Non-medical Contexts Research Articles

A lightweight augmented virtuality system for providing a faithful and spatially manipulable visual hand representation.

This paper introduces the technical foundations of a system designed to embed a lightweight, faithful and spatially manipulable representation of the user's hand into an otherwise virtual world - Augmented Virtuality (AV). A highly intuitive control during pointing-like near space interaction can be provided to the user, as well as a very flexible means to experimenters, in a variety of non-medical and medical contexts. Our approach essentially relies on stereoscopic video see-through Augmented Reality (AR) technology and a generic, extendible framework for managing 3-D visual hand displacements. Research from human-computer interaction, perception and motor control has contributed to the elaboration of our proposal which combines a) acting in co-location, b) avoiding occlusion violations by assuring a correct scene depth ordering and c) providing a convincing visual feedback of the user's hand. We further present two cases in which this system has already successfully been used and then outline some other applications that we think are promising, for instance, in the fields of neuromotor rehabilitation and experimental neuroscience.

The Detection of Premalignant Colon Polyps During Colonoscopy Is Stable Throughout the Workweek

Purpose: In numerous medical and non-medical work contexts, a decrease in the quality of task performance has been observed as the workweek progresses, most likely related to worker fatigue. In gastroenterology, studies have suggested that increasing colonoscopist fatigue can lead to decreasing polyp detection (and hence inferior cancer prevention) as the hour of the individual workday progresses. Our aim was to see whether quality variability also occurred day-to-day in colonoscopy practice. Methods: We performed a retrospective chart review of all patients (n=1,131) undergoing ambulatory surveillance or screening colonoscopy during 2009 by two high-volume colonoscopists within a four-person group practice. The endpoints we measured included polyp detection rate (polyps per procedure, number of patients with > one polyp) and bowel preparation quality. Independent variables included the day of the week (Monday through Friday) and the day in the queue (Day 1 through Day 5) on which the procedure occurred. For the queue analysis, we included only colonoscopies (n=1,023) done during weeks in which the physician performed procedures for four or five consecutive workdays. We defined “pre-malignant polyps” (PMPs) as adenomatous polyps (APs) plus sessile serrated polyps (SSPs). Results: A total of 1,010 PMPs were identified during 1,131 procedures (mean PMP/colonoscopy = 0.89; PMP detection rate = 50.5%). PMP detection, as well as the detection of APs alone, SSPs alone, or hyperplastic polyps (HPs) alone did not vary significantly by the day of the workweek (p=0.24, p=0.12, and p=0.85, respectively, Figure 1) or by day in the queue (p=0.08, p=0.81, p=0.19, respectively) on which the colonoscopy was performed. Bowel preparation quality (overall: excellent in 77.8%, good in 8.1%) and procedure duration (mean = 24.3 minutes) were also stable day-to-day. Polyp detection Friday afternoon was comparable to Monday-Thursday afternoons (p=0.99). Polyp detection Monday morning was comparable to polyp detection Tuesday-Friday (p=0.28).Figure: No Caption available.Conclusion: Stable PMP, AP, SSP, and HP detection rates occurred throughout the workweek. This observation requires confirmation in other practice settings. Disclosure: Lawrence Cohen - consultant: Salix.

THE PSYCHOLOGY OF REBELLION: COLONIAL MEDICAL RESPONSES TO DISSENT IN BRITISH EAST AFRICA

This article opens with a retelling of colonial accounts of the ‘mania of 1911’, which took place in the Kamba region of Kenya Colony. The story of this ‘psychic epidemic’ and others like it would be recounted over the years as evidence depicting the predisposition of Africans to episodic mass hysteria. This use of medical and psychological language in primarily non-medical contexts serves to highlight the intellectual and political roles psychiatric ideas played in colonial governance. The salience of such ideas was often apparent in the face of increasing social tension, charismatic leadership and a proliferation of East African prophetic movements. This article addresses the attempts by the colonial authorities to understand or characterize, in psychological terms, a progression of African ‘rebellious types’ in society that often took the form of prophets and visionaries, but were diagnosed as epileptic, neurotic or suffering from ‘religious mania’.

Racial and Ethnic Categories in Biomedical Research: There is No Baby in the Bathwater

The use of racial categories in biomedicine has had a long history in the United States. However, social hierarchy and discrimination, justified by purported scientific differences, has also plagued the history of racial categories. Because "race" has some correlation with biological and genetic characteristics, there has been a call not to "throw the baby out with the bathwater" by eliminating race as a research or clinical category. I argue that race is too undefined and fluid to be useful as a proxy for biology or genetics.

