Adapting Compassion Education Through Technology-Enhanced Learning: An Exploratory Study

PURPOSE

Compassion is central to health care. Efforts to promote compassion through educational interventions for health professionals show promise, yet such education has not gained widespread dissemination. Adapting compassion education through technology-enhanced learning may provide an opportunity to enhance the scale and spread of compassion education. However, challenges are inherent in translating such curricula for online delivery. In this study, the authors explored how technology influences the delivery of compassion education for health professionals.

METHOD

Using constructivist grounded theory methodology, the authors conducted semistructured interviews with 13 participants from across Ontario, Canada, from March to October 2019. The sample consisted of individuals who had experience with the design and evaluation of compassion education for health professionals. The interviews were coded and inductively analyzed to identify pertinent themes using constant comparative analysis. The study originated at the Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.

RESULTS

Participants provided a range of responses regarding technology and compassion education. While participants revealed concerns about the constraints of technology on human interaction, they also described technology as both inevitable and necessary for the delivery of future compassionate care curricula. Participants also shared ways in which technology may enhance compassion education for health professionals by increasing accessibility and learner comfort with vulnerability. Addressing technological ambivalence, improving facilitation, and maintaining a balance between face-to-face instruction and technology-enhanced learning were identified as elements that could advance compassion education into the future.

CONCLUSIONS

Compassion education can be enhanced by technology; however, evidence-informed adaptation may require deliberate efforts to maintain some level of face-to-face interaction to ensure that technology does not erode human connection. Further research is required to address the uncertainties surrounding technology and compassion education as identified by participants. These findings provide educators with guidance for adapting compassionate care curricula into a digital domain.

Structure Changes of a Membrane Polypeptide under an Applied Voltage Observed with Surface-Enhanced 2D IR Spectroscopy

The structures of many membrane-bound proteins and polypeptides depend on the membrane potential. However, spectroscopically studying their structures under an applied field is challenging, because a potential is difficult to generate across more than a few bilayers. We study the voltage-dependent structures of the membrane-bound polypeptide, alamethicin, using a spectroelectrochemical cell coated with a rough, gold film to create surface plasmons. The plasmons sufficiently enhance the 2D IR signal to measure a single bilayer. The film is also thick enough to conduct current and thereby apply a potential. The 2D IR spectra resolve features from both 3₁₀- and α-helical structures and cross-peaks connecting the two. We observe changes in the peak intensity, not their frequencies, upon applying a voltage. A similar change occurs with pH, which is known to alter the angle of alamethicin relative to the surface normal. The spectra are modeled using a vibrational exciton Hamiltonian, and the voltage-dependent spectra are consistent with a change in angle of the 3₁₀- and α-helices in the membrane from 55 to 44°and from 31 to 60°, respectively. The 3₁₀- and α-helices are coupled by approximately 10 cm^-1. These experiments provide new structural information about alamethicin under a potential difference and demonstrate a technique that might be applied to voltage-gated membrane proteins and compared to molecular dynamics structures.

Correlations Between Skin Barrier Integrity and Delivery of Hydrophilic Molecules in the Presence of Penetration Enhancers

PURPOSE

We investigated the potential correlations between skin barrier integrity and hydrophilic drugs distribution in skin in the presence of different types of penetration enhancers (PEs) and their combinations.

METHODS

We measured skin conductivity to evaluate skin barrier integrity before and after the topical application of different chemical PEs, physical PE, peptide PE and their combinations in vitro. We also investigated their effect on the skin distribution profiles of two hydrophilic model drugs, Fluorescein sodium (376 Da) and Fluorescein isothiocyanate-dextrans 10 (10 KDa).

RESULTS

The physical PE significantly increased the skin conductivity compared to all other PEs, while the peptide PE had no effect on it. The drug deposition in different skin layers was not only dependent on PE applied but also its own molecular weight. We further found two excellent correlations: one (R² = 0.9388) between skin barrier integrity and total skin absorption of FNa and another one(R² = 0.9212) between skin barrier integrity and the deposition of FNa in dermis and receptor in presence of chemical or physical PEs and their combinations.

CONCLUSIONS

The total skin absorption or the deposition in dermis and receptor of small hydrophilic drug in the presence of chemical and physical PEs and their combinations show a good correlation with skin barrier integrity. However, such correlations hold true neither for large hydrophilic drug nor for peptide PE. All good relationships found in this work will allow screening suitable PEs or combinations by measuring the skin conductivity induced by corresponding PEs. Graphical Abstract The total skin absorption of small hydrophilic drug shows a good correlation with skin barrier integrity in the presence of chemical and physical penetration enhancers and their combinations. However, such a correlation hold true neither for large hydrophilic drug nor for peptide penetration enhancer.

