Advance directives as autonomy enhancers: reality or myth?

In the last few decades there has been a wealth of literature and legislation on advance directives. As you all know, it is an instrument by which a person can express their wishes as regards what treatmentthey should be given or, more to the point, not to be given, when he is in a situation when he can not do so himself.Regulations in the western world seem to promote advance directives as a way to enhance patient¿s autonomy in thecontext of human rights, and the media has presented advance directives as another milestone in this era of selfdetermination.However, if we look closely at some of thoseregulations we will see that there are a few elements which may undermine their efficacy, shattering this nicely presentedpicture. I will focus on two elements. First, formal requirements, and secondly, certain limits or what I like to call "escape clauses".

Advance directives as autonomy enhancers: reality or myth?

In the last few decades there has been a wealth of literature and legislation on advance directives. As you all know, it is an instrument by which a person can express their wishes as regards what treatmentthey should be given or, more to the point, not to be given, when he is in a situation when he can not do so himself.Regulations in the western world seem to promote advance directives as a way to enhance patient¿s autonomy in thecontext of human rights, and the media has presented advance directives as another milestone in this era of selfdetermination.However, if we look closely at some of thoseregulations we will see that there are a few elements which may undermine their efficacy, shattering this nicely presentedpicture. I will focus on two elements. First, formal requirements, and secondly, certain limits or what I like to call "escape clauses".

Utility scores associated with the world health organisation drinking risk-level classification in alcohol dependence

BACKGROUND: Extensive research exists estimating the effect hazardous alcohol¦use on morbidity and mortality, but little research quantifies the association between¦alcohol consumption and utility scores in patients with alcohol dependence.¦In the context of comparative research, the World Health Organisation (WHO)¦proposed to categorise the risk for alcohol-related acute and chronic harm according¦to patients' average daily alcohol consumption. OBJECTIVES: To estimate utility¦scores associated with each category of the WHO drinking risk-level classification¦in patients with alcohol dependence (AD). METHODS: We used data from¦CONTROL, an observational cohort study including 143 AD patients from the Alcohol¦Treatment Center at Lausanne University Hospital, followed for 12 months.¦Average daily alcohol consumption was assessed monthly using the Timeline Follow-¦back method and patients were categorised according to the WHO drinking¦risk-level classification: abstinent, low, medium, high and very high. Other measures¦as sociodemographic characteristics and utility scores derived from the EuroQoL¦5-Dimensions questionnaire (EQ-5D) were collected every three months.¦Mixed models for repeated measures were used to estimate mean utility scores¦associated with WHO drinking risk-level categories. RESULTS: A total of 143 patients¦were included and the 12-month follow-up permitting the assessment of¦1318 person-months. At baseline the mean age of the patients was 44.6 (SD 11.8)¦and the majority of patients was male (63.6%). Using repeated measures analysis,¦utility scores decreased with increasing drinking levels, ranging from 0.80 in abstinent¦patients to 0.62 in patients with very high risk drinking level (p_0.0001).¦CONCLUSIONS: In this sample of patients with alcohol dependence undergoing¦specialized care, utility scores estimated from the EQ-5D appeared to substantially¦and consistently vary according to patients' WHO drinking level.

Advance directives as autonomy enhancers: reality or myth?

In the last few decades there has been a wealth of literature and legislation on advance directives. As you all know, it is an instrument by which a person can express their wishes as regards what treatmentthey should be given or, more to the point, not to be given, when he is in a situation when he can not do so himself.Regulations in the western world seem to promote advance directives as a way to enhance patient¿s autonomy in thecontext of human rights, and the media has presented advance directives as another milestone in this era of selfdetermination.However, if we look closely at some of thoseregulations we will see that there are a few elements which may undermine their efficacy, shattering this nicely presentedpicture. I will focus on two elements. First, formal requirements, and secondly, certain limits or what I like to call "escape clauses".

