Medicine and Literature

Background: Virtual reality (VR) has been previously shown as a means to mitigate acute pain. The critical parameters involved in the clinical efficacy of mitigating acute pain from different perspectives remains unknown. This study attempted to further deconstruct the critical parameters involved in mitigating acute pain by investigating whether affective and physiological responses to painful stimuli differed between a first and a third person perspective in virtual reality.Methods: Two conditions were compared in a repeated-measures within subject study design for 17 healthy participants: First person perspective (i.e., where participants experienced their bodies from an anatomical and egocentric perspective) and third person perspective (i.e., where participants experienced their bodies from an anatomical perspective from across the room). The participants received noxious electrical stimulation at pseudorandom intervals and anatomical locations during both conditions. Physiological stress responses were measured by means of electrocardiography (ECG) and impedance cardiography (ICG). Subjective scores measuring tension, pain, anger, and fear were reported after every block sequence.Results: There were no significant differences in physiological stress responses between conditions. However, the participants reported significantly higher tension during the third person condition.Conclusion: Relative to a third person perspective, there are no distinct physiological benefits to inducing a first person perspective to mitigate physiological stress responses to acute pain in healthy individuals. However, there may be additional clinical benefits for doing so in specific clinical populations that have shown to benefit from relaxation techniques. Further research is needed in order to refine the clinical utility of different perspectives during virtual reality immersions that serve to act as a non-pharmacological analgesic during acute pain.

P285 Communicating Needs and Features of IBD Experiences (CONFIDE) Survey: European and US Patient and Health Care Professional Perspectives on the Broad Impact of Bowel Urgency in Ulcerative colitis

This article focuses on patients' participation in decision-making in meetings with healthcare professionals in a healthcare system, based on neoliberal regulations and ideas. Drawing on two constructed empirical cases, primarily from the perspective of patients, this article analyses and discusses the clinical practice around decision-making meetings within a Foucauldian perspective. Patients' participation in decision-making can be seen as an offshoot of respect for patient autonomy. A treatment must be chosen, when patients consult physicians. From the perspective of patients, there is a tendency for healthcare professionals to supply the patients with the information that they think are necessary for them to make their own decision. But patients do not always want to be a 'customer' in the healthcare system; they want to be a patient, consulting an expert for help and advice, which creates resistance to some parts of the decision-making process. Both professionals and patients are subject to the structural frame of the medical field, formed of both neoliberal framework and medical logic. The decision-making competence in relation to the choice of treatment is placed away from the professionals and seen as belonging to the patient. A 'projectification' of the patient occurs, whereby the patient becomes responsible for his/her choices in treatment and care and the professionals support him/her with knowledge, preferences, and alternative views, out of which he/she must make his/her own choices, and the responsibility for those choices now and in the future. At the same time, there is a tendency towards de-professionalization. In that light, participation of patients in decision-making can be regarded as a tacit governmentality strategy that shapes the location of responsibility between individual and society, and independent patients and healthcare professionals, despite the basically desirable, appropriate, and necessary idea of involving patients in their own situations from a humanistic perspective.

SummaryA lack of national guidelines in some countries and lack ofconsensus amongst those that do exist in others is problematic.Specifically, poor and inconsistent advice on initiating and opti-mising therapeutic interventions is a barrier to improving out-comes. While European guidelines can help to fill the gap incountries without national guidelines, their role should primar-ily be to strengthen and harmonise existing guidelines, and toprovide a framework for the development of new nationalguidelines. They therefore need to lead the provision of advicethat is not given in existing guidelines. Limited awareness ofguidelines and increasing pressures on patient consultation can Figure 5 The concept of cumulative life course impairment(CLCI) in psoriasis. 22 CLCI results from an interaction betweenthe burden of stigmatisation, physical and psychological co-mor-bidities; and coping strategies and external factors. Significantimpairment may occur in patients with ineffective coping strate-gies and limited social support, even if they have a small burden.This impairment may be less in patients with effective copingstrategies and strong social support networks, even if the bur-den is large. (Figure adapted from Kimball 2010.)