Frequently overlooked realistic moral bioenhancement interventions

Many supporters of 'moral bioenhancement' (MBE), the use of biomedical interventions for moral improvement, have been criticised for having unrealistic proposals. The interventions they suggest have often been called infeasible and their implementation plans vague or unethical. I dispute these criticisms by showing that various interventions to implement MBE are practically and ethically feasible enough to warrant serious consideration. Such interventions include transcranial direct current stimulation over the medial and dorsolateral prefrontal cortex, as well as supplementation with lithium and omega-3. Considering their efficacy and feasibility, it is strange that these interventions have rarely been proposed or discussed as MBE. I review evidence that each of those interventions can reduce antisocial behaviour, reduce racial bias, increase executive function or increase prosocial traits like fairness and altruism. I then specify and defend realistic, ethically permissible ways to implement these interventions, especially for violent offenders and public servants-the former as rehabilitation and the latter to meet the high standards of their occupations. These interventions could be given to violent offenders in exchange for a reduced sentence or compulsorily in some cases. Potential intervention methods for non-prisoners include increasing the USDA-recommended dose of omega-3, encouraging food companies to supplement their products with omega-3 or trace lithium, requiring MBE for employment as a police officer or political leader, and insurance companies providing discounts for undergoing MBE. In some reasonably limited form, using these interventions may be a good first step to implement the project of MBE.

The brain as an agentic system: how the brain is articulated in the field of neuroenhancement

This article analyses the material of a European Project on Responsible Research and Innovation in Neuroenhancement (NERRI) to explore how the brain is articulated in this field. Since brains are closely connected to ideas of self, responsibility, free will and being human, and since brain metaphors have important effects on research practices and perspectives, it also matters how people talk about and use the brain. In the NERRI project, the brain is articulated as an agent interacting with or substituting the self; as a system that can, cannot or should not be analysed; and as the part of oneself that can potentially change human nature in positive and negative ways. Since most of the material analysed was produced by neuroscientists or other neuroenhancement experts, this article emphasises the responsibility of the experts in this process. By showing what brain images are disseminated within the field of neuroenhancement, and analysing how this depiction is related to ideas of self or being human, this article does not only intend to contribute to a more empirically based and societally relevant neuroenhancement debate, but also to a more realistic and societally relevant idea of the brain.

Determinants of mobile technology use and smartphone application interest in cancer patients

BACKGROUND

Supportive care is a critical component of the treatment of cancer patients that is underutilized; patient lack of information about these services is an important barrier. Mobile technologies may be useful tools for delivering information, but cancer patient use of and interest in using them to learn about supportive care services have not been described. This study evaluates factors associated with cancer patient use of mobile technologies and interest in smartphone applications for information delivery about supportive care.

METHODS

We conducted a cross-sectional survey among cancer patients from one urban academic hospital and 11 community hospitals. Patients self-reported use of mobile technologies and interest in smartphone applications. Multivariate logistic analysis was used to identify determinants of mobile technology use and smartphone interest.

RESULTS

Among 631 participants, 466 (74%) reported regular use of mobile devices and 242 (39%) expressed an interest in supportive care information via smartphone applications. Patients under 45 were more likely to use a mobile device (Adjusted Odds Ratio [AOR] 6.8, 2.8-16.9 95% CI, P < 0.001) and were interested in smartphone applications for delivery of information (AOR 3.2, 1.8-5.9 95% CI, P < 0.001). Non-white patients had similar use of mobile technology compared to whites but reported greater interest in smartphone application-based information (AOR 3.4, 2.1-5.5 95% CI, P < 0.001).

CONCLUSION

Many patients expressed interest in smartphone application-based information about supportive care services, especially those who are younger and non-white. Future studies should investigate the characteristics of patients and smartphones applications that will optimize information delivery through a mobile technology platform.

The contrasting role of technology as both supportive and hindering in the everyday lives of people with mild cognitive deficits: a focus group study

BACKGROUND

It is well known that people with mild cognitive deficits face challenges when performing complex everyday activities, and that the use of technology has become increasingly interwoven with everyday activities. However, less is known of how technology might be involved, either as a support or hindrance, in different areas of everyday life and of the environments where challenges appear. The aim of this study was to investigate the areas of concern where persons with cognitive deficits meet challenges in everyday life, in what environments these challenges appear and how technology might be involved as part of the challenge and/or the solution to the challenge.

METHODS

Data were gathered through four focus group interviews with participants that live with cognitive deficits or cohabit with a person with cognitive deficits, plus health professionals and researchers in the field. Data were transcribed, coded and categorized, and finally synthesized to trace out the involvement of technology.

