with regard to the technical aspects of the tests themselves. Some of these technica
Prevalence and incidence density rates of chronic comorbidity in type 2 diabetes patients: an exploratory cohort study
Luijks Hilde,Schermer Tjard,Bor Hans,van Weel Chris
BMC Medicine , 2012, DOI: 10.1186/1741-7015-10-128
Abstract: Background Evidence-based diabetes guidelines generally neglect comorbidity, which may interfere with diabetes management. The prevalence of comorbidity described in patients with type 2 diabetes (T2D) shows a wide range depending on the population selected and the comorbid diseases studied. This exploratory study aimed to establish comorbidity rates in an unselected primary-care population of patients with T2D. Methods This was a cohort study of 714 adult patients with newly diagnosed T2D within the study period (1985-2007) in a practice-based research network in the Netherlands. The main outcome measures were prevalence and incidence density rates of chronic comorbid diseases and disease clusters. All chronic disease episodes registered in the practice-based research network were considered as comorbidities. We categorised comorbidity into 'concordant' (that is, shared aetiology, risk factors, and management plans with diabetes) and 'discordant' comorbidity. Prevalence and incidence density were assessed for both categories of comorbidity. Results The mean observation period was 17.3 years. At the time of diabetes diagnosis, 84.6% of the patients had one or more chronic comorbid disease of 'any type', 70.6% had one or more discordant comorbid disease, and 48.6% and 27.2% had three or more chronic comorbid diseases of 'any type' or of 'discordant only', respectively. A quarter of those without any comorbid disease at the time of their diabetes diagnosis developed at least one comorbid disease in the first year afterwards. Cardiovascular diseases (considered concordant comorbidity) were the most common, but there were also high rates of musculoskeletal and mental disease. Discordant comorbid diseases outnumbered concordant diseases. Conclusions We found high prevalence and incidence density rates for both concordant and discordant comorbidity. The latter may interfere with diabetes management, thus future research and clinical practice should take discordant comorbidity in patients with T2D into account.
PELICAN: A quality of life instrument for childhood asthma: Study Protocol of two Randomized Controlled Trials in Primary and Specialized Care in the Netherlands
Stephanie van Bragt, Lisette van den Bemt, Bart Thoonen, Chris van Weel, Peter Merkus, Tjard Schermer
BMC Pediatrics , 2012, DOI: 10.1186/1471-2431-12-137
Abstract: This study consists of two randomized controlled trials to assess the effectiveness of the Pelican intervention in primary and specialized care. The trial in primary care is a multilevel design with 170 children with asthma in 16 general practices. All children in one general practices are allocated to the same treatment group. The trial in specialized care is a multicentre trial with 100 children with asthma. Children in one outpatient clinic are randomly allocated to the intervention or usual care group. In both trials, children will visit the care provider four times during a follow-up of nine months. This study is registered and ethically approved.This article describes the study protocol of the Pelican study in different health care settings. If the Pelican intervention proves to be effective and efficient, implementation in primary and specialized care for paediatric asthma in the Netherlands will be recommended.This study is registered by clinicaltrial.gov (NCT01109745)Asthma [1] is the most common chronic disease in childhood in the Netherlands. Its prevalence ranges from 3% in children aged 5–9?years to 3.7% in children aged 10–14?years [2,3]. Although the prevalence is leveling off [4], asthma remains a significant burden for the child, family and the society at large [5]. In the Netherlands, children with intermittent and mild asthma are usually treated by a family physician, while patients with more severe or uncontrolled asthma are treated by specialized paediatric care [6]. This implies that children with asthma treated in primary and specialized care may differ in features like disease severity and complexity, level of symptom control, functional status and co-morbidity [7]. Recent reports point to substantial room for improvement in the management of childhood asthma [8-11]. Poor adherence to therapy and inadequately treatment are two important reasons why asthma is uncontrolled [9]. Poor adherence has been associated with discrepancies between the p
Diagnostic accuracy of spirometry in primary care
Antonius Schneider, Lena Gindner, Lisa Tilemann, Tjard Schermer, Geert-Jan Dinant, Franz Meyer, Joachim Szecsenyi
BMC Pulmonary Medicine , 2009, DOI: 10.1186/1471-2466-9-31
Abstract: Cross sectional diagnostic study of 219 adult patients attending 10 general practices for the first time with complaints suspicious for OAD. All patients underwent spirometry and structured medical histories were documented. All patients received whole-body plethysmography (WBP) in a lung function laboratory. The reference standard was the Tiffeneau ratio (FEV1/VC) received by the spirometric maneuver during examination with WBP. In the event of inconclusive results, bronchial provocation was performed to determine bronchial hyper-responsiveness (BHR). Asthma was defined as a PC20 fall after inhaling methacholine concentration ≤ 16 mg/ml.90 (41.1%) patients suffered from asthma, 50 (22.8%) suffered from COPD, 79 (36.1%) had no OAD. The sensitivity for diagnosing airway obstruction in COPD was 92% (95%CI 80–97); specificity was 84% (95%CI 77–89). The positive predictive value (PPV) was 63% (95%CI 51–73); negative predictive value (NPV) was 97% (95%CI 93–99). The sensitivity for diagnosing airway obstruction in asthma was 29% (95%CI 21–39); specificity was 90% (95%CI 81–95). PPV was 77% (95%CI 60–88); NPV was 53% (95%CI 45–61).COPD can be estimated with high diagnostic accuracy using spirometry. It is also possible to rule in asthma with spirometry. However, asthma can not be ruled out only using spirometry. This diagnostic uncertainty leads to an overestimation of asthma presence. Patients with inconclusive spirometric results should be referred for nitric oxide (NO) – measurement and/or bronchial provocation if possible to guarantee accurate diagnosis.Asthma is a common chronic disease with a high prevalence of approx. 5% in industrialized nations. It is characterized by a chronic inflammation process which induces bronchial hyper-responsiveness and in most cases, reversible airway obstruction [1]. Another common pulmonary disease is chronic obstructive pulmonary disease (COPD) which shows irreversible airway obstruction, and which is mostly caused by inhaling tobac
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