BackgroundThere appears to be an inconsistency in experimental paradigms used in fMRI research on moral judgments. As stimuli, moral dilemmas or moral statements/ pictures that induce emotional reactions are usually employed; a main difference between these stimuli is the perspective of the participants reflecting first-person (moral dilemmas) or third-person perspective (moral reactions). The present study employed functional magnetic resonance imaging (fMRI) in order to investigate the neural correlates of moral judgments in either first- or third-person perspective.ResultsOur results indicate that different neural mechanisms appear to be involved in these perspectives. Although conjunction analysis revealed common activation in the anterior medial prefrontal cortex, third person-perspective elicited unique activations in hippocampus and visual cortex. The common activation can be explained by the role the anterior medial prefrontal cortex may play in integrating different information types and also by its involvement in theory of mind. Our results also indicate that the so-called "actor-observer bias" affects moral evaluation in the third-person perspective, possibly due to the involvement of the hippocampus. We suggest two possible ways in which the hippocampus may support the process of moral judgment: by the engagement of episodic memory and its role in understanding the behaviors and emotions of others.ConclusionWe posit that these findings demonstrate that first or third person perspectives in moral cognition involve distinct neural processes, that are important to different aspects of moral judgments. These results are important to a deepened understanding of neural correlates of moral cognition—the so-called “first tradition” of neuroethics, with the caveat that any results must be interpreted and employed with prudence, so as to heed neuroethics “second tradition” that sustains the pragmatic evaluation of outcomes, capabilities and limitations of neuroscientific techniques and technologies.

Disruption on right temporoparietal junction with transcranial magnetic stimulation affects moral judgment: No difference between first- and third-personal narration with TMS

Exploring Tobacco Use and Smoking Cessation Best Practices From the Perspectives of Individuals With Lung Cancer and Health Care Professionals

Comprehensive user evaluations of outdoor augmented reality (AR) applications in the architecture, engineering, construction and facilities management (AEC/FM) industry are rarely reported in the literature. This paper presents an AR prototype system for infrared thermographic façade inspection and its evaluation. The system employs markerless tracking based on image registration using natural features and a third person perspective (TPP) augmented view displayed on a hand-held smart device. We focus on evaluating the system in user experiments with the task of designating positions of heat spots on an actual façade as if acquired through thermographic inspection. User and system performance were both assessed with respect to target designation errors. The main findings of this study show that positioning accuracy using this system is adequate for objects of the size of one decimeter. After ruling out the system inherent errors, which mainly stem from our application-specific image registration procedure, we find that errors due to a human’s limited visual-motoric and cognitive performance, which have a more general implication for using TPP AR for target designation, are only a few centimeters.

IntroductionPersonal perspective on an event and its extension in time are two key factors in social interactions. Both impact the evaluation of an event and the intensity of different interpersonal exchanges - the goods exchange, money transaction or harmonization of political plans. Fruitful social transactions would be impossible if human mind could not produce both: first- and third-person perspectives on one and the same object or relation. Distinguishing between personal perspective and perspective taken by of others is fundamental for social communication (Decety & Sommerville, 2003). One's own goals and attitudes are expressed from the first person perspective (1PP), while the goals and attitudes of others are presented as the third-person perspective (3PP). So, for a moment an individual human mind should be able to identify itself with others. This ability helps to plan one's own behavior and contributes to a more optimal communicative action. A number of the social interactions extend over time, e.g., money depositing, securing future income or planning of future family life. Economic transactions like investing in the stock market and planning a corporate investment are also realized in time dimension and depend on cognitive representation of time flow. As shown in the studies by Loewenstein (1988) there are different ways to frame a decision in time dimension, thus, the properties of time dimension of human experience may have an impact on such actions. Therefore, we examined the variation of subjective acceptability of one and the same monetary saving proposition depending on a) the personal perspective (1PP vs. 3PP) and b) on the representation of proposition in time. So, an impact of the firstand the third-person perspectives on monetary proposition and its variation over time are of interest in this study.Cognitive Representations of Time Flow: Situational and Propositional TimeIn cognitive sciences time flow is conventionally conceptualized as linear, homogeneous and equal for all objects. But one can raise the question: is a subject served well just by one cognitive representation of time flow? Must the time flow be represented in the mind exclusively as a singular temporal process? The indications of the mind's ability to develop few cognitive representations of time flow can be found in an implicit form in the studies by Chen (2013) and Read et al. (2005). Chen (2013) has shown that languages differ widely in the ways they encode time. He has proved the hypothesis that those languages that grammatically associate the future and the present, foster futureoriented behavior. According to Chen (2013), the speakers of such languages: 'save more, retire with more wealth, smoke less, practice safer sex, and are less obese'. This finding holds both across countries and within countries when comparing demographically similar native households. Read et al. (2005) have shown that one and the same future proposition but once marked by the calendar date and the other time as time delay induce different preferences. In conclusion they state: the description of a temporal interval affects discounting of proposition. But describing this paradox they avoid an explicit assumption about the minds ability to produce more than one representation of time flow.Based on Freyd's (1987) assumption about the temporal dimension of a mental representation, a temporal variable was introduced into a topical account paradigm (Polunin, 2009). By varying it, a number of temporal processes were distinguished: past openness, aging in the past and future time mode, and zero probability barrier in the future time mode (Polunin, 2009, 2011). Each of them has specific properties and, therefore, is as a separate temporal process to consider. A temporal process is defined as a change of an object-representation over time in one qualitative domain, e.g., its subjective attractiveness. Such change reflects a specific development of object over time but without change of its identity. …