RESULTS

Five areas of concern in everyday life were identified as offering challenges to persons with cognitive deficits: A) Managing personal finances, B) Getting around, C) Meeting family and friends, D) Engaging with culture and media and, E) Doing everyday chores. Findings showed that the involvement of technology in everyday activities was often contrastive. It could be hindering and evoke stress, or it could bring about feelings of control; that is, being a part of the solution. The involvement of technology was especially obvious in challenges linked to Managing personal finances, which is a crucial necessity in many everyday activities. In contrast, technology was least obviously involved in the area Socializing with family and friends.

CONCLUSIONS

The findings imply that technology used for orientation and managing finances, often used outside home, would benefit from being further developed in order to be more supportive; i.e. accessible and usable. To make a positive change for many people, the ideas of inclusive design fit well for this purpose and would contribute to an age-friendly society.

Would you be willing to zap your child's brain? Public perspectives on parental responsibilities and the ethics of enhancing children with transcranial direct current stimulation

BACKGROUND

Transcranial direct current stimulation (tDCS) is an experimental brain stimulation technology that may one day be used to enhance the cognitive capacities of children. Discussion about the ethical issues that this would raise has rarely moved beyond expert circles. However, the opinions of the wider public can lead to more democratic policy decisions and broaden academic discussion of this issue.

METHODS

We performed a quantitative survey of members of the U.S. public. A between-subjects design was employed, where conditions varied based on the trait respondents considered for enhancement.

RESULTS

There were 227 responses included for analysis. Our key finding was that the majority were unwilling to enhance their child with tDCS. Respondents were most reluctant to enhance traits considered fundamental to the self (such as motivation and empathy). However, many respondents may give in to implicit coercion to enhance their child in spite of an initial reluctance. A ban on tDCS was not supported if it were to be used safely for the enhancement of mood or mathematical ability. Opposition to such a ban may be related to the belief that tDCS use would not represent cheating or violate authenticity (as it relates to achievements rather than identity).

CONCLUSIONS

The wider public appears to think that crossing the line from treatment to enhancement with tDCS would not be in a child's best interests. However, an important alternative interpretation of our results is that lay people may be willing to use enhancers that matched their preference for "natural" enhancers. A ban on the safe use of tDCS for enhancing nonfundamental traits would be unlikely to garner public support. Nonetheless, it could become important to regulate tDCS in order to prevent misuse on children, because individuals reluctant to enhance may be likely to give in to implicit coercion to enhance their child.

Four ethical priorities for neurotechnologies and AI

Artificial intelligence and brain-computer interfaces must respect and preserve people’s privacy, identity, agency and equality, say Rafael Yuste, Sara Goering and colleagues.

Compulsory administration of oxytocin does not result in genuine moral enhancement

The question will be raised whether oxytocin can serve as an effective moral enhancer. Different types of moral enhancement will be addressed, one of them being compulsory moral enhancement. It will be argued that oxytocin cannot serve as an effective moral enhancer if its use is being made compulsory. Hence, compulsory administration of oxytocin does not result in genuine moral enhancement. In order to demonstrate this, a stipulation of the main potentially beneficial outcomes of using oxytocin as a moral enhancer will be offered, as well as a discussion of objections to the notion that oxytocin can be an effective moral enhancer. It will be concluded that mandatory administration of oxytocin is ineffective because of a combination of two reasons: (1) mandatory administration of oxytocin renders moral reflection practically superfluous; (2) without moral reflection the beneficial outcomes of the use of oxytocin do not outweigh its drawbacks to the degree that we could speak of effective moral enhancement.

Conceptual and practical problems of moral enhancement

Recently, the debate on human enhancement has shifted from familiar topics like cognitive enhancement and mood enhancement to a new and - to no one's surprise - controversial subject, namely moral enhancement. Some proponents from the transhumanist camp allude to the 'urgent need' of improving the moral conduct of humankind in the face of ever growing technological progress and the substantial dangers entailed in this enterprise. Other thinkers express more sceptical views about this proposal. As the debate has revealed so far, there is no shared opinion among philosophers (or scientists) about the meaning, prospects, and ethical evaluation of moral enhancement. In this article I will address several conceptual and practical problems of this issue, in order to encourage discussion about the prospects of (thinking about) moral enhancement in the future. My assumption is that (i) for the short term, there is little chance of arriving at an agreement on the proper understanding of morality and the appropriateness of one single (meta-)ethical theory; (ii) apart from this, there are further philosophical puzzles loosely referred to in the debate which add to theoretical confusion; and (iii) even if these conceptual problems could be solved, there are still practical problems to be smoothed out if moral enhancement is ever to gain relevance apart from merely theoretical interest. My tentative conclusion, therefore, will be that moral enhancement is not very likely to be made sense of - let alone realized - in the medium-term future.

