"There's not enough studies": Views of black breast and ovarian cancer patients on research participation.

BACKGROUND: Black breast and ovarian cancer patients are underrepresented in clinical cancer trials disproportionate to the prevalence of these cancers in Black females. Historically, lower enrollment has been attributed to individualized factors, including medical mistrust, but more recently structural factors, including systemic racism, have received additional scrutiny. We interviewed Black women with a personal or family history of breast and ovarian cancer to understand their views and experiences related to research participation. METHODS: Qualitative interviews were conducted via telephone or video conference and transcribed verbatim. Transcripts were qualitatively analyzed for iterative themes related to the offer and participation in cancer clinical trials and research studies, impact on cancer care, and recommendations to increase enrollment of Black patients. RESULTS: Sixty-one Black women completed an interview. Participants expressed that Black women are underrepresented in cancer research, and that this negatively impacted their own care. Many cited past historical abuses, including the Tuskegee syphilis trial, as a potential factor for lower enrollment but suggested that lower enrollment was better understood in the context of the entirety of their healthcare experiences, including present-day examples of patient mistreatment or dismissal. Participants suggested that proactive community engagement, transparency, and increased representation of Black research team members were strategies likely to foster trust and bolster research participation. CONCLUSION(S): Medical mistrust is only a partial factor in the lower participation of Black patients in cancer research. Researchers should implement the strategies identified by our participants to promote diverse enrollment and ensure that Black patients are included in future therapeutic advances.

Willingness of Women with Endometriosis Planning to Undergo IVF to Participate in a Randomized Clinical Trial and the Effects of the COVID-19 Pandemic on Potential Participation.

The Pre-IVF Treatment with a GnRH Antagonist in Women with Endometriosis (PREGnant) Trial (clinicaltrials.gov no. NCT04173169) was designed to test the hypothesis that 60-day pre-treatment with an oral GnRH antagonist in women with documented endometriosis and planning an IVF cycle will result in a superior live birth rate to placebo. Eight hundred fourteen women are required from 4 national sites. To determine the feasibility of using an electronic medical record (EMR)-based strategy to recruit 204 participants at the Colorado site, we conducted a survey of women within the UCHealth system. Eligible women, identified using relevant ICD-10 codes, were invited to complete a 6-question survey to assess planned utilization of IVF, potential interest in participation, and whether delays in treatment due to COVID-19 would influence their decision to participate. Of 6354 age-eligible women with an endometriosis diagnosis, 421 had a concurrent infertility diagnosis. After eliminating duplicates, 212 were emailed a survey; 76 (36%) responded, 6 of whom reported no endometriosis diagnosis. Of the remaining 70, 29 (41%) were planning fertility treatment; only 19 planned IVF. All 19 expressed interest in participation. COVID-19 delays in treatment were not considered as a factor affecting participation by 8/19; the remaining 11 felt that it would "somewhat" affect their decision. None reported that they would not consider participation because of COVID-19. EMR-based recruitment for an endometriosis clinical trial is feasible although the overall yield of participants is low. Delays in treatment due to COVID-19 did not appear to overly influence potential recruitment.

Del discurso capitalista al neoliberalismo: apuntes sobre la producción del sujeto / From capitalist discourse to neoliberalism: notes on the production of the subject

Las economías globalizadas de mercado conllevan consecuencias de inequidad social basadas en la privatización de sectores laborales y productivos donde los sujetos se involucran en modos singulares de concebirse y construir la realidad. Propone el psicoanálisis lacaniano que el discurso capitalista deshace el lazo social, al obrar con una lógica que consiste en gozar del consumo que supone felicidad. El neoliberalismo promueve un sistema aparentemente horizontal que incorpora las capacidades empoderadas del sujeto promoviéndolo a ser emprendedor y, por tanto, convirtiendo a cada uno en gestor de su propio bienestar pero impedidos para forjar lazos solidarios. No porque el sujeto pueda consumir más, queda desprovisto de su falta constitutiva; paradójicamente, la subjetividad neoliberal reproduce incesantemente un vacío que socava el reconocimiento de las diferencias del otro

Globalized market economies entail consequences of social inequality, based on the privatization of labor and productive sectors, where subjects engage in unique ways of conceiving and constructing reality. Lacanian psychoanalysis proposes that capitalist discourse undoes the social bond, by acting with a logic that consists in enjoying the consumption that supposes happiness. Neoliberalism promotes an apparently horizontal system that incorporates the empowered capacities of the subject by promoting him to be an entrepreneur and, therefore, turning each one into a manager of his own well-being, but prevented from forging solidarity ties. Not because the subject can consume more, he is devoid of his constitutive lack; paradoxically, neoliberal subjectivity incessantly reproduces a vacuum that undermines the recognition of each other's differences.