Vibration Training Elicits a Mixed Aerobic and Resistance-type Exercise in Sedentary Subjects

PURPOSE: We hypothesize that untrained subjects can benefit from a greater cardiovascular stimulation than trained athletes, resembling classical aerobic-type activity, in addition to eliciting strength gains.METHODS: 3 groups of male subjects, inactive (SED), endurance trained (END) and strength trained (STR) underwent fitness (VO2max) and lower-body strength tests (isokinetic). Subjects were submitted to a session of oscillating VT, composed of 3 exercises (isometric half-squat, dynamic squat, dynamic squat with added load), each of 3 minutes duration, and repeated at 3 vibration frequencies (20, 26 and 32 Hz). VO2, heart rate and Borg scale were monitored.RESULTS: 27 healthy subjects (10 SED, 9 END and 8 STR), mean age 24.5 (SED), 25.0 (STR) and 29.8 (END) were included. VO2max was significantly different as expected (47.9 vs. 52.9 vs. 63.9 mL?min-1?kg-1, resp. for SED, STR and END). Isokinetic dominant leg extensors strength was higher in STR (3.32 N?m?kg-1 vs. 2.60 and 2.74 in SED and END). During VT, peak oxygen consumption (% of VO2max) attained was 59.3 in SED, 50.8 in STR and 48.0 in END (P<0.001 between SED and other subjects). Peak heart rate (% of heart rate max) was 82.7 in SED, 80.4 in STR and 72.4 in END. In SED, dynamic exercises without extra load elicited 51.0 % of VO2max and 72.1 % of heart rate max, and perceived effort reached 15.1/20.CONCLUSIONS: VT is an unconventional type of exercise, known to enhance strength, bone density, balance and flexibility. Users are attracted by the relative passivity. In SED, VT elicits sufficient cardiovascular response to benefit overall fitness in addition to the strength effects. VT's higher acceptance as an exercise in sedentary people, compared to jogging or cycling, can lead to better adherence to physical activity. Although long-term effects of VT on health are not available, we believe this type of mixed aerobic and resistance-type exercise can be beneficial on multiple health parameters, especially cardiovascular health.

Desarrollo de una aplicación para móviles basada en la tecnología de realidad aumentada

En este TFC se pretende implementar en un dispositivo móvil Android la funcionalidad de una aplicación de AR (Augmented Reality, "realidad aumentada") basada en Wikitude World Browser de Mobilizy para encontrar las paradas de autobús que más se ajustan a las necesidades del usuario.

Enhanced-reality video fluorescence: a real-time assessment of intestinal viability.

OBJECTIVE: Our aim was to evaluate a fluorescence-based enhanced-reality system to assess intestinal viability in a laparoscopic mesenteric ischemia model. MATERIALS AND METHODS: A small bowel loop was exposed, and 3 to 4 mesenteric vessels were clipped in 6 pigs. Indocyanine green (ICG) was administered intravenously 15 minutes later. The bowel was illuminated with an incoherent light source laparoscope (D-light-P, KarlStorz). The ICG fluorescence signal was analyzed with Ad Hoc imaging software (VR-RENDER), which provides a digital perfusion cartography that was superimposed to the intraoperative laparoscopic image [augmented reality (AR) synthesis]. Five regions of interest (ROIs) were marked under AR guidance (1, 2a-2b, 3a-3b corresponding to the ischemic, marginal, and vascularized zones, respectively). One hour later, capillary blood samples were obtained by puncturing the bowel serosa at the identified ROIs and lactates were measured using the EDGE analyzer. A surgical biopsy of each intestinal ROI was sent for mitochondrial respiratory rate assessment and for metabolites quantification. RESULTS: Mean capillary lactate levels were 3.98 (SD = 1.91) versus 1.05 (SD = 0.46) versus 0.74 (SD = 0.34) mmol/L at ROI 1 versus 2a-2b (P = 0.0001) versus 3a-3b (P = 0.0001), respectively. Mean maximal mitochondrial respiratory rate was 104.4 (±21.58) pmolO2/second/mg at the ROI 1 versus 191.1 ± 14.48 (2b, P = 0.03) versus 180.4 ± 16.71 (3a, P = 0.02) versus 199.2 ± 25.21 (3b, P = 0.02). Alanine, choline, ethanolamine, glucose, lactate, myoinositol, phosphocholine, sylloinositol, and valine showed statistically significant different concentrations between ischemic and nonischemic segments. CONCLUSIONS: Fluorescence-based AR may effectively detect the boundary between the ischemic and the vascularized zones in this experimental model.