Training versus engagement as paths to cognitive enrichment with aging

While a training model of cognitive intervention targets the improvement of particular skills through instruction and practice, an engagement model is based on the idea that being embedded in an intellectually and socially complex environment can impact cognition, perhaps even broadly, without explicit instruction. We contrasted these 2 models of cognitive enrichment by randomly assigning healthy older adults to a home-based inductive reasoning training program, a team-based competitive program in creative problem solving, or a wait-list control. As predicted, those in the training condition showed selective improvement in inductive reasoning. Those in the engagement condition, on the other hand, showed selective improvement in divergent thinking, a key ability exercised in creative problem solving. On average, then, both groups appeared to show ability-specific effects. However, moderators of change differed somewhat for those in the engagement and training interventions. Generally, those who started either intervention with a more positive cognitive profile showed more cognitive growth, suggesting that cognitive resources enabled individuals to take advantage of environmental enrichment. Only in the engagement condition did initial levels of openness and social network size moderate intervention effects on cognition, suggesting that comfort with novelty and an ability to manage social resources may be additional factors contributing to the capacity to take advantage of the environmental complexity associated with engagement. Collectively, these findings suggest that training and engagement models may offer alternative routes to cognitive resilience in late life.

Religious perspectives on the use of psychopharmaceuticals as an enhancement technology

The use of psychopharmaceuticals as an enhancement technology has been the focus of attention in the bioethics literature. However, there has been little examination of the challenges that this practice creates for religious traditions that place importance on questions of being, authenticity, and identity. We asked expert commentators from six major world religions to consider the issues raised by psychopharmaceuticals as an enhancement technology. These commentaries reveal that in assessing the appropriate place of medical therapies, religious traditions, like secular perspectives, rely upon ideas about health and disease and about normal human behavior. But unlike secular perspectives, faith traditions explicitly concern themselves with ways in which medicine should or should not be used to live a "good life".

Is neuroenhancement by noninvasive brain stimulation a net zero-sum proposition?

In the past several years, the number of studies investigating enhancement of cognitive functions through noninvasive brain stimulation (NBS) has increased considerably. NBS techniques, such as transcranial magnetic stimulation and transcranial current stimulation, seem capable of enhancing cognitive functions in patients and in healthy humans, particularly when combined with other interventions, including pharmacologic, behavioral and cognitive therapies. The "net zero-sum model", based on the assumption that brain resources are subjected to the physical principle of conservation of energy, is one of the theoretical frameworks proposed to account for such enhancement of function and its potential cost. We argue that to guide future neuroenhancement studies, the net-zero sum concept is helpful, but only if its limits are tightly defined.

[Single laparoscopic approach in newborns and infants]

The aim of this investigation is evidence of opportunity of single laparoscopic approach using during operations in newborns and infants. The authors have an experience of 274 single-port operations performed from January 2009 to December 2013. Success of single laparoscopic approach has been demonstrated in patients with inguinal hernia, congenital hypertrophic pyloric stenosis, feeding violations, ovarian cyst and multi-cystic kidney dysplasia.

[Potential of using inertial sensors in high level sports]

The article thoroughly covers development of wireless inertial sensors technology in medicine. The authors describe main criteria of diagnostic value of inertial sensors, advantages and prospects of using these systems in sports medicine, in comparison with other conventional methods of biomechanical examination in sports medicine. The results obtained necessitate further development of this approach, specifically creation of algorithms and methods of biomechanic examination of highly qualified athletes in high achievements sports.

Cognitive neuroenhancement: false assumptions in the ethical debate

The present work critically examines two assumptions frequently stated by supporters of cognitive neuroenhancement. The first, explicitly methodological, assumption is the supposition of effective and side effect-free neuroenhancers. However, there is an evidence-based concern that the most promising drugs currently used for cognitive enhancement can be addictive. Furthermore, this work describes why the neuronal correlates of key cognitive concepts, such as learning and memory, are so deeply connected with mechanisms implicated in the development and maintenance of addictive behaviour so that modification of these systems may inevitably run the risk of addiction to the enhancing drugs. Such a potential risk of addiction could only be falsified by in-depth empirical research. The second, implicit, assumption is that research on neuroenhancement does not pose a serious moral problem. However, the potential for addiction, along with arguments related to research ethics and the potential social impact of neuroenhancement, could invalidate this assumption. It is suggested that ethical evaluation needs to consider the empirical data as well as the question of whether and how such empirical knowledge can be obtained.

Smart drugs "as common as coffee": media hype about neuroenhancement

Background

The use of prescription drugs to improve cognitive functioning in normal persons –“neuroenhancement” – has gained recent attention from bioethicists and neuroscientists. Enthusiasts claim that the practice is widespread and increasing, and has many potential benefits; however recent evidence provides weak support for these claims. In this study we explored how the newsprint media portrays neuroenhancement.

Aims

We conducted an empirical study of media reporting of neuroenhancement to explore: media portrayals of the prevalence of neuroenhancement; the types of evidence used by the media to support claims about its prevalence; and, the possible benefits and risks of neuroenhancement mentioned in these media articles.

