Challenges for Implementing a PTSD Preventive Genomic Sequencing Program in the U.S. Military

There is growing interest in using the quickly developing field of genomics to contribute to military readiness and effectiveness. Specifically, influential military advisory panels have recommended that the U.S. military apply genomics to help treat, prevent, or minimize the risk for post-traumatic stress disorder (PTSD) among service members. This article highlights some important scientific, legal, and ethical challenges regarding the development and deployment of a preventive genomic sequencing (PGS) program to predict the risk of PTSD among military service members

The Fiduciary Relationship Model for Managing Clinical Genomic “Incidental” Findings

This paper examines how the application of legal fiduciary principles (e.g., physicians' duty of loyalty and care, duty to inform, and duty act within the scope of authority), can serve as a framework to promote management of clinical genomic "incidental" or secondary target findings that is patient-centered and consistent with recognized patient autonomy rights. The application of fiduciary principles to the clinical genomic testing context gives rise to at least four physician fiduciary duties in conflict with recent recommendations by the American College of Medical Genetics and Genomics (ACMG). These recommendations have generated much debate among lawyers, clinicians, and bioethicists hence I believe this publication will be of value and interest to your readership

Ethical considerations for integrating multimodal computer perception and neurotechnology

BackgroundArtificial intelligence (AI)-based computer perception technologies (e.g., digital phenotyping and affective computing) promise to transform clinical approaches to personalized care in psychiatry and beyond by offering more objective measures of emotional states and behavior, enabling precision treatment, diagnosis, and symptom monitoring. At the same time, passive and continuous nature by which they often collect data from patients in non-clinical settings raises ethical issues related to privacy and self-determination. Little is known about how such concerns may be exacerbated by the integration of neural data, as parallel advances in computer perception, AI, and neurotechnology enable new insights into subjective states. Here, we present findings from a multi-site NCATS-funded study of ethical considerations for translating computer perception into clinical care and contextualize them within the neuroethics and neurorights literatures.MethodsWe conducted qualitative interviews with patients (n = 20), caregivers (n = 20), clinicians (n = 12), developers (n = 12), and clinician developers (n = 2) regarding their perspective toward using PC in clinical care. Transcripts were analyzed in MAXQDA using Thematic Content Analysis.ResultsStakeholder groups voiced concerns related to (1) perceived invasiveness of passive and continuous data collection in private settings; (2) data protection and security and the potential for negative downstream/future impacts on patients of unintended disclosure; and (3) ethical issues related to patients’ limited versus hyper awareness of passive and continuous data collection and monitoring. Clinicians and developers highlighted that these concerns may be exacerbated by the integration of neural data with other computer perception data.DiscussionOur findings suggest that the integration of neurotechnologies with existing computer perception technologies raises novel concerns around dignity-related and other harms (e.g., stigma, discrimination) that stem from data security threats and the growing potential for reidentification of sensitive data. Further, our findings suggest that patients’ awareness and preoccupation with feeling monitored via computer sensors ranges from hypo- to hyper-awareness, with either extreme accompanied by ethical concerns (consent vs. anxiety and preoccupation). These results highlight the need for systematic research into how best to implement these technologies into clinical care in ways that reduce disruption, maximize patient benefits, and mitigate long-term risks associated with the passive collection of sensitive emotional, behavioral and neural data

Which Results to Return: Subjective Judgments in Selecting Medically Actionable Genes

Background: Advances in genomics have led to calls for returning information about medically actionable genes (MAGs) to patients, research subjects, biobank participants, and through screening programs, the general adult population. Which MAGs are returned affects the harms and benefits of every genetic testing endeavor. Despite published recommendations of selection criteria for MAGs to return, scant data exist regarding how decision makers actually apply such criteria

Lesions of lateral or central amygdala abolish aversive Pavlovian-to-instrumental transfer in rats

Aversive Pavlovian conditioned stimuli (CSs) elicit defensive reactions (e.g., freezing) and motivate instrumental actions like active avoidance (AA). Pavlovian reactions require connections between the lateral (LA) and central (CeA) nuclei of the amygdala, whereas AA depends on LA and basal amygdala (BA). Thus, the neural circuits mediating conditioned reactions and motivation appear to diverge in the amygdala. However, AA is not ideal for studying conditioned motivation, because Pavlovian and instrumental learning are intermixed. Pavlovian-to-instrumental transfer (PIT) allows for the study of conditioned motivation in isolation. PIT refers to the ability of a Pavlovian CS to modulate a separately-trained instrumental action. The role of the amygdala in aversive PIT is unknown. We designed an aversive PIT procedure in rats and tested the effects of LA, BA, and CeA lesions. Rats received Pavlovian tone-shock pairings followed by Sidman shock-avoidance training. PIT was assessed by comparing shuttling rates in the presence and absence of the tone. Tone presentations facilitated instrumental responding. Aversive PIT was abolished by lesions of LA or CeA, but was unaffected by lesions of BA. These results suggest that LA and CeA are essential for aversive conditioned motivation. More specifically, the results are consistent with a model of amygdala processing in which the CS is encoded in the LA and then, via connections to CeA, the motivation to perform the aversive task is enhanced. These findings have implications for understanding the contribution of amygdala circuits to aversive instrumental motivation, but also for the relation of aversive and appetitive behavioral control