Beaming into the rat world: enabling real-time intereaction between rat and human each at their own scale

Immersive virtual reality (IVR) typically generates the illusion in participants that they are in the displayed virtual scene where they can experience and interact in events as if they were really happening. Teleoperator (TO) systems place people at a remote physical destination embodied as a robotic device, and where typically participants have the sensation of being at the destination, with the ability to interact with entities there. In this paper, we show how to combine IVR and TO to allow a new class of application. The participant in the IVR is represented in the destination by a physical robot (TO) and simultaneously the remote place and entities within it are represented to the participant in the IVR. Hence, the IVR participant has a normal virtual reality experience, but where his or her actions and behaviour control the remote robot and can therefore have physical consequences. Here, we show how such a system can be deployed to allow a human and a rat to operate together, but the human interacting with the rat on a human scale, and the rat interacting with the human on the rat scale. The human is represented in a rat arena by a small robot that is slaved to the human"s movements, whereas the tracked rat is represented to the human in the virtual reality by a humanoid avatar. We describe the system and also a study that was designed to test whether humans can successfully play a game with the rat. The results show that the system functioned well and that the humans were able to interact with the rat to fulfil the tasks of the game. This system opens up the possibility of new applications in the life sciences involving participant observation of and interaction with animals but at human scale.

Beaming into the rat world: enabling real-time intereaction between rat and human each at their own scale

Immersive virtual reality (IVR) typically generates the illusion in participants that they are in the displayed virtual scene where they can experience and interact in events as if they were really happening. Teleoperator (TO) systems place people at a remote physical destination embodied as a robotic device, and where typically participants have the sensation of being at the destination, with the ability to interact with entities there. In this paper, we show how to combine IVR and TO to allow a new class of application. The participant in the IVR is represented in the destination by a physical robot (TO) and simultaneously the remote place and entities within it are represented to the participant in the IVR. Hence, the IVR participant has a normal virtual reality experience, but where his or her actions and behaviour control the remote robot and can therefore have physical consequences. Here, we show how such a system can be deployed to allow a human and a rat to operate together, but the human interacting with the rat on a human scale, and the rat interacting with the human on the rat scale. The human is represented in a rat arena by a small robot that is slaved to the human"s movements, whereas the tracked rat is represented to the human in the virtual reality by a humanoid avatar. We describe the system and also a study that was designed to test whether humans can successfully play a game with the rat. The results show that the system functioned well and that the humans were able to interact with the rat to fulfil the tasks of the game. This system opens up the possibility of new applications in the life sciences involving participant observation of and interaction with animals but at human scale.

Beaming into the rat world: enabling real-time intereaction between rat and human each at their own scale

Immersive virtual reality (IVR) typically generates the illusion in participants that they are in the displayed virtual scene where they can experience and interact in events as if they were really happening. Teleoperator (TO) systems place people at a remote physical destination embodied as a robotic device, and where typically participants have the sensation of being at the destination, with the ability to interact with entities there. In this paper, we show how to combine IVR and TO to allow a new class of application. The participant in the IVR is represented in the destination by a physical robot (TO) and simultaneously the remote place and entities within it are represented to the participant in the IVR. Hence, the IVR participant has a normal virtual reality experience, but where his or her actions and behaviour control the remote robot and can therefore have physical consequences. Here, we show how such a system can be deployed to allow a human and a rat to operate together, but the human interacting with the rat on a human scale, and the rat interacting with the human on the rat scale. The human is represented in a rat arena by a small robot that is slaved to the human"s movements, whereas the tracked rat is represented to the human in the virtual reality by a humanoid avatar. We describe the system and also a study that was designed to test whether humans can successfully play a game with the rat. The results show that the system functioned well and that the humans were able to interact with the rat to fulfil the tasks of the game. This system opens up the possibility of new applications in the life sciences involving participant observation of and interaction with animals but at human scale.

The Use of virtual reality in the study of people's responses to violent incidents

This paper reviews experimental methods for the study of the responses of people to violence in digital media, and in particular considers the issues of internal validity and ecological validity or generalisability of results to events in the real world. Experimental methods typically involve a significant level of abstraction from reality, with participants required to carry out tasks that are far removed from violence in real life, and hence their ecological validity is questionable. On the other hand studies based on fi eld data, while having ecological validity, cannot control multiple confounding variables that may have an impact on observed results, so that their internal validity is questionable. It is argued that immersive virtual reality may provide a unifi cation of these two approaches. Since people tend to respond realistically to situations and events that occur in virtual reality, and since virtual reality simulations can be completely controlled for experimental purposes, studies of responses to violence within virtual reality are likely to have both ecological and internal validity. This depends on a property that we call"plausibility"- including the fi delity of the depicted situation with prior knowledge and expectations. We illustrate this with data from a previously published experiment, a virtual reprise of Stanley Milgram"s 1960s obedience experiment, and also with pilot data from a new study being developed that looks at bystander responses to violent incidents.

