Tag: rehabilitation

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Space to grow? Neurological risks of moving to Mars

By Carlie Hoffman
Artistic rendition of a human colony on Mars, image
courtesy of Wikimedia Commons

Humans have been venturing into space for over 50 years. Starting in 1961 when the Russian cosmonaut Yuri Gagarin became the first human to travel into space, by 1969 Neil Armstrong, Michael Collins, and Buzz Aldrin became the first humans on the moon, and by 1998 the International Space Station had launched its first module. More recently our exploration of space has started to reach new heights, with 2011 seeing the launch of the Mars One company and its mission to produce the first human colony on Mars by 2033.

Despite our half century of space exploration, scientists have only recently started researching the effects of space travel on the brain. The question of what our brains will look like after spending an extended amount of time in space is increasingly pressing with the impending inception of the Mars colony. The first group of Mars colonists are expected to begin training later this year and will undergo 14 years of training before departing Earth in 2031 and finally landing on Mars in 2032. Though establishing a human colony on Mars will be another giant leap for mankind, will the colonists that travel to and live on Mars have the same brains as when they left Earth? 

Scientists have known for some time that space travel is hard on the body. As astronauts become farther away from Earth, the pull coming from Earth’s gravitational field becomes weaker and astronauts experience weightlessness; however, the human body is not designed to live in a weightless state.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

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Embryonic stem cells treatment is used to treat spinal cord injury with apparent success

Doctors are careful not to predict Boesen’s future progress

Keck Medical Centre of the University of Southern California (USC, United States) announced that a team of doctors from the Center became the first in California to inject an experimental treatment made from stem cells, AST-OPC1, into the damaged cervical spine of Kris Boesen, a recently paralysed 21-year-old man, as part of a multicentre clinical trial (see HERE). Leading the surgical team, and working in collaboration with Rancho Los Amigos National Rehabilitation Center and Keck Medicine, Charles Liu, director of the USC Neurorestoration Center, injected an experimental dose of 10 million AST-OPC1 cells directly into Boesen’s cervical spinal cord in early April. Two weeks after the surgery, Boesen began to show signs of improvement . Three months later, he is able to feed himself, use his mobile phone, write his name, operate a motorised wheelchair and hug his friends and family. Improved sensation and movement in both arms and hands also makes it easier for him to take care of himself, and to imagine a life lived more independently. AST-OPC1 cells are made from embryonic stem cells by carefully converting them into oligodendrocyte progenitor cells (OPCs), which are cells found in the brain and spinal cord that support the healthy functioning of nerve cells.  Doctors are careful not to predict Boesen’s future progress, see original article in https://stemcell.usc.edu/2016/09/07/paralyzed-man-regains-use-of-arms-and-hands-after-experimental-stem-cell-therapy-at-keck-hospital-of-usc/.

Bioethical assessment.

From a bioethical point of view, it should not be forgotten that embryonic stem cells have been used in these experiments, which adds an unquestionable ethical difficulty.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

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Embryonic stem cells treatment is used to treat spinal cord injury with apparent success

Doctors are careful not to predict Boesen’s future progress

Keck Medical Centre of the University of Southern California (USC, United States) announced that a team of doctors from the Center became the first in California to inject an experimental treatment made from stem cells, AST-OPC1, into the damaged cervical spine of Kris Boesen, a recently paralysed 21-year-old man, as part of a multicentre clinical trial (see HERE). Leading the surgical team, and working in collaboration with Rancho Los Amigos National Rehabilitation Center and Keck Medicine, Charles Liu, director of the USC Neurorestoration Center, injected an experimental dose of 10 million AST-OPC1 cells directly into Boesen’s cervical spinal cord in early April. Two weeks after the surgery, Boesen began to show signs of improvement . Three months later, he is able to feed himself, use his mobile phone, write his name, operate a motorised wheelchair and hug his friends and family. Improved sensation and movement in both arms and hands also makes it easier for him to take care of himself, and to imagine a life lived more independently. AST-OPC1 cells are made from embryonic stem cells by carefully converting them into oligodendrocyte progenitor cells (OPCs), which are cells found in the brain and spinal cord that support the healthy functioning of nerve cells.  Doctors are careful not to predict Boesen’s future progress, see original article in https://stemcell.usc.edu/2016/09/07/paralyzed-man-regains-use-of-arms-and-hands-after-experimental-stem-cell-therapy-at-keck-hospital-of-usc/.

Bioethical assessment.

From a bioethical point of view, it should not be forgotten that embryonic stem cells have been used in these experiments, which adds an unquestionable ethical difficulty.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

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A Matter of Life and Death

Guest Post by Professor Lynn Turner-Stokes

Re: A matter of life and death – controversy at the interface between clinical and legal decision-making in prolonged disorders of consciousness

In an article published in the JME, I highlight the confusion that exists amongst many clinicians, lawyers and members of the public about decisions with withdraw life-sustaining treatments from patients in permanent vegetative and minimally conscious states.