Presence experienced in smartphone-based exposure: First and third person perspectives

ObjectivesLimited health literacy (LHL) is associated with faster kidney deterioration. Health care professionals (HCPs) promote self-management to maintain kidney function, which is difficult for patients with LHL. Evidence lacks on perceived barriers and best strategies to optimize their self-management. Our study aims to explore experiences with and barriers for self-management from the perspectives of LHL patients and HCPs to identify strategies to optimize self-management. MethodsWe performed a longitudinal qualitative study with semi-structured in-depth interviews and focus group discussions among CKD patients and LHL (n = 24) and HCPs (n = 37) from general practices and hospitals. ResultsFour themes arose among patients: (1) CKD elusiveness, (2) suboptimal intake of knowledge (3) not taking a front-seat role, and (4) maintaining change. Among HCPs, three themes emerged: (1) not recognizing HL problems, (2) lacking effective strategies, and (3) health care barriers. ConclusionWe suggest three routes to optimize self-management: providing earlier information, applying person-centered strategies to maintain changes, and improving competencies of HCPs. Practice implicationsHCPs need to explain CKD self-management better to prevent kidney deterioration. New interventions, based on behavioral approaches, are needed to optimize self-management. HCPs need training to improve recognition and support of LHL patients.

Objectives:Medical ethics practice and the attitude and knowledge toward it was our concern and aim to investigate.Methods:A cross-sectional study was conducted on 1943 healthcare practitioners from three tertiary care hospitals. A questionnaire requesting demographic data and items related to the level of knowledge and awareness beside the real-life practice of medical ethics among healthcare providers was used. A score was given for each response and a total score was calculated.Results:Of the participants, 86.9% had studied medical ethics, 70.3% thought patients should know about their rights, 87.4% supported that the patient have the right to know and be informed if any malpractice happened, 61.8% never engaged in healthcare-related act on a patient without informed consent, 73% ensured that no one was present other than medical team during assessments or procedures, and 86.6% tried to give only what was necessary to the patient regarding their situation. Nursing specialists/technicians, with of 20-<30 years of practice and participants who had previous training in bioethics had significantly higher mean attitude scores than others. Females, laboratory specialists/technicians, and those who reported previous study of medical ethics had a significantly higher practice scores. A cogent positive correlation was found between the practice and attitude scores.Conclusion:Interduce medical ethics and insist on its importance in medical institutions will positively affect practitioners' knowledge, attitude, and practice.

