Developing an informational tool for ethical engagement in medical tourism

Background

Medical tourism, the practice of persons intentionally travelling across international boundaries to access medical care, has drawn increasing attention from researchers, particularly in relation to potential ethical concerns of this practice. Researchers have expressed concern for potential negative impacts to individual safety, public health within both countries of origin for medical tourists and destination countries, and global health equity. However, these ethical concerns are not discussed within the sources of information commonly provided to medical tourists, and as such, medical tourists may not be aware of these concerns when engaging in medical tourism. This paper describes the methodology utilized to develop an information sheet intended to be disseminated to Canadian medical tourists to encourage contemplation and further public discussion of the ethical concerns in medical tourism.

Methods

The methodology for developing the information sheet drew on an iterative process to consider stakeholder feedback on the content and use of the information sheet as it might inform prospective medical tourists’ decision making. This methodology includes a literature review as well as formative research with Canadian public health professionals and former medical tourists.

Results

The final information sheet underwent numerous revisions throughout the formative research process according to feedback from medical tourism stakeholders. These revisions focused primarily on making the information sheet concise with points that encourage individuals considering travelling for medical tourism to do further research regarding their safety both within the destination country, while travelling, and once returning to Canada, and the potential impacts of their trip on third parties. This methodology may be replicated for the development of information sheets intending to communicate ethical concerns of other practices to providers or consumers of a certain service.

     

Suppression of overt attentional capture by salient-but-irrelevant color singletons

For more than 2 decades, researchers have debated the nature of cognitive control in the guidance of visual attention. Stimulus-driven theories claim that salient stimuli automatically capture attention, whereas goal-driven theories propose that an individual’s attentional control settings determine whether salient stimuli capture attention. In the current study, we tested a hybrid account called the signal suppression hypothesis, which claims that all stimuli automatically generate a salience signal but that this signal can be actively suppressed by top-down attentional mechanisms. Previous behavioral and electrophysiological research has shown that participants can suppress covert shifts of attention to salient-but-irrelevant color singletons. In this study, we used eye-tracking methods to determine whether participants can also suppress overt shifts of attention to irrelevant singletons. We found that under conditions that promote active suppression of the irrelevant singletons, overt attention was less likely to be directed toward the salient distractors than toward nonsalient distractors. This result provides direct evidence that people can suppress salient-but-irrelevant singletons below baseline levels.     

Does direction of walking impact binocular rivalry between competing patterns of optic flow?

When dissimilar monocular images are viewed simultaneously by the two eyes, stable binocular vision gives way to unstable vision characterized by alternations in dominance between the two images in a phenomenon called binocular rivalry. These alternations in perception reveal the existence of inhibitory interactions between neural representations associated with conflicting visual inputs. Binocular rivalry has been studied since the days of Wheatstone, but one recent strategy is to investigate its susceptibility to influences caused by one’s own motor activity. This paper focused on the activity of walking, which produces an expected, characteristic direction of optic flow dependent upon the direction of one’s walking. In a set of experiments, we employed virtual reality technology to present dichoptic stimuli to observers who walked forward, backward, or were sitting. Optic flow was presented to a given eye, and was sometimes congruent with the direction of walking, sometimes incongruent, and sometimes random, except when the participant was sitting. Our results indicate that, while walking had a reliable influence on rivalry dynamics, the predominance of congruent or incongruent motion did not.     

The role of executive attention in object substitution masking

It was long thought that a key characteristic of object substitution masking (OSM) was the requirement for spatial attention to be dispersed for the mask to impact visual sensitivity. However, recent studies have provided evidence questioning whether spatial attention interacts with OSM magnitude, suggesting that the previous reports reflect the impact of performance being at ceiling for the low attention load conditions. Another technique that has been employed to modulate attention in OSM paradigms involves presenting the target stimulus foveally, but with another demanding task shown immediately prior, and thus taxing executive/temporal attention. Under such conditions, when the two tasks occur in close temporal proximity relatively to greater temporal separation, masking is increased. However this effect could also be influenced by performance being at ceiling in some conditions. Here, we manipulated executive attention for a foveated target using a dual-task paradigm. Critically, ceiling performance was avoided by thresholding the target stimulus prior to it being presented under OSM conditions. We found no evidence for an interaction between executive attention load and masking. Collectively, along with the previous findings, our results provide compelling evidence that OSM as a phenomenon occurs independently of attention.     

Distances on hills look farther than distances on flat ground: Evidence from converging measures

Distances on hills are judged as farther than when the same distance is presented on the flat ground. The hypothesized reason for this difference is because perception is influenced by the increased effort required to walk up a hill than to walk the same distance on flat ground. Alternatively, distances presented up a hill might be judged as farther for other, nonperceptual reasons such as bias from demand characteristics. To test whether distances on hills are perceived as farther or are merely judged as farther, we used a variety of measures, including visual matching and blindwalking tasks, and found similar effects across all measures. This convergence is consistent with a perceptual explanation. Second, we mined our data with the goal of making recommendations for future research on this paradigm. Although all of the perceptual measures used showed similar effects, visual matching was the only measure that had good intrasubject reliability. We recommend that future research on this action-specific effect could use any measure unless the research is geared towards individual differences, in which case, only the visual matching measure of perceived distance should be used.     

