Intraoperative application of mixed and augmented reality for digital surgery: a systematic review of ethical issues.

Introduction: Head-mounted displays (HMDs) that superimpose holograms onto patients are of particular surgical interest as they are believed to dramatically change surgical procedures by including safety warning and allowing real-time offsite consultations. Although there are promising benefits of mixed and augmented reality (MR/AR) technologies in surgery, they also raise new ethical concerns. The aim of this systematic review is to determine the full spectrum of ethical issues that is raised for surgeons in the intraoperative application of MR/AR technology. Methods: Five bibliographic databases were searched for publications on the use of MR/AR, HMDs and other devices, their intraoperative application in surgery, and ethical issues. We applied qualitative content analysis to the n = 50 articles included. Firstly, we coded the material with deductive categories derived from ethical frameworks for surgical innovations, complications and research. Secondly, clinical aspects with ethical relevance were inductively coded as ethical issues within the main categories. Thirdly, we pooled the ethical issues into themes and sub-themes. We report our findings according to the reporting guideline RESERVE. Results: We found n = 143 ethical issues across ten main themes, namely patient-physician relationship, informed consent, professionalism, research and innovation, legal and regulatory issues, functioning equipment and optimal operating conditions, allocation of resources, minimizing harm, good communication skills and the ability to exercise sound judgement. The five most prevalent ethical issues are "Need for continuous research and innovation", "Ensuring improvement of the learning curve", "MR/AR enables new maneuvers for surgeons", "Ensuring improvement of comfort, ergonomics, and usability of devices," and "Not withholding MR/AR if it performs better". Conclusions: Recognizing the evidence-based limitations of the intraoperative MR/AR application is of paramount importance to avoid ethical issues, but clinical trials in surgery pose particular ethical risks for patients. Regarding the digital surgeon, long-term impact on human workforce, potentially harmful "negative training," i.e., acquiring inappropriate behaviors, and the fear of surveillance need further attention. MR/AR technologies offer not only challenges but significant advantages, promoting a more equitable distribution of surgical expertise and optimizing healthcare. Aligned with the core principle of social justice, these technologies enable surgeons to collaborate globally, improving training conditions and addressing enduring global healthcare inequalities.

Altered brain network organization in adults with Asperger's syndrome: decreased connectome transitivity and assortativity with increased global efficiency.

Introduction: Autism spectrum disorder (ASD) is a neurodevelopmental disorder that persists into adulthood with both social and cognitive disturbances. Asperger's syndrome (AS) was a distinguished subcategory of autism in the DSM-IV-TR defined by specific symptoms including difficulties in social interactions, inflexible thinking patterns, and repetitive behaviour without any delay in language or cognitive development. Studying the functional brain organization of individuals with these specific symptoms may help to better understand Autism spectrum symptoms. Methods: The aim of this study is therefore to investigate functional connectivity as well as functional network organization characteristics using graph-theory measures of the whole brain in male adults with AS compared to healthy controls (HC) (AS: n = 15, age range 21-55 (mean ± sd: 39.5 ± 11.6), HC: n = 15, age range 22-57 [mean ± sd: 33.5 ± 8.5]). Results: No significant differences were found when comparing the region-by-region connectivity at the whole-brain level between the AS group and HC. However, measures of "transitivity," which reflect local information processing and functional segregation, and "assortativity," indicating network resilience, were reduced in the AS group compared to HC. On the other hand, global efficiency, which represents the overall effectiveness and speed of information transfer across the entire brain network, was increased in the AS group. Discussion: Our findings suggest that individuals with AS may have alterations in the organization and functioning of brain networks, which could contribute to the distinctive cognitive and behavioural features associated with this condition. We suggest further research to explore the association between these altered functional patterns in brain networks and specific behavioral traits observed in individuals with AS, which could provide valuable insights into the underlying mechanisms of its symptomatology.

Pathologies and the Healing of the soul: medical terms as metaphors in philosophy.

