The use of virtual humans holds the potential for interactive, automated interaction in domains such as remote communication, customer service, or public announcements. For signed language users, signing avatars could potentially provide accessible content by sharing information in the signer's preferred or native language. As the development of signing avatars has gained traction in recent years, researchers have come up with many different methods of creating signing avatars. The resulting avatars vary widely in their appearance, the naturalness of their movements, (...) and facial expressions—all of which may potentially impact users' acceptance of the avatars. We designed a study to test the effects of these intrinsic properties of different signing avatars while also examining the extent to which people's own language experiences change their responses to signing avatars. We created video stimuli showing individual signs produced by a live human signer, an avatar made using computer-synthesized animation, and an avatar made using high-fidelity motion capture. We surveyed 191 American Sign Language users, including Deaf, Hard-of-Hearing, and Hearing groups. Participants rated the three signers on multiple dimensions, which were then combined to form ratings of Attitudes, Impressions, Comprehension, and Naturalness. Analyses demonstrated that the Mocap avatar was rated significantly more positively than the CS avatar on all primary variables. Correlations revealed that signers who acquire sign language later in life are more accepting of and likely to have positive impressions of signing avatars. Finally, those who learned ASL earlier were more likely to give lower, more negative ratings to the CS avatar, but we did not see this association for the Mocap avatar or the Human signer. Together, these findings suggest that movement quality and appearance significantly impact users' ratings of signing avatars and show that signed language users with earlier age of ASL acquisition are the most sensitive to movement quality issues seen in computer-generated avatars. We suggest that future efforts to develop signing avatars consider retaining the fluid movement qualities integral to signed languages. (shrink)

Exposure is key element of photography as well as in the relationship between the category of regime and the subjects it entails. This article sets out to re-examine the characteristics of exposure across these different contexts and on the basis of Jean-Luc Nancy’s thought. The article focuses on the relation between the practice of photography and civil actions pursued by human rights organizations. Combining theoretical ­considerations, analysis of photographs and interviews with human rights workers, the article points to the key (...) role that exposure plays in civic action and seeks to articulate its complexity. Adopting an ­interdisciplinary methodology, the article argues that exposure is no simple relation between an ‘exposer’ and that which is ‘exposed’, but, rather, that as a process exposure reveals complex social political dynamics which defy ­conventional binary determinations of such relations. (shrink)

This article explores the relationship between political freedom and collaboration in the work of human rights organizations. I focus here on the ethical and political implications involved in the production of evidence once the documenting tool, the camera, is in the hands of an engaged civilian rather than a bystander, such as a photojournalist. By examining cases in the Occupied Palestinian Territories where the Palestinians are the photographers of human rights violations, I outline the relations and tensions between emancipatory acts (...) and collaboration via visual information production. Human rights organizations laud new technology and celebrate the participation of those afflicted by such violations in knowledge production as a form of empowerment, and those afflicted may experience the visual practice as a mode of self-representation. But inevitably such a practice is based on collaborative action. In the Israeli/Palestinian conflict case study below, such collaboration has negative effects, which impinge upon the emancipatory features of this mode of documenting. (shrink)

Background Voluntary assisted dying became lawful in Victoria, the first Australian state to permit this practice, in 2019 via the Voluntary Assisted Dying Act 2017 (Vic). While conscientious objection by individual health professionals is protected by the Victorian legislation, objections by institutions are governed by policy. No research has been conducted in Victoria, and very little research conducted internationally, on how institutional objection is experienced by patients seeking assisted dying. Methods 28 semi-structured interviews were conducted with 32 family caregivers and (...) one patient about the experience of 28 patients who sought assisted dying. Participants were interviewed during August-November 2021. Data from the 17 interviews (all with family caregivers) which reported institutional objection were analysed thematically. Results Participants reported institutional objection affecting eligibility assessments, medication access, and taking the medication or having it administered. Institutional objection occurred across health settings and was sometimes communicated obliquely. These objections resulted in delays, transfers, and choices between progressing an assisted dying application and receiving palliative or other care. Participants also reported objections causing adverse emotional experiences and distrust of objecting institutions. Six mediating influences on institutional objections were identified: staff views within objecting institutions; support of external medical practitioners and pharmacists providing assisted dying services; nature of a patient’s illness; progression or state of a patient’s illness; patient’s geographical location; and the capability and assertiveness of a patient and/or caregiver. Conclusions Institutional objection to assisted dying is much-debated yet empirically understudied. This research found that in Victoria, objections were regularly reported by participants and adversely affected access to assisted dying and the wider end-of-life experience for patients and caregivers. This barrier arises in an assisted dying system that is already procedurally challenging, particularly given the limited window patients have to apply. Better regulation may be needed as Victoria’s existing policy approach appears to preference institutional positions over patient’s choice given existing power dynamics. (shrink)