Recent improvements in acute care for patient who have suffered catastrophic brain injury undoubtedly save lives. However, some patients who would otherwise have died now survive but remain profoundly disabled. Many patients experience a brief period of unconsciousness (or ‘coma’) lasting a few days or weeks. However, an unfortunate few with very severe brain injury remain in a vegetative and minimally conscious state (VS/MCS) for many months – or in some cases permanently.

Unfortunately the lay press, and even much of the medical literature, tends to conflate VS/MCS with coma, but they are in fact very different. Coma is a state of ‘unrousable unresponsiveness’ from which the patient cannot be awakened. It rarely persists for more than a few days or weeks, as the large majority of patients will either die or start to regain consciousness. Patients in VS or MCS are awake, but have either very limited awareness of themselves and their environment (MCS), or none at all (VS). With supportive treatment, many will live in these states for a decade or more.

Patients in VS/MCS are unable to make decisions regarding their care and treatment. The Mental Capacity Act 2005 (MCA) provides a framework for clinicians to make ‘best interests’ decisions for them, working with family members to take into account the patient’s own likely wishes, values and beliefs.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

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In the Journals – December 2016, Part I by Livia Garofalo

Here is the first part of our December article roundup. Three journals have special issues this month (abstracts in the post below):

Enjoy reading (and what’s left of the holidays)!

American Anthropologist

The Contingency of Humanitarianism: Moral Authority in an African HIV Clinic

Betsey Behr Brada

One consequence of the recent expansion of anthropological interest in humanitarianism is the seeming obviousness and conceptual stability of “humanitarianism” itself. In this article, I argue that, rather than being a stable concept and easily recognizable phenomenon, humanitarianism only becomes apparent in relation to other categories. In short, humanitarianism is contingent: it depends on circumstance and varies from one context to another. Furthermore, its perceptibility rests on individuals’ capacity to mobilize categorical similarities and distinctions. One cannot call a thing or person “humanitarian” without denying the humanitarian character of someone or something else. Drawing on research conducted in clinical spaces where Botswana’s national HIV treatment program and private US institutions overlapped, I examine the processes by which individuals claimed people, spaces, and practices as humanitarian, the contrasts they drew to make these claims, and the moral positions they attempted to occupy in the process. More than questions of mere terminology, these processes of categorization and contradistinction serve as crucibles for the larger struggles over sovereignty, inequality, and the legacies of colonialism that haunt US-driven global health interventions.

Scripting Dissent: US Abortion Laws, State Power, and the Politics of Scripted Speech

Mara Buchbinder

Abortion laws offer a point of entry for “the state” to intervene in intimate clinical matters.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

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We Launched a New Website! Surrogacy360

Members of Women’s Rehabilitation Center in Nepal lead community discussions on international surrogacy

This blog was cross-posted from Our Bodies, Our Blog, the blog of Our Bodies, Ourselves.

As the journey to create a family takes more individuals and couples outside their own country in search of less-expensive surrogacy arrangements, it’s easy to find websites offering, for a fee, to broker such arrangements – and difficult to find information not tied to commercial interests. 

Want to know what’s even harder? Finding informative analysis that’s completely transparent about the process and the risks facing all parties: intended parents, paid egg providers, surrogates (or gestational mothers), and children.

In an effort to fill this information gap, Our Bodies Ourselves teamed up with the Center for Genetics and Society to develop Surrogacy360.org, an educational website that provides factual information for people considering parenthood through international commercial surrogacy.

The site launched today. We hope you’ll take a look and send us your feedback.

Why Surrogacy360 – and why now? From women in Central America and South Asia – often marginalized socially, politically, and financially in their community – to educated young women in the United States recruited for genes/eggs perceived as superior, increasing numbers of women are becoming involved in contractual third-party reproduction. The market for their services is global, largely unregulated, and growing. This is leaving a dangerous vacuum, in which women on all sides are persuaded by financial and other incentives in the absence of safety data and redress.

At the other end of these arrangements, there are accounts of intended parents (those that hire gestational mothers) being duped by fertility clinics and recruiting agents.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

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A Good Death: Towards Alternative Dementia Personhoods

By Melissa Liu
Melissa is a Medical Anthropology PhD student at the U. of Washington, Seattle. Her nascent research circles the intersection of neuroscience, dementia, and design. Melissa is also a Neuroethics Fellow with the Center for Sensorimotor Neural Engineering, an NSF ERC.  
Something is amiss. Why is there a neighborhood of houses within this assisted living facility? Why do all the houses in the neighborhood have the same 1950s design? Am I standing on carpet? It looks like a garden path. The ceiling feels like a sunset in real time. [1] Where am I? When is this? The questions above are inspired by Lantern, one of several memory care facilities in Ohio based on a patent-pending memory care program created by Jean Makesh where rehabilitation is the goal [2] [3]. However, many more models around the world are based on Reminiscence therapy, a type of therapy which technically has “[no] single definition” but generally “[involves] the recalling of early life events and interaction between individuals” [4]. Research shows that “Reminiscence therapy is used extensively in dementia care and evidence shows when used effectively it helps individuals retain a sense of self-worth, identity and individuality” [4].