Methods

Using the Factiva database, we found 142 newspaper articles about the non-medical use prescription drugs for neuroenhancement for the period 2008-2010. We conducted a thematic content analysis of how articles portrayed the prevalence of neuroenhancement; what type of evidence they used in support; and, the potential benefits and risks/side-effects of neuroenhancement that were mentioned.

Results

87% of media articles mentioned the prevalence of neuroenhancement, and 94% portrayed it as common, increasing or both. 66% referred to the academic literature to support these claims and 44% either named an author or a journal. 95% of articles mentioned at least one possible benefit of using prescription drugs for neuroenhancement, but only 58% mentioned any risks/side effects. 15% questioned the evidence for efficacy of prescription drugs to produce benefits to users.

Conclusions

News media articles mentioned the possible benefits of using drugs for neuroenhancement more than the potential risks/side effects, and the main source for media claims that neuroenhancement is common and increasingly widespread has been reports from the academic literature that provide weak support for this claim. We urge journalists and researchers to be cautious in their portrayal of the non-medical use of drugs for neuroenhancement.

Remodeling of the infarct territory in the time course of infarct healing in humans

OBJECT

To analyze the remodeling processes of the infarct territory in the time course of infarct healing.

MATERIALS AND METHODS

Serial late enhancement (LE) studies were performed in 30 patients following reperfused myocardial infarction (MI) in the first and second week post-MI and after 3 months. To characterize infarct remodeling over time, the following variables were derived and analyzed in a blinded fashion: Infarct size (IS, in mm(3)), maximum infarct thickness (IT(max), mm), mean infarct thickness (IT(mean), mm) and the variability of infarct thickness (VIT=IT(max)/IT(mean)). Further, a new parameter for the assessment of infarct remodeling, the infarct extent (IE, mm(2)) was computed. IE quantifies IS in two dimensions along the heart's circumferential and longitudinal directions. IS was divided by the IE to obtain IT(mean).

RESULTS

Overall infarct thickness was highly variable. Infarct shrinkage due to infarct thinning and IE reduction was found in the first months of healing. IS, IT(mean) and IT(max) significantly decreased during follow-up. There was a less consistent change of the IE: IE decreased in 75% of all infarcts from the first week up to 3 months post-MI, whereas 25% of infarcts expanded. Infarct thinning was found in almost all patients (92%), hence occurring in patients with infarct expansion and in patients without infarct expansion.

CONCLUSION

Infarct thinning and-to a lesser extent-IE reduction, contribute to infarct shrinkage in the time course of infarct healing. Infarct thinning may occur without infarct expansion.

Preliminary results of a novel enhancement method for high-frequency hearing loss

In this study, a software program was developed for high-frequency hearing loss subjects that includes a detailed audiogram and novel enhancement methods. The software performs enhancements of the audibility of high-frequency sounds according to the subject's detailed 31-point audiogram. This provides subject-specific gains in the entire frequency spectrum, and especially for high frequencies, of sounds. Amplification, compression, and transposition are the three main processing methods used to obtain the desired enhancements for the subjects. For low frequencies, only the amplification method was used according to the dB value of the input. For mid and high frequencies, the compression and transposition methods were used together. To obtain the preliminary results of the study, 10 subjects were enrolled in a detailed audiogram study for five weeks. In the study, environmental, music, and speech sounds were used. While the perceptual mean performances of the subjects were in the range of 25.33-63.77% in the first week, those values increased to 68.75-95.75% in the fifth week. In particular, all noisy and speech sounds were more significantly identified and understood by the subjects with the enhancement method (from 25.33% to 87.5% and from 42.33% to 90.5%, respectively). Three subjects had dropped out at the end of the study and small number of participants are the limitations of this study; however, as a preliminary result, some ideas can be inferred from the results for a smaller set of subjects obtained in the five weeks of the study. Thus, the reliability of the study needs to be tested with more subjects and a comparison with their own hearing aids should be conducted.

Facilitate insight by non-invasive brain stimulation

Our experiences can blind us. Once we have learned to solve problems by one method, we often have difficulties in generating solutions involving a different kind of insight. Yet there is evidence that people with brain lesions are sometimes more resistant to this so-called mental set effect. This inspired us to investigate whether the mental set effect can be reduced by non-invasive brain stimulation. 60 healthy right-handed participants were asked to take an insight problem solving task while receiving transcranial direct current stimulation (tDCS) to the anterior temporal lobes (ATL). Only 20% of participants solved an insight problem with sham stimulation (control), whereas 3 times as many participants did so (p = 0.011) with cathodal stimulation (decreased excitability) of the left ATL together with anodal stimulation (increased excitability) of the right ATL. We found hemispheric differences in that a stimulation montage involving the opposite polarities did not facilitate performance. Our findings are consistent with the theory that inhibition to the left ATL can lead to a cognitive style that is less influenced by mental templates and that the right ATL may be associated with insight or novel meaning. Further studies including neurophysiological imaging are needed to elucidate the specific mechanisms leading to the enhancement.