Research Involving Participants With Impaired Consent Capacity: An Examination of Methods to Determine Capacity to Consent.

OBJECTIVE: To examine methods of assessing consent capacity in research protocols involving participants with impaired consent capacity, and examine instruments used to evaluate research consent capacity. METHODS: A retrospective review of 330 active research protocols involving participants lacking capacity to consent over a 10-year period (January 1, 2009, through March 1, 2019) was conducted to collect protocol characteristics (medical specialty, level of risk and type of study, consent and assent procedures, and type of vulnerable or protected population). Methods to assess consent capacity are described, and instruments to assess consent capacity are summarized. RESULTS: The specialties most frequently involving participants with impaired consent capacity in research were Neurology (27.3%), Critical Care (16.7%), and Surgery (10%). Type of studies are observational (43.9%), clinical trials (33%), chart review (11.5%), biobank (6.1%), and biomarker (5.5%). Minimal risk (53.3%) outnumbered greater than minimal risk (46.7%) studies. Most obtained written informed consent (77%) and assent (40.9%). The most common method to assess consent capacity was direct assessment by investigators (32.7%). Only 86 (26%) studies used instruments to assess consent capacity. Of the 13 instruments used, the most common was the Evaluation of Decision-Making Capacity for Consent to Act as a Research Subject, and is the only instrument that assesses all four components of decisional capacity: understanding, appreciation, reasoning, and choice. CONCLUSION: Generally, there was lack of uniformity in determining capacity to consent to research participation. Very few studies used instruments to assess consent capacity. Institutional review boards can provide greater guidance for research consent capacity determination.

Effectiveness and Ethics of Incentives for Research Participation: 2 Randomized Clinical Trials.

Importance: Incentivizing research participation is controversial and variably regulated because of uncertainty regarding whether financial incentives serve as undue inducements by diminishing peoples' sensitivity to research risks or unjust inducements by preferentially increasing enrollment among underserved individuals. Objective: To determine whether incentives improve enrollment in real randomized clinical trials (RCTs) or serve as undue or unjust inducements. Design, Setting, and Participants: Two RCTs of incentives that were embedded in 2 parent RCTs, 1 comparing smoking cessation interventions (conducted at smoking cessation clinics in 2 health systems) and 1 evaluating an ambulation intervention (conducted across wards of the Hospital of the University of Pennsylvania) included all persons eligible for the parent trials who did not have prior knowledge of the incentives trials. Recruitment occurred from September 2017 to August 2019 for the smoking trial and January 2018 through May 2019 for the ambulation trial; data were analyzed from January 2020 to July 2020. Interventions: Patients were randomly assigned to incentives of $0, $200, or $500 for participating in the smoking cessation trial and $0, $100, or $300 for the ambulation trial. Main Outcomes and Measures: The primary outcome of each incentive trial was the proportion of people assigned to each recruitment strategy that consented to participate. Each trial was powered to test the hypotheses that incentives served neither as undue inducements (based on the interaction between incentive size and perceived research risk, as measured using a 10-point scale, on the primary outcome), nor unjust inducements (based on the interaction between incentive size and participants' self-reported income). Noninferiority methods were used to test whether the data were compatible with these 2 effects of incentives and superiority methods to compare the primary and other secondary outcomes. Results: There were a total of 654 participants (327 women [50.0%]; mean [SD] age, 50.6 [12.1] years; 394 Black/African American [60.2%], 214 White [32.7%], and 24 multiracial individuals [3.7%]) in the smoking trial, and 642 participants (364 women [56.7%]; mean [SD] age, 46.7 [15.6] years; 224 Black/African American [34.9%], 335 White [52.2%], and 5 multiracial individuals [0.8%]) in the ambulation trial. Incentives significantly increased consent rates among those in the smoking trial in 47 of 216 (21.8%), 78 of 217 (35.9%), and 104 of 221 (47.1%) in the $0, $200, and $500 groups, respectively (adjusted odds ratio [aOR] for each increase in incentive, 1.70; 95% CI, 1.34-2.17; P < .001). Incentives did not increase consent among those in the ambulation trial: 98 of 216 (45.4%), 102 of 212 (48.1%), and 92 of 214 (43.0%) in the $0, $100, and $300 groups, respectively (aOR, 0.88; 95% CI, 0.64-1.22; P = .45). In neither trial was there evidence of undue or unjust inducement (upper confidence limits of ORs for undue inducement, 1.15 and 0.99; P < .001 showing noninferiority; upper confidence limits of ORs for unjust inducement, 1.21 and 1.26; P = .01 and P < .001, respectively). There were no significant effects of incentive size on the secondary outcomes in either trial, including time spent reviewing the risk sections of consent forms, perceived research risks, trial understanding, perceived coercion, or therapeutic misconceptions. Conclusions and Relevance: In these 2 randomized clinical trials, financial incentives increased trial enrollment in 1 of 2 trials and did not produce undue or unjust inducement or other unintended consequences in either trial. Trial Registration: ClinicalTrials.gov Identifier: NCT02697799.