Reminiscence therapy serves as the foundation of many types of dementia village (DV) iterations. DV and similarly designed places are based on various models of caregiving and therapies. DV are memory care communities designed with the goal of caring for residents with dementia who live in their personal memories. The communities are designed to provide spaces for a high degree of reminiscence that allows freedom for residents to live their realities.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

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Musings on the Materiality of Health Care by Cristina A. Pop

Nightstand in a psychiatry hospital from Alba-Iulia, Romania. The picture was taken by Odeta Catana in November 2014, as part of a project initiated by the Center for Legal Resources. Reproduced with permission.

In October of 2014, Romanian mass-media featured the local story of a few dozen citizens—most of them Orthodox nuns—refusing their newly issued state health insurance cards, on the grounds that the term card imprinted on the card would spell, when read backwards, drac—the Romanian word for “devil.” It seemed that the nuns, along with a few Orthodox priests and monks and other laymen, rejected the cards because they saw in them instruments of population control imbued with malefic powers. In their view, anyone who would accept the biometric chip-enabled health insurance card would bear the “mark of the beast,” as prophesied in the Christian Book of Revelation. “The beast” would be the computerized data system of global surveillance, whose ultimate aim is to strip humans of their God-bestowed freedom.

Upon reading this news, I was not necessarily astonished by the fact that a narrow demographic group would express such apocalyptically articulated anxieties when facing the biopolitical regimes of health care provision. In Romania, as elsewhere, fundamentalist Orthodox websites disavow various biomedical procedures—like vaccination—on similar grounds, by equating them with receiving “the mark” and by evoking the millennialist opening of the seals that precede the coming of the Antichrist. What did surprise me was the backwards reading of the word card as drac. Why would someone read anything backwards? And how does one get the idea of reading in reverse in the first place?

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

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Special Issue! Nonsecular Medical Anthropology by Anna Zogas

Ian Whitmarsh and Elizabeth F. S. Roberts have edited a Special Issue of Medical Anthropology called “Nonsecular Medical Anthropology.”  Here is an excerpt from their introduction to the issue, along with the abstracts of its commentary and six articles.  Enjoy!

Nonsecular Medical Anthropology (open access)
Ian Whitmarsh & Elizabeth F. S. Roberts

A nonsecular medical anthropology insists on the ways medicine and science have constituted ‘the secular’ itself through the ‘secular self’—how medical knowing has been used to craft the secular political subject. As James Boon noted, too often in social theory, “religion gets safely tucked away—restricted theoretically to ‘meaning’ rather than power” (1998:245). The authors of the six articles in this special issue ‘untuck’ religiosity from within the norms and numbers of medicine itself, and examine how ‘secular’ medicine has relied on religious traditions to produce political secularity. These articles demonstrate that ‘secular’ medicine relies on religious others whose exclusion bespeaks latent religious commitments of citizenship in the modern political realm of health.

In the past few decades, anthropologists of religion and secularity have provided a vigorous critique of the liberal political subject constituted through the distinction between the secular and the religious (Asad 2003; Mahmood 2005). Meanwhile medical anthropologists have developed tools to examine how medicine constitutes the human. With this special issue, we draw together insights from both these literatures to query the relationship between the secular and health, medicine, and the body.

Gods, Germs, and Petri Dishes: Toward a Nonsecular Medical Anthropology (open access)
Elizabeth F. S. Roberts

This commentary calls on medical anthropology to become programmatically non-secular.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

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Special Issue! Practical Anthropology for a Global Public Psychiatry by Anna Zogas

A very exciting special issue of Transcultural Psychiatry has just been published: Practical Anthropology for a Global Public Psychiatry: Provocations and Future Directions is edited by Neely Myers, Rebecca Lester, and Kim Hopper. Here are the abstracts!

Reflections on the anthropology of public psychiatry: The potential and limitations of transdisciplinary work
Neely Myers, Rebecca Lester, and Kim Hopper 

Transcultural psychiatry and anthropology have long championed the comparative study of emotional distress to better understand how people experience, interpret, and manage extraordinary mental events and emotional quandaries around the globe. This special issue brings together practitioners, scholars, and experts from both disciplines working at the intersections of the community and the clinic, the personal and the social, the local and the global, to ask: where does this effort currently stand? We hope this collection of articles will serve as a bellwether selection of provocations and future directions for transdisciplinary research in psychiatric anthropology.

Much research on the mental health system in the US, at least, skirts the sprawling, fragmented, poorly mapped terrain of “de facto” services—a motley array of institutional arrangements claiming to offer custody and care, such as jails, prisons, detention facilities, residential institutions for teenagers, homeless shelters, and a variety of quasi-institutions for the deaf, blind, and elderly. Rather than avoiding these settings, the researchers contributing to this issue reflect on the challenging work of engaging intimately with interlocutors living with these conditions. We use the term “public psychiatry” to refer to this ad hoc, patch-worked, and ill-monitored system. Unlike “public health,” as we use the term here, public psychiatry encompasses not populations but structures: state, private, and informal configurations of care, the surrogates of care and the default options offered when care is unavailing.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.