Background In June 2016, Canada legalized medical assistance in dying (MAiD). From the outset, some healthcare institutions (including faith-based and non-faith-based hospitals, hospices, and residential aged care facilities) have refused to allow aspects of MAiD onsite, resulting in patient transfers for MAiD assessments and provision. There have been media reports highlighting the negative consequences of these “institutional objections”, however, very little research has examined their nature and impact. Methods This study reports on findings from 48 semi-structured qualitative interviews conducted with (...) MAiD assessors and providers, MAiD team members (working to coordinate care and lead MAiD programs in institutions and health authorities), and family caregivers on their experiences with institutional objection. Participants were recruited from the Canadian provinces of British Columbia, Ontario, and Nova Scotia. Data were analyzed using inductive thematic analysis. Results Themes identified were: (1) basis for institutional objection (with objections commonly rooted in religious values and a particular philosophy of palliative care); (2) scope of objection (demonstrating a wide range of practices objected to); (3) lack of transparency regarding institutional position; (4) impacts on patients; (5) impacts on health practitioners; and (6) catalysts for change. Participants reported that many institutions’ objections had softened over time, lessening barriers to MAiD access and adverse impacts on patients and health practitioners. Participants attributed this positive change to a range of catalysts including advocacy by health practitioners and family members, policymaking by local health authorities, education, and relationship building. Nevertheless, some institutions, particularly faith-based ones, retained strong objections to MAiD, resulting in forced transfers and negative emotional and psychological impacts on patients, family members, and health practitioners. Conclusions This paper adds to the limited evidence base about the impacts of institutional objection and can inform practical and regulatory solutions in Canada and abroad. Reform is needed to minimize the negative impacts on patients, their caregivers, and health practitioners involved in MAiD practice. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Medical Tourism:Crossing Borders to Access Health CareHarriet Hutson Gray (bio) and Susan Cartier Poland (bio)Traveling abroad for one's health has a long history for the upper social classes who sought spas, mineral baths, innovative therapies, and the fair climate of the Mediterranean as destinations to improve their health. The newest trend in the first decade of the twenty-first century has the middle class traveling from developed countries to those (...) with emerging economies to avoid treatment delays, prohibitive costs for life-saving procedures, or simply high costs for elective surgery. Others leave to have access to assisted suicide in countries that have legalized it: Belgium, The Netherlands, and Switzerland. This new era of globalization in health care has arrived without the benefit of international standards, government oversight, or ethical and legal review.Howard Staab, a self-employed carpenter from North Carolina, flew to India for his medically necessary heart surgery, scheduled a side trip to the Taj Mahal, and returned home to work in North Carolina. He spent a total of less than $10,000, instead of the $200,000 required from the local hospital (I, Milstein and Smith 2006).At first blush, the outsourcing of medical care to India seems to be a particular solution for a particular problem. However, the particularity of Mr. Staab is not unique. His experience is emblematic of those patients in the United States with a medical need for major and elective procedures, but who also must bear the total cost of these procedures. These middle-class, under-insured Americans go abroad.In tandem with increasingly aggressive marketing campaigns, American hospitals and companies have begun to leverage their connections in Asia to grow the medical tourism business into a major economic force. What are the consequences of this?Several authors point to the effect on the host country's population, particularly the poor, to be pushed farther down the queue to receive adequate, affordable care. Resources are applied to the foreign trade instead of building the local [End Page 193] medical infrastructure. Another potential problem is the obligation of the home-country physician to provide follow-up care. What are the legal ramifications when the procedure was illegal to begin with? Are there opportunities for redress for medical errors?These factors may be converging into a "perfect storm" for health care in the U.S., in which the potential participation of the major insurance companies in promoting offshore care will be the tipping point in the precarious structure that represents the economic currents in health care. Third-party administrators and self-funded employers may be on the cutting edge in 2009 by providing incentives to employees to travel overseas for care.I. Economic ConsiderationsConnell, John. Medical Tourism: Sea, Sun, Sand and... Surgery. Tourism Management 27: 1093–1100, 2006.As evidence of the interest of traditional tour operators in this newer twist on the industry, the author explores medical tourism as an element of the growth of world tourism. In promoting medical tourism, he urges consideration of such issues as the privatization of health care, the foundational role of technology, and uneven access to health resources.Dunn, Philip. Medical Tourism Takes Flight. H and HN: Hospitals and Health Networks: 40–44, November 2007.Writing for U.S. health care executives, Dunn emphasizes that the reality of medical tourism competes with the local medical center for patients and their insurance dollars in a significant way. He examines the possibility that U.S. insurance plans soon may offer to pay for what is currently a cash only business and that the economic impact to the local medical center could be significant or even devastating.Frontiers of Health Services Management [Selected Articles] 24 (2), Winter 2007.In "Managing Healthcare Services in the Global Marketplace" (pp. 3–18), Bruce J. Fried and Dean M. Harris consider legal, ethical, and financial implications of the international workforce. In "Globalization of Health Care" (pp. 19–30), Lynn Schroth and Ruthy Khawahja point out that the transfer of comprehensive management expertise and intellectual property from U.S. medical centers to international sites is driving the success of collaboration between U.S. and foreign health care centers. In "Is... (shrink)

Billy Idol was the name we gave Ruthie in the hospital in the days immediately after she was born. She had fluorescent white hair, and had she been born to different parents, they might have thought more of it. But both of Ruthie's parents had bleached blond hair as young children. So in the late summer and into the fall of 2006, we happily celebrated the arrival of our second child, little blond baby Ruthie "Billie Idol" Weiss.Like (...) many second-time parents, we doted less. We did not love less, but we were clearly less excited. We were much more exhausted. We also paid a little less attention. Around the time Ruthie turned one month old, Palmer started to tell me about things she had noticed that seemed off. By... (shrink)