Colonic stents: the modern treatment of colonic obstruction

Colonic stents traditionally have been used for the management of colorectal cancer, either as a palliative treatment or as a bridge to surgery. More recently, colonic stents have also been advocated as part of the therapy of benign strictures. A number of colonic stents are available worldwide, four of which are made in the USA. These stents are classified as covered or uncovered, with similar clinical applications. Technical and clinical success rates are similar among these different stents, as well as the rate of complications, which mainly consist of obstruction and migration. The deployment systems utilize fluoroscopy, endoscopy, or both. More recently, stents became available that are deployed "through the scope" (TTS) making the procedure faster. However, this advance does not exclude the use of fluoroscopy, particularly in those cases where the direct visualization of the proximal end of the stricture is absent. The increasing experience in the management of colorectal cancer with colonic stents decreases the morbidity and mortality, as well as cost, in comparison with surgical intervention for acute colonic obstruction. Management with colonic stents can also rule out proximal synchronous lesions after initial decompression prior to definitive surgery. Benign conditions may also be treated with stents. A multidisciplinary approach for the use of colonic stents during assessment and management of acute colonic obstruction is necessary in order to achieve a satisfactory outcome, whether that be better quality of life or improved survival.

Cognitive enhancement: methods, ethics, regulatory challenges

Cognitive enhancement takes many and diverse forms. Various methods of cognitive enhancement have implications for the near future. At the same time, these technologies raise a range of ethical issues. For example, they interact with notions of authenticity, the good life, and the role of medicine in our lives. Present and anticipated methods for cognitive enhancement also create challenges for public policy and regulation.

[Therapeutic and cosmetic psychopharmacology. Risks and limits]

In this paper, I analyze risks and limits of the current psychopharmacology and how both are promoting a new social interpretation of health concept. Besides, I show how such interpretation can be detected in four issues related to safety, equality, psychiatrization of human condition, and autonomy. In the conclusions, I defend, first, the obligation of physician to inform patients about the important long-term uncertainties around psychopharmacology. Second, I justify the necessity of promote more prolonged monitoring of patients treated with such kind of drugs. Third, I insist in the relevance of increasing research about drugs ' adverse effects extended over a long time. And forth, I bring up the utility of health concept to avoid the subjective stigmatization of cognitive or affective traits, to prevent potential problems of inequality and coercion, and to keep from mental disorders caused by attempts of getting psychical states supposedly optimized.

Enhancements, easy shortcuts, and the richness of human activities

One argument that is frequently invoked against the technological enhancement of human functioning is that it is morally suspect, or even wrong, to take an easy shortcut. Some things that usually take effort, endurance or struggle can come easily with the use of an enhancer. This paper analyses the various arguments that circle round the idea that enhancement of human functioning is problematic because of the 'easy shortcut' that it offers. It discusses the concern that quick fixes lead to corrosion of character and the idea that suffering, pain, hard work and effort are essential for real and worthy achievements, and argues that these views are largely mistaken. Next, the paper argues that the core worry about taking an easy shortcut is that it makes us lose sight of the complexities of our means and ends; in other words, the argument warns against reducing the richness of human activities. A vocabulary of 'practices', 'internal goods' and 'focal engagement' will be used to articulate this argument further. The conclusion is that the easy shortcut argument has no general validity as an argument against enhancement 'as such'. The paper urges us, however, to evaluate enhancement technologies not only in terms of their efficiency in reaching certain goals but also in terms of their contribution to intrinsically worthwhile human activities. It can point out some of the caveats, as well as the opportunities, of the use of enhancement technologies.

Design of a knee rotatory kinaesthetic device

The anterior cruciate ligament (ACL) constrains rotatory motion at the knee and is commonly injured during rotational movements in athletic activity. This densely innervated ligament is assumed to play a role in knee proprioception, however, no study has measured proprioception in a manner relevant to either the kinematics of the ligament or the mechanism of injury, partly because of a lack of suitable equipment. The aims of this technical note are to document the development of a novel knee rotatory kinaesthetic device, and to present details of its construction, reproducibility, accuracy and application. The purpose-built device allows rotational movements at the knee to occur with minimal frictional resistance and provides accurate limits to the magnitude of these movements. This allows analysis of subjects' ability to discriminate between movements of differing magnitudes and thus allows calculation of subjects' sensitivity to small differences in magnitude of active knee rotation. Measurements taken with the device had a high level of agreement with those of a calibrated digital inclinometer (ICC=0.99; 95% CI 0.88 to 0.99) with a mean error of 0.24 degrees . The device also demonstrated excellent reproducibility (Pearson's r=1.0). A single case study is presented to detail the clinical application of the device. This novel device allows subjects to perform active knee rotational movements in a closed kinetic chain with discrete, self-paced movement, enabling calculation of movement discrimination. The device is compact and portable enabling testing to be undertaken in remote settings enhancing its clinical applicability.