This paper analyzes the collaboration between healthcare professionals and algorithms in making decisions within the realm of public healthcare. By extending the concept of ‘tinkering’ from previous research conducted by philosopher Mol (Care in practice. On tinkering in clinics, homes and farms Verlag, Amsterdam, 2010) and anthropologist Pols (Health Care Anal 18: 374–388, 2009), who highlighted the improvisational and adaptive practices of healthcare professionals, this paper reveals that in the context of digitalizing healthcare, both professionals and algorithms engage in what I call ‘collaborative tinkering’ as they navigate the intricate and unpredictable nature of healthcare situations together. The paper draws upon an idea that is increasingly common in academic literature, namely that healthcare professionals and the algorithms they use can form a hybrid decision-making entity, challenging the conventional notion of agency and intelligence as being exclusively confined to individual humans or machines. Drawing upon an international, ethnographic study conducted in different hospitals around the world, the paper describes empirically how humans and algorithms come to decisions together, making explicit how, in the practice of daily work, agency and intelligence are distributed among a range of actors, including humans, technologies, knowledge resources, and the spaces where they interact. The concept of collaborative tinkering helps to make explicit how both healthcare professionals and algorithms engage in adaptive improvisation. This exploration not only enriches the understanding of collaborative dynamics between humans and AI but also problematizes the individualistic conception of AI that still exists in regulatory frameworks. By introducing empirical specificity through ethnographic insights and employing an anthropological perspective, the paper calls for a critical reassessment of current ethical and policy frameworks governing human–AI collaboration in healthcare, thereby illuminating direct implications for the future of AI ethics in medical practice.

Stigma towards individuals with schizophrenia reduces quality of life, creating a barrier to accessing education and employment opportunities. Schizophrenia is one of the most stigmatized mental health conditions, and stigma is prevalent particularly among healthcare professionals. In this study, we investigated whether Virtual Reality (VR) can be incorporated into interventions to reduce stigma. In particular, we compared the effectiveness of three VR conditions based on intergroup contact theory in reducing stigma in form of implicit and explicit attitudes, and behavioral intentions. Through an immersive virtual consultation in a clinical setting, participants (N=60) experienced one of three different conditions: the Doctor's perspective (embodiment in a majority group member during contact), the Patient's perspective (embodiment in a minority group member) and a Third-person perspective (vicarious contact). Results demonstrated an increase of stigma on certain explicit measures (perceived recovery and social restriction) but also an increase of empathy (perspective-taking, empathic concern) across all conditions regardless of perspective. More importantly, participants' viewpoint influenced the desire for social distance differently depending on the perspective: the Third-person observation significantly increased the desire for social distance, Doctor embodiment marginally decreased it, while Patient embodiment showed no significant change. No change was found in the Implicit Association Test. These findings suggest that VR intergroup contact can effectively reduce certain dimensions of stigma toward schizophrenia, but the type of perspective experienced significantly impacts outcomes.

Studies in children with Typical Development (TD) and with Autism Spectrum Disorder (ASD) revealed that autism affects the personal space regulation, influencing both its size (permeability) and its changes depending on social interaction (flexibility). Here, we investigate how the nature of social interaction (Cooperative vs. Uncooperative) and the person perspective influence permeability and flexibility of interpersonal distance. Moreover, we tested whether the deficit observed in ASD children, reflects the social impairment (SI) in daily interactions. The stop-distance paradigm was used to measure the preferred distance between the participant and an unfamiliar adult (first-person perspective, Experiment 1), and between two other people (third-person perspective, Experiment 2). Interpersonal distance was measured before and after the interaction with a confederate. The Wing Subgroups Questionnaire was used to evaluate SI in everyday activities, and each ASD participant was accordingly assigned either to the lower (children with low social impairment [low-SI ASD]), or to the higher SI group (children with high social impairment [high-SI ASD]). We observed larger interpersonal distance (permeability) in both ASD groups compared to TD children. Moreover, depending on the nature of social interaction, a modulation of interpersonal distance (flexibility) was observed in TD children, both from the first- and third-person perspective. Similar findings were found in low-SI but not in high-SI ASD children, in Experiment 1. Conversely, in Experiment 2, no change was observed in both ASD groups. These findings reveal that SI severity and a person's perspective may account for the deficit observed in autism when flexibility, but not permeability, of personal space is considered. Autism Res 2017, 10: 144-154. © 2016 International Society for Autism Research, Wiley Periodicals, Inc.