Demographic and Health Behavior Factors Associated With Clinical Trial Invitation and Participation in the United States.

Importance: Representative enrollment in clinical trials is critical to ensure equitable and effective translation of research to practice, yet disparities in clinical trial enrollment persist. Objective: To examine person-level factors associated with invitation to and participation in clinical trials. Design, Setting, and Participants: This cross-sectional study analyzed responses from 3689 US adults who participated in the nationally representative Health Information National Trends Survey, collected February through June 2020 via mailed questionnaires. Exposures: Demographic, clinical, and health behavior-related characteristics. Main Outcomes and Measures: History of invitation to and participation in a clinical trial, primary information sources, trust in information sources, and motives for participation in clinical trials were described. Respondent characteristics are presented as absolute numbers and weighted percentages. Associations between respondent demographic, clinical, and health behavior-related characteristics and clinical trial invitation and participation were estimated using survey-weighted logistic regression models. Results: The median (IQR) age of the 3689 respondents was 48 (33-61) years, and most were non-Hispanic White individuals (2063 [59%]; non-Hispanic Black, 452 [10%]; Hispanic, 521 [14%]), had more than a high school degree (2656 [68%]), were employed (1809 [58%]), and had at least 1 medical condition (2535 [61%]). Overall, 439 respondents (9%) had been invited to participate in any clinical trial. Respondents with increased odds of invitation were non-Hispanic Black compared with non-Hispanic White (adjusted odds ratio [aOR], 1.85; 95% CI, 1.13-3.02), had greater than a high school education compared with less than high school education (eg, ≥college degree: aOR, 4.84; 95% CI, 1.89-12.39), were single compared with married or living as married (aOR, 1.68; 95% CI, 1.04-2.73), and had at least 1 medical condition compared to none (eg, 1 medical condition: aOR, 2.25; 95% CI, 1.32-3.82). Respondents residing in rural vs urban areas had 77% decreased odds of invitation to a clinical trial (aOR 0.33; 95% CI 0.17-0.65). Of invited respondents, 199 (47%) participated. Compared with non-Hispanic White respondents, non-Hispanic Black respondents had 72% decreased odds of clinical trial participation (aOR, 0.28; 95% CI, 0.09-0.87). Respondents most frequently reported "health care providers" as the first and most trusted source of clinical trial information (first source: 2297 [59%]; most trusted source: 2597 [70%]). The most frequently reported motives for clinical trials participation were "wanting to get better" (2294 [66%]) and the standard of care not being covered by insurance (1448 [41%]). Conclusions and Relevance: The findings of this study suggest that invitation to and participation in clinical trials may differ by person-level demographic and clinical characteristics. Strategies toward increasing trial invitation and participation rates across diverse patient populations warrant further research to ensure equitable translation of clinical benefits from research to practice.

Exploring the impact of COVID-19 on the willingness of older adults to participate in physiology research: views from past and potential volunteers.

We explored the views of older (≥65 years) past and potential volunteers in regard to participating in physiology research during the COVID-19 pandemic. Using an online questionnaire and focus groups, we found that past volunteers (n = 55) were more likely to take part in both acute (p < 0.05) and chronic (p < 0.05) physiology studies, compared with potential future volunteers (n = 57). Both cohorts demonstrated a positive attitude towards volunteering during the COVID-19 pandemic, although concern was evident. Novelty: Volunteers demonstrated a positive attitude and also concern towards participating in physiology research during COVID-19.