Automatic Placement of Genomic Research Results in Medical Records: Do Researchers Have a Duty? Should Participants Have a Choice?

In genomics research, it is becoming common practice to return individualized primary and incidental findings to participants and several ongoing major studies have begun to automatically transfer these results to a participant's clinical medical record. This paper explores who should decide whether to place genomic research findings into a clinical medical record. Should participants make this decision, or does a researcher's duty to place this information in a medical record override the participant's autonomy? We argue that there are no clear ethical, legal, professional, or regulatory duties that mandate placement without the consent of the participant. We conclude that informing participants of results, together with a clear explanation, relevant recommendations and referral sources, and the option to consent to placement in the medical records will best discharge researchers' ethical and legal duties towards participants

Looking for Trouble: Preventive Genomic Sequencing in the General Population and the Role of Patient Choice

Advances in genomics have led to calls for developing population-based preventive genomic sequencing (PGS) programs with the goal of identifying genetic health risks in adults without known risk factors. One critical issue for minimizing the harms and maximizing the benefits of PGS is determining the kind and degree of control individuals should have over the generation, use, and handling of their genomic information. In this article we examine whether PGS programs should offer individuals the opportunity to selectively opt-out of the sequencing or analysis of specific genomic conditions (the menu approach) or whether PGS should be implemented using an all-or-nothing panel approach. We conclude that any responsible scale up of PGS will require a menu approach that may seem impractical to some, but which draws its justification from a rich mix of normative, legal, and practical considerations

La Imagen y la Narrativa como Herramientas de Abordaje Psicosocial en Escenarios de Violencia - Departamento del Cesar, Tolima y Distrito Noord Aruba

La violencia por grupos al margen de la ley es un flagelo que ha vivido la nación colombiana, no solo por las realidades de la violencia física y desplazamientos, que ya en si son un trauma que exige la atención de los diferentes organismos estatales encargado de brindar seguridad a la población, sino por los efectos y secuelas post-trauma. En este sentido se orienta la propuesta de la UNAD Universidad Nacional Abierta y a Distancia de Colombia a través del Diplomado de Profundización Acompañamiento Psicosocial en Escenarios de Violencia. En este estudio se analiza la importancia de “la Imagen y la narrativa como herramientas de abordaje psicosocial en escenarios de violencia”, se elige y realiza el análisis del “caso # 3. Alfredo Campo, desplazado de la comunidad indígena del pueblo nasa” en Colombia Tomado del documento “Voces Relatos de violencia y esperanza en Colombia’’. Se realizaron la formulación de preguntas circulares, reflexivas y estratégicas como herramientas de abordaje psicosocial. Se aborda el Análisis y presentación de tres estrategias de abordaje psicosocial sobre el caso Pandurí. Las estrategias propuestas son; la acción integral, La autorregulación familiar como herramienta de autocuidado al post-trauma caso Pandurí y Estrategia de activación de redes de apoyo. Finalmente se presenta el blog realizado en el paso 3, conclusiones y referencias bibliográficas.Violence by groups outside the law is a scourge that the Colombian nation has experienced, not only because of the realities of physical violence and displacement, which in itself is a trauma that requires the attention of the different state agencies in charge of providing safety to the population, but for the post-trauma effects and consequences. In this sense, the proposal of the UNAD National Open and Distance University of Colombia is oriented through “the Diploma of Deepening Psychosocial Accompaniment in Scenarios of Violence”. In this study, the importance of The Image and the narrative as psychosocial approach tools in violence scenarios is analyzed, the analysis of case # 3 Alfredo Campo, displaced from the indigenous community of the Nasa people, Colombia, is chosen and carried out. Taken from the document "Voices, stories of violence and hope in Colombia". Circular, reflective, and strategic questions were formulated as tools for a psychosocial approach. The Analysis and presentation of three psychosocial approach strategies on the Pandurí case are addressed. The proposed strategies are comprehensive action, family self-regulation as a self-care tool for the post-trauma case of Pandurí and strategy for activating support networks. Finally, the blog made in step 3 is presented, conclusions and bibliographic references