This paper critically examines the metaphorical use of medical terms in philosophy. Three examples selected from distinct philosophical contexts demonstrate that such terms have been employed as metaphors both to describe the practice of philosophising and historically to diagnose philosophical positions. The selected examples are (i) the title of Avicenna's main philosophical work, The Book of Healing, (ii) the criticism of medical metaphors in Enlightenment philosophy, and (iii) recent historical diagnoses in philosophy. The underlying epistemological assumptions of all three contexts are reconstructed to critically analyse the medical metaphors. Through this tripartite synopsis, I arrive at a normative conclusions medical metaphors, such as the "healing of the soul" or "pathology of reason", do not stand up to the critique of Enlightenment and are obsolete against the theoretical background of my reference texts.

Historical forerunners of neuropsychiatry: The psychiatric works of Albert W. Adamkiewicz (1850-1921).

Albert Wojciech Adamkiewicz (1850-1821) was a Polish neurologist and researcher who is best known for his description of the so-called Adamkiewicz-artery. In contrast to his achievements in neurology, his research in psychiatry from his time in Vienna (1891-1921) is commonly overlooked. We examined all titles of his publications from 1891 to 1921 and provided a close reading of those works that were related to his research on the neural basis of mental phenomena and disorders. We demonstrate that, in later stages of his scientific career, Adamkiewicz critically engaged with contemporary positions in psychiatry and the psychogenic explanation of mental disorders. He developed a theory based on his neurological research, correlating central theorems of late-nineteenth-century psychiatry to neural networks in the human cortex. These achievements make him a historical forerunner of neuropsychiatric concepts of mental phenomena and disorders.

Access to Healthcare for Minors: An Ethical Analysis of Judgments of the European Court of Human Rights.

The right to non-discriminatory access to healthcare is anchored in the European Convention on Human Rights and other international treaties or guidelines. Since its ratification, the European Convention on Human Rights was made binding in all Member States of the Council of Europe and is interpreted by the European Court of Human Rights (ECtHR). Despite its legal recognition, discrimination in healthcare provision has repeatedly been an issue of medicoethical and political consideration. In this context, minors are particularly in danger of being deprived of this fundamental right. The aim of this study is to analyze the current state of the ECtHR jurisdiction on challenges in accessing healthcare for minor patients. We conducted a systematic search of judgments by the ECtHR using the keywords "healthcare" and "child". We performed descriptive statistics and qualitative thematic analysis. Our search resulted in n = 66 judgments, which were all screened. Access to healthcare for minors played a role in n = 21 judgments, which involved applications against n = 13 countries. We formed five, partially overlapping categories, which represent recurring themes regarding the research topic. These themes are governance failure (n = 11), the status of refugee, asylum seeker or migrant (n = 5), parental home (n = 5), maternity and birth (n = 4) and others (n = 2). The normative framework of the ECtHR's jurisprudence illustrates intersections between social, legal and medicoethical aspects of minors' discrimination in the healthcare system. It emphasizes the particular vulnerability of children, who require exceptional protection. Inadequate access to healthcare manifests itself in specific situations, such as in the context of migration or staying in public institutions. Healthcare professionals need to be sensitized for such discrimination mechanisms, as they are often at the forefront of encountering structural discrimination in the healthcare system.

Auditory Deficits in Audiovisual Speech Perception in Adult Asperger's Syndrome: fMRI Study.

Audiovisual (AV) integration deficits have been proposed to underlie difficulties in speech perception in Asperger's syndrome (AS). It is not known, if the AV deficits are related to alterations in sensory processing at the level of unisensory processing or at levels of conjoint multisensory processing. Functional Magnetic-resonance images (MRI) was performed in 16 adult subjects with AS and 16 healthy controls (HC) matched for age, gender, and verbal IQ as they were exposed to disyllabic AV congruent and AV incongruent nouns. A simple semantic categorization task was used to ensure subjects' attention to the stimuli. The left auditory cortex (BA41) showed stronger activation in HC than in subjects with AS with no interaction regarding AV congruency. This suggests that alterations in auditory processing in unimodal low-level areas underlie AV speech perception deficits in AS. Whether this is signaling a difficulty in the deployment of attention remains to be demonstrated.