O próximo e o ódio: questões da psicanálise na atualidade / The neighbour and the hatred: Our time psychoanalysis' issues / El prójimo y el odio: cuestiones de psicoanálisis en la actualidad

Na contemporaneidade, acirram-se os efeitos estruturais do mal-estar da civilização discutidos por Freud. Nos deteremos naquele que advém da relação com o próximo. Quando a pulsão de morte reproduz uma forma de insatisfação reiterada, o tratamento desse excesso pode recair sobre o corpo do outro que guarda uma diferença de gozo. A maneira como o gozo íntimo ganha forma de estrangeiro habitando, como o pior, o próximo, configura uma suposição de suspeita que sustenta um modo de laço social. Lacan chega a falar que, na matriz de toda fraternidade, está a segregação. Formamos comunidades de gozo e excluímos toda a forma diferente de satisfação que nos ameace. Na atualidade, com o acúmulo do capital, aliado aos efeitos do avanço científico, algo se modificou no laço social e produziu, dessa matriz, uma nova gramática de inimigo, que denominamos sujeito suposto suspeito como um dos nomes do pior. Contra essa lógica, a emancipação e as saídas possíveis que a psicanálise aponta para uma vida em-comum, na solidão da responsabilidade do gozo de cada um, dizem respeito às soluções éticas que enfrentam, desde dentro, todo o idealismo superegóico.

In contemporary times, the structural effects discussed by Freud in the malaise of civilization are intensified. We will dwell on what comes from the relationship with the neighbor. When the death drive reproduces a form of repeated dissatisfaction, the treatment for this excess can fall on the body of the other who has a different satisfaction. The way intimate satisfaction takes shape as a foreigner inhabiting, like the worst, the neighbor, determines an assumption of suspicion that supports a mode of social bonding. Lacan even says that segregation is in the matrix of all fraternity. We create communities of satisfaction and exclude any different form of enjoyment that threatens us. Currently, the accumulation of capital mixed with the effects of scientific advancement brought changes to social bonding and produced, from this matrix, a new grammar for what's enemy. Suspected subject is a naming for the worse. Against this logic, the emancipation and the possible solutions that psychoanalysis suggests for a life in common, in the solitude and responsibility of each one's satisfaction, concerns the ethical solutions that face, from within, all the superegoic idealism.

En los tiempos contemporáneos, los efectos estructurales del malestar de la civilización discutidos por Freud se intensifican. Nos detendremos en el que proviene de la relación con los demás. Cuando el pulsion de la muerte reproduce una forma de insatisfacción repetida, el tratamiento de este exceso puede recaer en el cuerpo del otro, que tiene una diferencia de goce. El goce íntimo es proyectado como extranjero habitando en el prójimo, como si encarnara lo peor que proyectaba sobre él, configura una presunción de sospecha que sustenta un modo de vínculo social. Lacan llega al extremo de decir que la segregación está en el corazón de cada fraternidad. Formamos comunidades de goce y excluimos cualquier forma diferente de satisfacción que nos amenace. Hoy en día, con la acumulación de capital, combinada con los efectos del avance científico, algo ha cambiado en el vínculo social y ha producido, a partir de esta matriz, una nueva gramática del enemigo, que llamamos el sujeto supuesto sospechoso como uno de los nombres de lo peor. Contra esta lógica, la emancipación y las posibles soluciones que apunta el psicoanálisis en una vida común, en la soledad de la responsabilidad del goce de cada uno, conciernen a las soluciones éticas que enfrentan, desde adentro, todo idealismo superegoico.

Taming Time: Configuring Cancer Patients as Research Subjects.

This article explores how incurable cancer patients in the affluent Danish welfare state are recruited to clinical trials. We show that patients' impending death constitutes their potential for being configured as research subjects. To produce valuable data, patients who enroll in trials and health care professionals must engage in daily "time practices" that prolong the threshold between life and death. When death becomes inevitable, the limit of configuring dying cancer patients as research subjects is reached. Navigating this temporal logic, health care professionals balance the boundary between patients' instrumental worth as research subjects and their intrinsic worth as dying cancer patients. Whereas previous studies have critically uncovered how clinical trials operate at socioeconomic margins, we point to the ways in which clinical trials operate through temporal margins. We argue that clinical trials are dependent on configuring marginal societal spaces and marginal bodies from which to produce knowledge.