When kinesthetic information is neglected in learning a Novel bimanual rhythmic coordination

Many studies have shown that rhythmic interlimb coordination involves perception of the coupled limb movements, and different sensory modalities can be used. Using visual displays to inform the coupled bimanual movement, novel bimanual coordination patterns can be learned with practice. A recent study showed that similar learning occurred without vision when a coach provided manual guidance during practice. The information provided via the two different modalities may be same (amodal) or different (modality specific). If it is different, then learning with both is a dual task, and one source of information might be used in preference to the other in performing the task when both are available. In the current study, participants learned a novel 90° bimanual coordination pattern without or with visual information in addition to kinesthesis. In posttest, all participants were tested without and with visual information in addition to kinesthesis. When tested with visual information, all participants exhibited performance that was significantly improved by practice. When tested without visual information, participants who practiced using only kinesthetic information showed improvement, but those who practiced with visual information in addition showed remarkably less improvement. The results indicate that (1) the information is not amodal, (2) use of a single type of information was preferred, and (3) the preferred information was visual. We also hypothesized that older participants might be more likely to acquire dual task performance given their greater experience of the two sensory modes in combination, but results were replicated with both 20- and 50-year-olds.     

Sustained attention to a predictable,unengaging Go/No-Go task shows ongoing development between 6 and 11 years

Response time variability (RTV) is a useful measure of sustained attention; however, little is known about developmental changes in RTV at different temporal frequencies. Thirty-five 6-year-olds, 31 8-year-olds, and 37 10-year-olds completed the fixed-sequence Sustained Attention to Response Task on three occasions, six months apart. Fast Fourier Transform and ex-Gaussian analyses of response time (RT) data assessed momentary fluctuations in RT, gradual changes in RT, and very long responses, thought to reflect attentional control fluctuations, slow-shifting arousal, and infrequent lapses in attention, respectively. A half-by-half analysis measured within-occasion time-on-task effects. The 10-to 11-year-olds performed with less momentary fluctuations in RT, fewer long responses, and fewer commission and omission errors than the younger groups. This group performed well in the first half of the task but showed time-on-task effects on measures of momentary fluctuations in RT, very long responses, target sensitivity (d’), and commission errors. The 6- to 7-year-olds performed less well than the older groups, and showed time-on-task effects, on almost all measures. The 8- to- 9-year-olds mostly performed at an intermediate level compared with the other groups; however, this group performed with a similar level of momentary fluctuations in RT and very long responses as the 6- to 7-year-olds. These findings indicate that there is ongoing maturation of various aspects of sustained attention on a predictable task, with a period of relative stability in performance between 8 and 9 years of age.     

The role of spatial frequency in emotional face classification

Previous studies with emotional face stimuli have revealed that our ability to identify different emotional states is dependent on the faces’ spatial frequency content. However, these studies typically only tested a limited number of emotional states. In the present study, we measured the consistency with which 24 different emotional states are classified when the faces are unfiltered, high-, or low-pass filtered, using a novel rating method that simultaneously measures perceived arousal (high to low) and valence (pleasant to unpleasant). The data reveal that consistent ratings are made for every emotional state independent of spatial frequency content. We conclude that emotional faces possess both high- and low-frequency information that can be relied on to facilitate classification.     

Ensemble coding remains accurate under object and spatial visual working memory load

A number of studies have provided evidence that the visual system statistically summarizes large amounts of information that would exceed the limitations of attention and working memory (ensemble coding). However the necessity of working memory resources for ensemble coding has not yet been tested directly. In the current study, we used a dual task design to test the effect of object and spatial visual working memory load on size averaging accuracy. In Experiment 1, we tested participants’ accuracy in comparing the mean size of two sets under various levels of object visual working memory load. Although the accuracy of average size judgments depended on the difference in mean size between the two sets, we found no effect of working memory load. In Experiment 2, we tested the same average size judgment while participants were under spatial visual working memory load, again finding no effect of load on averaging accuracy. Overall our results reveal that ensemble coding can proceed unimpeded and highly accurately under both object and spatial visual working memory load, providing further evidence that ensemble coding reflects a basic perceptual process distinct from that of individual object processing.     

Headphone screening to facilitate web-based auditory experiments

Psychophysical experiments conducted remotely over the internet permit data collection from large numbers of participants but sacrifice control over sound presentation and therefore are not widely employed in hearing research. To help standardize online sound presentation, we introduce a brief psychophysical test for determining whether online experiment participants are wearing headphones. Listeners judge which of three pure tones is quietest, with one of the tones presented 180° out of phase across the stereo channels. This task is intended to be easy over headphones but difficult over loudspeakers due to phase-cancellation. We validated the test in the lab by testing listeners known to be wearing headphones or listening over loudspeakers. The screening test was effective and efficient, discriminating between the two modes of listening with a small number of trials. When run online, a bimodal distribution of scores was obtained, suggesting that some participants performed the task over loudspeakers despite instructions to use headphones. The ability to detect and screen out these participants mitigates concerns over sound quality for online experiments, a first step toward opening auditory perceptual research to the possibilities afforded by crowdsourcing.