Lay conceptions of the ethical and scientific justifications for random allocation in clinical trials

Randomised controlled trials (RCTs) play a central role in modern medical advance, and they require participants who understand and accept the procedures involved. Published evidence suggests that RCT participants often fail to understand that treatments are allocated at random and that clinicians are in equipoise about which treatment is best. We examine background assumptions that members of the public might draw upon if invited to take part in a RCT. Four studies ( N=82; 67; 67; 128), in the UK, identified whether members of the public (i) accept that an individual clinician might be genuinely unsure which of two treatments was better; (ii) judge that when there is uncertainty it is acceptable to suggest deciding at random; (iii) recognise scientific benefits of random allocation to treatment conditions in a trial. Around half the participants were loathe to accept that a clinician could be completely uncertain, and this was no different whether the context was one of individual treatment or research. Most participants found it unacceptable to suggest allocating treatment at random, though there was weak evidence that a research context may reduce the unacceptability. Participants did not judge that more certain knowledge would be gained about which treatment was best when treatments were allocated at random rather than by patient/doctor choice: scientific benefits of randomisation were apparently not recognised. Judgements were no different in non-medical contexts. Results suggest a large mismatch between the assumptions underlying the trial design, and the assumptions that lay participants can bring to bear when they try to make sense of descriptive information about randomisation and equipoise. Previous attempts to improve understanding by improving the clarity or salience of trial information, or of making explicit the research context, while helpful, may need to be supplemented with accessible explanations for random allocation.

Policy before practice: genetic discrimination reviewed.

The value of genetics in medicine has been steadily developing with our increasing knowledge of the human genome. Genetic testing to determine disease risk or potential drug effects is set to become more commonplace. With this comes increasing concern about access to genetic information, and the potential for discriminatory usage of such information. At present, the scope and predictability of genetic testing and the conclusions that may be drawn fairly from genetic information are limited. Nonetheless, public concerns about discrimination based on the possession of a genetic trait or condition are well documented. The prospect that such information might be used in decisions regarding employment or insurability has caused anxiety and prompted legislation largely dedicated to the use of information about one's genotype rather than medical information in general. These laws emphasize genetic information as distinct from other medical information and attempt to prioritize interests in genetic information. As the distinction between genetic and medical information becomes untenable, those who would regulate the use of genotypic information will find this approach to policy problematic.In considering the limits of legislation as an effective tool of regulating genetic discrimination, several conclusions can be drawn: firstly, despite the promise of genomic medicine, current knowledge is insufficient to justify the use or application of certain genetic information in nonmedical contexts; secondly, public resistance to genomic medicine that is based on fear of genetic discrimination poses a danger that justifies a policy response; and thirdly, such a response may be purely symbolic and not entirely effective, provided that the policy establishes a consensus regarding the applicability of genetic information in nonmedical contexts.

What Does Genetic Technology Have to Do with Ethics?

A number of problematic issues have arisen in anticipation of the potential role of molecular tests for genetic predispositions to illness in risk assessment by insurance underwriters. We argue in this paper that the regrettable history and current risks of genetic discrimination warrant a presumption that genetic predisposition status should not be used in any nonmedical contexts, unless compelling evidence can demonstrate that serious harm will result to third-party interests without such use. We argue that insurers should not be able to initiate testing for genetic predisposition. We also argue that there are many reasons to doubt whether patients’ test results will result in such serious adverse selection as to cause substantial harm to insurance markets, except possibly at higher policy amounts in life or disability income insurance. We conclude that the burden of proof must be on insurers to demonstrate necessity of use in specific cases in which test availability shows high probability of imminent, serious harm to insurance markets.

Pharmacological properties of ketamine

Ketamine is a dissociative anaesthetic that is being used in non-medical contexts. The effects of ketamine are very similar to those of phencyclidine, another dissociative anaesthetic that has enjoyed considerable popularity as a recreational drug. The effects of ketamine include analgesia, cardiovascular and respiratory stimulation, dissociation, hallucinations and anaesthesia. The potential dangers of uncontrolled ketamine use include psychosis and violence, accidents and marked psychomotor and cognitive impairment. Although studies have shown potential for tolerance to and physical dependence on ketamine, further investigation of these phenomena is needed. Ketamine is thought to produce most of its effects through antagonist activity at the PCP site of the NMDA receptor complex. Ketamine has sympathomimetic properties resulting from enhancement of catecholamine, and particularly dopamine, activity. While opioid receptor activity has been identified, this is relatively weak and the contribution to the effects of ketamine is not clear. Although much is known of the clinical uses and effects of ketamine, as yet little is understood of ketamine as a recreational drug and potential drug of dependence.

Patient selection for heart transplantation: when is a discriminating choice discrimination?

Section 504 of the Rehabilitation Act of 1973 prohibits discrimination against the handicapped in any program receiving federal funds. With its implementing regulations, Section 504 may well apply to the selection of patients for medical treatments. This article examines patient selection for heart transplantation, in light of the Rehabilitation Act and its previous application in similar (but non-medical) contexts. With the growing need to allocate scarce medical resources comes a need to examine carefully the legal bounds for patient-selection procedures.