Views on genomic research result delivery methods and informed consent: a review.

There has been little discussion of the way genomic research results should be returned and how to obtain informed consent for this. We systematically searched the empirical literature, identifying 63 articles exploring stakeholder perspectives on processes for obtaining informed consent about return of results and/or result delivery. Participants, patients and members of the public generally felt they should choose which results are returned to them and how, ranging from direct (face-to-face, telephone) to indirect (letters, emails, web-based delivery) communication. Professionals identified inadequacies in result delivery processes in the research context. Our findings have important implications for ensuring participants are supported in deciding which results they wish to receive or, if no choice is offered, preparing them for potential research outcomes.

Unblinding in Randomized Controlled Trials: A Research Ethics Case.

A pregnant woman was enrolled in a double-blind randomized controlled trial (RCT) in which participants were randomized to a placebo or a drug being tested to prevent a hypertensive complication. After completing the trial, the research participant insisted on being told which drug she received to prepare for a future pregnancy. This case highlights an element of RCT procedure that has received minimal attention-whether to unblind study participants at the end of their participation. Given that unblinding is not standard practice for nonserious adverse events, what actions are justifiable for the investigators to take? To synthesize the information about this case, we used the CASES model, created by the National Center for Ethics in Health Care to analyze ethics cases. Ethical principles that guide research emphasize communication with participants and the importance of reducing harm within the constraints of the scientific goals. Participants may value knowing which drug they received for future health care decision-making. We review information about the benefits and harms of unblinding.

Real-time dialogue between experimenters and dreamers during REM sleep.

Dreams take us to a different reality, a hallucinatory world that feels as real as any waking experience. These often-bizarre episodes are emblematic of human sleep but have yet to be adequately explained. Retrospective dream reports are subject to distortion and forgetting, presenting a fundamental challenge for neuroscientific studies of dreaming. Here we show that individuals who are asleep and in the midst of a lucid dream (aware of the fact that they are currently dreaming) can perceive questions from an experimenter and provide answers using electrophysiological signals. We implemented our procedures for two-way communication during polysomnographically verified rapid-eye-movement (REM) sleep in 36 individuals. Some had minimal prior experience with lucid dreaming, others were frequent lucid dreamers, and one was a patient with narcolepsy who had frequent lucid dreams. During REM sleep, these individuals exhibited various capabilities, including performing veridical perceptual analysis of novel information, maintaining information in working memory, computing simple answers, and expressing volitional replies. Their responses included distinctive eye movements and selective facial muscle contractions, constituting correctly answered questions on 29 occasions across 6 of the individuals tested. These repeated observations of interactive dreaming, documented by four independent laboratory groups, demonstrate that phenomenological and cognitive characteristics of dreaming can be interrogated in real time. This relatively unexplored communication channel can enable a variety of practical applications and a new strategy for the empirical exploration of dreams.

Perspectives of pregnant and breastfeeding women on longitudinal clinical studies that require non-invasive biospecimen collection - a qualitative study.

BACKGROUND: Investigation of the microbiome during early life has stimulated an increasing number of cohort studies in pregnant and breastfeeding women that require non-invasive biospecimen collection. The objective of this study was to explore pregnant and breastfeeding women's perspectives on longitudinal clinical studies that require non-invasive biospecimen collection and how they relate to study logistics and research participation. METHODS: We completed in-depth semi-structured interviews with 40 women who were either pregnant (n = 20) or breastfeeding (n = 20) to identify their understanding of longitudinal clinical research, the motivations and barriers to their participation in such research, and their preferences for providing non-invasive biospecimen samples. RESULTS: Perspectives on research participation were focused on breastfeeding and perinatal education. Participants cited direct benefits of research participation that included flexible childcare, lactation support, and incentives and compensation. Healthcare providers, physician offices, and social media were cited as credible sources and channels for recruitment. Participants viewed lengthy study visits and child protection as the primary barriers to research participation. The barriers to biospecimen collection were centered on stool sampling, inadequate instructions, and drop-off convenience. CONCLUSION: Women in this study were interested in participating in clinical studies that require non-invasive biospecimen collection, and motivations to participate center on breastfeeding and the potential to make a scientific contribution that helps others. Effectively recruiting pregnant or breastfeeding participants for longitudinal microbiome studies requires protocols that account for participant interests and consideration for their time.