Beaming into the rat world: enabling real-time intereaction between rat and human each at their own scale

Immersive virtual reality (IVR) typically generates the illusion in participants that they are in the displayed virtual scene where they can experience and interact in events as if they were really happening. Teleoperator (TO) systems place people at a remote physical destination embodied as a robotic device, and where typically participants have the sensation of being at the destination, with the ability to interact with entities there. In this paper, we show how to combine IVR and TO to allow a new class of application. The participant in the IVR is represented in the destination by a physical robot (TO) and simultaneously the remote place and entities within it are represented to the participant in the IVR. Hence, the IVR participant has a normal virtual reality experience, but where his or her actions and behaviour control the remote robot and can therefore have physical consequences. Here, we show how such a system can be deployed to allow a human and a rat to operate together, but the human interacting with the rat on a human scale, and the rat interacting with the human on the rat scale. The human is represented in a rat arena by a small robot that is slaved to the human"s movements, whereas the tracked rat is represented to the human in the virtual reality by a humanoid avatar. We describe the system and also a study that was designed to test whether humans can successfully play a game with the rat. The results show that the system functioned well and that the humans were able to interact with the rat to fulfil the tasks of the game. This system opens up the possibility of new applications in the life sciences involving participant observation of and interaction with animals but at human scale.

In a better world (2011): the ethics of a doctor facing violence

The main theme"In a Better World" (S. Bier, 2011), is violence and its possible answers: forgiveness and revenge. The film revolves around a doctor Anton who works in a refugee camp in sub-Saharan Africa. His family lives in a quiet village in Denmark, where his teenage son suffers bullying at school. This movie shows the fragility of a modern society, normal in appearance but with deep fissures that reflect the tragedies plaguing much of the African continent. It helps to understand the reality experienced by more than 10 million refugees and 15 million internally displaced persons surviving in sub-Saharan Africa. Hævnen, the original title whose meaning in Spanish is revenge, invites reflection on another possible response to violence-forgiveness. It is an excellent film for teaching and learning issues related to humanitarian work developed by health professionals in refugee camps around world.

In a better world (2011): the ethics of a doctor facing violence

The main theme"In a Better World" (S. Bier, 2011), is violence and its possible answers: forgiveness and revenge. The film revolves around a doctor Anton who works in a refugee camp in sub-Saharan Africa. His family lives in a quiet village in Denmark, where his teenage son suffers bullying at school. This movie shows the fragility of a modern society, normal in appearance but with deep fissures that reflect the tragedies plaguing much of the African continent. It helps to understand the reality experienced by more than 10 million refugees and 15 million internally displaced persons surviving in sub-Saharan Africa. Hævnen, the original title whose meaning in Spanish is revenge, invites reflection on another possible response to violence-forgiveness. It is an excellent film for teaching and learning issues related to humanitarian work developed by health professionals in refugee camps around world.

Beaming into the rat world: enabling real-time intereaction between rat and human each at their own scale

Immersive virtual reality (IVR) typically generates the illusion in participants that they are in the displayed virtual scene where they can experience and interact in events as if they were really happening. Teleoperator (TO) systems place people at a remote physical destination embodied as a robotic device, and where typically participants have the sensation of being at the destination, with the ability to interact with entities there. In this paper, we show how to combine IVR and TO to allow a new class of application. The participant in the IVR is represented in the destination by a physical robot (TO) and simultaneously the remote place and entities within it are represented to the participant in the IVR. Hence, the IVR participant has a normal virtual reality experience, but where his or her actions and behaviour control the remote robot and can therefore have physical consequences. Here, we show how such a system can be deployed to allow a human and a rat to operate together, but the human interacting with the rat on a human scale, and the rat interacting with the human on the rat scale. The human is represented in a rat arena by a small robot that is slaved to the human"s movements, whereas the tracked rat is represented to the human in the virtual reality by a humanoid avatar. We describe the system and also a study that was designed to test whether humans can successfully play a game with the rat. The results show that the system functioned well and that the humans were able to interact with the rat to fulfil the tasks of the game. This system opens up the possibility of new applications in the life sciences involving participant observation of and interaction with animals but at human scale.