Caffeine use by children: the quest for enhancement

Fair play, both in academics and sports, is a concept that is challenged by the notion of performance enhancement. Both cognitive and physical performance can be viewed as potentially enhanceable, and arguments can be made that enhancement can serve two purposes: gaining an edge or keeping up with others (who may or may not have used performance-enhancing substances). Caffeine, a central nervous system and cardiac stimulant, is frequently used by children for both academic and athletic performance enhancement. In fact, the marketplace contains a plethora of caffeinated products marketed directly to children. This article examines safety and ethical issues associated with the use of caffeine by children and explores the question: Can cognitive performance enhancement be ethically permissible if sports performance enhancement is not?

A psychophysical evaluation of spectral enhancement

Listeners with sensorineural hearing loss have well-documented elevated hearing thresholds; reduced auditory dynamic ranges; and reduced spectral (or frequency) resolution that may reduce speech intelligibility, especially in the presence of competing sounds. Amplification and amplitude compression partially compensate for elevated thresholds and reduced dynamic ranges but do not remediate the loss in spectral resolution. Spectral-enhancement processing algorithms have been developed that putatively compensate for decreased spectral resolution by increasing the spectral contrast, or the peak-to-trough ratio, of the speech spectrum. Several implementations have been proposed, with mixed success. It is unclear whether the lack of strong success was due to specific implementation parameters or whether the concept of spectral enhancement is fundamentally flawed. The goal of this study was to resolve this ambiguity by testing the effects of spectral enhancement on detection and discrimination of simple, well-defined signals. To that end, groups of normal-hearing (NH) and hearing-impaired (HI) participants listened in 2 psychophysical experiments, including detection and frequency discrimination of narrowband noise signals in the presence of broadband noise. The NH and HI listeners showed an improved ability to detect and discriminate narrowband increments when there were spectral decrements (notches) surrounding the narrowband signals. Spectral enhancements restored increment detection thresholds to within the normal range when both energy and spectral-profile cues were available to listeners. When only spectral-profile cues were available for frequency discrimination tasks, performance improved for HI listeners, but not all HI listeners reached normal levels of discrimination. These results suggest that listeners are able to take advantage of the local improvement in signal-to-noise ratio provided by the spectral decrements.

In defense of posthuman dignity

Positions on the ethics of human enhancement technologies can be (crudely) characterized as ranging from transhumanism to bioconservatism. Transhumanists believe that human enhancement technologies should be made widely available, that individuals should have broad discretion over which of these technologies to apply to themselves, and that parents should normally have the right to choose enhancements for their children-to-be. Bioconservatives (whose ranks include such diverse writers as Leon Kass, Francis Fukuyama, George Annas, Wesley Smith, Jeremy Rifkin, and Bill McKibben) are generally opposed to the use of technology to modify human nature. A central idea in bioconservativism is that human enhancement technologies will undermine our human dignity. To forestall a slide down the slippery slope towards an ultimately debased 'posthuman' state, bioconservatives often argue for broad bans on otherwise promising human enhancements. This paper distinguishes two common fears about the posthuman and argues for the importance of a concept of dignity that is inclusive enough to also apply to many possible posthuman beings. Recognizing the possibility of posthuman dignity undercuts an important objection against human enhancement and removes a distortive double standard from our field of moral vision.

Enhancement Technologies and Human Identity

As the President's Council on Bioethics emphasized in a recent report, rapid growth of biotechnologies creates increasingly many possibilities for enhancing human traits. This article addresses the claim that enhancement via biotechnology is inherently problematic for reasons pertaining to our identity. After clarifying the concept of enhancement, and providing a framework for understanding human identity, I examine the relationship between enhancement and identity. Then I investigate two identity-related challenges to biotechnological enhancements: (1) the charge of inauthenticity and (2) the charge of violating inviolable core characteristics. My thesis is that a lucid, plausible understanding of human identity largely neutralizes these charges, liberating our thinking from some seductive yet unsound objections to enhancement via biotechnology.

Cosmetic neurology

Advances in cognitive neuroscience and neuropharmacology are yielding exciting treatments for neurologic diseases. Many of these treatments are also likely to have uses for people without disease. Here, I review the ways in which medicine might make bodies and brains function better by modulating motor, cognitive, and affective systems. These potential "quality of life" interventions raise ethical concerns, some related to the individual and others related to society. Despite these concerns, I argue that major restraints on the development of cosmetic neurology are not likely. Neurologists and other clinicians are likely to encounter patient-consumers who view physicians as gatekeepers in their own pursuit of happiness.