Incorporating ethics and welfare into randomized experiments.

Randomized controlled trials (RCTs) enroll hundreds of millions of subjects and involve many human lives. To improve subjects' welfare, I propose a design of RCTs that I call Experiment-as-Market (EXAM). EXAM produces a welfare-maximizing allocation of treatment-assignment probabilities, is almost incentive-compatible for preference elicitation, and unbiasedly estimates any causal effect estimable with standard RCTs. I quantify these properties by applying EXAM to a water-cleaning experiment in Kenya. In this empirical setting, compared to standard RCTs, EXAM improves subjects' predicted well-being while reaching similar treatment-effect estimates with similar precision.

How nurses can support the inclusion in research of older people who lack capacity to consent.

Research is important because it underpins evidence-based care. However, people who lack capacity to consent are often excluded from research, due partly to ethical concerns and practical challenges, and partly to a lack of awareness among professionals of the legal framework that supports their inclusion. The COVID-19 pandemic, which has extensively affected care home residents, has reinforced the importance of including older people with cognitive impairment in research. Nurses who care for older people with impaired cognition have an important role in ensuring these people have the opportunity to contribute to and benefit from research. This article discusses some of the challenges associated with the inclusion in research of older people who lack capacity to consent, including the involvement of relatives and friends in decision-making. The article describes the findings of recent research and shares resources with the aim of supporting nurses to ensure that older people in their care who lack capacity can participate in research.

Is Reluctance to Share Alzheimer's Disease Biomarker Status with a Study Partner a Barrier to Preclinical Trial Recruitment?

BACKGROUND: Preclinical Alzheimer's disease clinical trials test candidate treatments in individuals with biomarker evidence but no cognitive impairment. Participants are required to co-enroll with a knowledgeable study partner, to whom biomarker information is disclosed. OBJECTIVE: We investigated whether reluctance to share biomarker results is associated with viewing the study partner requirement as a barrier to preclinical trial enrollment. DESIGN: We developed a nine-item assessment on views toward the study partner requirement and performed in-person interviews based on a hypothetical clinical trial requiring biomarker testing and disclosure. SETTING: We conducted interviews on campus at the University of California, Irvine. PARTICIPANTS: Two hundred cognitively unimpaired older adults recruited from the University of California, Irvine Consent-to-Contact Registry participated in the study. MEASUREMENTS: We used logistic regression models, adjusting for potential confounders, to examine potential associations with viewing the study partner requirement as a barrier to preclinical trial enrollment. RESULTS: Eighteen percent of participants reported strong agreement that the study partner requirement was a barrier to enrollment. Ten participants (5%) agreed at any level that they would be reluctant to share their biomarker result with a study partner. The estimated odds of viewing the study partner requirement as a barrier to enrollment were 26 times higher for these participants (OR=26.3, 95% CI 4.0, 172.3), compared to those who strongly disagreed that they would be reluctant to share their biomarker result. Overall, participants more frequently agreed with positive statements than negative statements about the study partner requirement, including 76% indicating they would want their study partner with them when they learned biomarker results. CONCLUSIONS: This is one of the first studies to explore how potential preclinical Alzheimer's disease trial participants feel about sharing their personal biomarker information with a study partner. Most participants viewed the study partner as an asset to trial enrollment, including having a partner present during biomarker disclosure.

Human vs. machine: the psychological and behavioral consequences of being compared to an outperforming artificial agent.

While artificial agents (AA) such as Artificial Intelligence are being extensively developed, a popular belief that AA will someday surpass human intelligence is growing. The present research examined whether this common belief translates into negative psychological and behavioral consequences when individuals assess that an AA performs better than them on cognitive and intellectual tasks. In two studies, participants were led to believe that an AA performed better or less well than them on a cognitive inhibition task (Study 1) and on an intelligence task (Study 2). Results indicated that being outperformed by an AA increased subsequent participants' performance as long as they did not experience psychological discomfort towards the AA and self-threat. Psychological implications in terms of motivation and potential threat as well as the prerequisite for the future interactions of humans with AAs are further discussed.