Enhanced therapeutic efficacy of a novel liposome-based formulation of SN-38 against human tumor models in SCID mice

SN-38 is an active metabolite of CPT-11. The poor solubility of SN-38 in any pharmaceutically acceptable solvent and pH-dependent activity has limited its clinical use. Our objective was to evaluate an easy-to-use liposome-based formulation of SN-38 (LE-SN38) and compare the antitumor activity with its pro-drug CPT-11 against cancer cell lines and human xenograft tumor models. The cytotoxicity of LE-SN38 and CPT-11 was determined in four human cancer cell lines using the sulforhodamine B assay. The therapeutic efficacy was tested against human colon (HT-29) and breast (MX-1) xenograft tumor models in SCID mice. LE-SN38 with greater than 95% drug entrapment was found to be highly cytotoxic against four different cell lines with GI50 values of less than 0.1 microM. In the HT-29 tumor model, LE-SN38 (q x d5) at 2, 4 or 8 mg/kg resulted in 33, 81 and 91% tumor growth inhibition, respectively, compared to the drug-free liposome group. In contrast, similar dose levels of CPT-11 treatment led to only 2, 36 and 46% growth inhibition. For the MX-1 model, LE-SN38 (q x d5) regressed tumor growth by 44 and 88% at 4 and 8 mg/kg dose, respectively, whereas no regression was observed in the CPT-11-treated group. We conclude that LE-SN38 is a novel liposome-based formulation with enhanced therapeutic efficacy against human tumor models.

Neuroethical considerations: cognitive liberty and converging technologies for improving human cognition

Developers of NBIC (Nano-Bio-Info-Cogno) technologies face a multitude of obstacles, not the least of which is navigating the public ethics of their applied research. Biotechnologies have received widespread media attention and spawned heated interest in their perceived social implications. Now, in view of the rapidly expanding purview of neuroscience and the growing array of technologic developments capable of affecting or monitoring cognition, the emerging field of neuroethics calls for a consideration of the social and ethical implications of neuroscientific discoveries and trends. To negotiate the complex ethical issues at stake in new and emerging kinds of technologies for improving human cognition, we need to overcome political, disciplinary, and religious sectarianism. We need analytical models that protect values of personhood at the heart of a functional democracy-values that allow, as much as possible, for individual decision-making, despite transformations in our understanding and ability to manipulate cognitive processes. Addressing cognitive enhancement from the legal and ethical notion of "cognitive liberty" provides a powerful tool for assessing and encouraging NBIC developments.

Science and technology integration for increased human potential and societal outcomes

Unifying science based on the material unity of nature at the nanoscale provides a new foundation for knowledge, innovation, and integration of technology. Revolutionary and synergistic advances at the interfaces between previously separated fields of science, engineering and areas of relevance are ready to create nano-bio-info-cogno (NBIC) transforming tools. Developments in systems approach, mathematics, and computation in conjunction with NBIC allow us to understand the natural world and scientific research as closely coupled, complex, hierarchical entities. At this unique moment of scientific and technical achievement, improvement of human performance at individual and group levels, as well as development of suitable revolutionary products, becomes possible and these are primary goals for converging new technologies. NBIC addresses long-term advances in key areas of human activity, including working, learning, aging, group interaction, organizations, and human evolution ((Roco and Bainbridge, 2003)). Fundamentally new tools, technologies, and products will be integrated into individual and social human architecture. This introductory chapter of the Annals outlines research and education trends, funding activities, and the potential of development of revolutionary products and services.

Designing the future: NBIC technologies and human performance enhancement

Never before has any civilization had the unique opportunity to enhance human performance on the scale that we will face in the near future. The convergence of nanotechnology, biotechnology, information technology, and cognitive science (NBIC) is creating a set of powerful tools that have the potential to significantly enhance human performance as well as transform society, science, economics, and human evolution. As the NBIC convergence becomes more understood, the possibility that we may be able to enhance human performance in the three domains of therapy, augmentation, and designed evolution will become anticipated and even expected. In addition, NBIC convergence represents entirely new challenges for scientists, policymakers, and business leaders who will have, for the first time, vast new and powerful tools to shape markets, societies, and lifestyles. The emergence of NBIC convergence will challenge us in new ways to balance risk and return, threat and opportunity, and social responsibility and competitive advantage as we step into the 21st century.

Early convergence research and education supported by the National Science Foundation

The following pages describe research grants awarded by the National Science Foundation that illustrate how different fields of science and technology can converge in order to increase human potential. Technological convergence involves the unification of the sciences of Nanotechnology, Biotechnology, Information Technology, and new technologies based on Cognitive Science (NBIC). Because it supports research across all major branches of science and technology, including the social and behavioral sciences, the NSF has been a focus of discussions about converging technologies to enhance human capabilities and serve human needs.