Jul 4 2011
Should Adult Sexting Be Considered for the DSM?

In the wake of the news about the unfortunate events that led to the resignation of Anthony Weiner, aged 46, from the U.S. House of Representatives, we ask: Should adult sexting be considered a deviant behavior worthy of inclusion in the DSM?

Former Rep. Weiner’s fall from grace began when he ac- cidentally posted a link to a lewd photo of himself on a Twitter account that he used to communicate with constituents. He subsequently admitted that he had been sexting both photographs and messages to various women before and during his marriage.

Sexting can be defined as ‘‘sending, receiving, or for- warding sexually explicit messages, photographs, or images via cell phone, computer, or other digital devices.’’1 To date, much of the research has focused on adolescents and young adults, the age group most involved in this activity.

An online survey of undergraduate students found that nearly two-thirds had sexted nude or semi-nude pictures of themselves, mostly to their boyfriend or girlfriend. About a quarter sexted someone they wanted to hook up with or date, and 15% sexted people they had met online only.2 While being sexy or initiating sex were the primary motivations of this group, an earlier pencil-and-paper survey by this same author found that self-expression was a primary motivation.3

Some authors place sexting in the category of cyberbullying,4 which it certainly can be when used by adolescents to harass other teens. But what about adults? Do we know anything about why adults use sexting and if it is associated with other high-risk sexual behaviors?

To date, research to answer this question is limited. One study of young, mostly Hispanic older adolescents and young adults aged 16–25 found that 20% used sexting. The women who used it were slightly more likely to enjoy sex and slightly more likely to exhibit histrionic behavior.5

Perhaps it is just that some politicians lack the internal controls, such as conscience, or the external controls, such as police, to guard against what may be perceived as deviant behavior. Sexting among consenting adults is not a crime, and some adults would not consider sexting with a person other than a spouse ‘‘cheating’’ in a marriage. Others, however, might think that such behavior is a sign of a sex addict. Is it deviant behavior? Is it any different from watching porn movies, with or without your partner?

Mr. Weiner’s lapse of judgment brought to light that, in the age of Facebook and Twitter, cyber privacy cannot be guaranteed. Moreover, as clinical and research professionals, we need to be mindful that other issues may contribute to the reasons why some of our adult clients may engage in sexting.

We believe there is a need for more research on adult sexting. What drives people who are married or in a committed relationship to text sexual messages and photos to someone other than their spouse? Does this behavior vary by gender and age? We need to understand the etiology of and treatment options appropriate for such behaviors.

In the relatively new field of cyberpsychology, we strive to learn about the many challenges of current behavior that social networking makes possible. Certainly, such research will help us to prepare for the many behavioral changes that advances in interactive technology will inspire.

 

References
1. O’Keefe GS, Clarke-Pearson K, Council on Communication and Media. The impact of social media on children, adoles- cents, and families. Pediatrics 2011; 127:800–804.
2. Henderson L. Sexting and sexual relationships among teens and young adults. McNair Scholars Research Journal 2011; 7:31–39. http://scholarworks.boisestate.edu/mcnair_journal/ vol7/iss1/9 (accessed June 26, 2011).
3. Henderson L. Sexting: Self-expression or sexual attention. Boise State University, 2010 Undergraduate Conference, College of Social Sciences and Public Affairs. Poster presentation. http:// scholarworks.boisestate.edu/sspa_10/ (accessed June 26, 2011).
4. Newey KA, Magson N. A critical review of the current cyber bullying research: Definitional, theoretical and methodologi- cal issues. Where do we go from here? Conference Proceed- ings, Australian Association for Research in Education (AARE) International Education Research Conference, Mel- bourne, Nov 28–Dec 2, 2010. www.aare.edu.au/10pap/ 2521NeweyMagson.pdf (accessed June 26, 2011).
5. Ferguson CJ. Sexting behaviors among young Hispanic women: Incidence and association with other high-risk sexual behaviors. The Psychiatric quarterly 2010 [Epub ahead of print] PMID: 21153441.

 

Brenda K. Wiederhold

Editor-in-Chief

CyberPsychology Behavior & Social Networking

http://www.liebertpub.com/overview/cyberpsychology-behavior-and-social-networking/10/

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Jun 6 2011
Who Gets Funding? Let the People Decide

In The Department of Mad Scientists,1 Michael Belfiore offers a glimpse into the workings of the maverick Defense Advanced Research Projects Agency (DARPA), which is re- sponsible for the birth of the Internet and GPS, among other amazing inventions. The small percentage of Americans who know about DARPA may have heard about it because it funds the Grand Challenge Race, with a $2 million prize for the first autonomous robot that makes it through a desert course, avoiding obstacles and following the rules.

‘‘One enormous continuing development is the exponen- tial growth of social networking media and the increasing use of social media by companies to crowdsource ideas, mount contests to award prizes and gather audiences, and attempt to create dialogues with customers,’’ wrote Rosabeth Moss Kanter in her syndicated column toward the end of 2010.2 The following examples illustrate how these new types of contests can work, and provide food for thought about new possi- bilities for research and development funding.

In 2010, Google awarded a total of $10 million to five finalists in its Project 10^100 contest, which solicited ideas for changing the world by helping as many people as possible. From 150,000 ideas submitted by people in 170 countries, Google selected 16 big ideas and let people vote for their favorites.

The Pepsi Refresh Project is looking for great ideas that are going to ‘‘refresh the world.’’ As with traditional grant funding, there are specific grant cycles, applications, and ca- tegories for projects costing from $5,000 to $50,000. What is new is that the project director gets to promote his/her pro- ject through videos and social media such as Twitter and Facebook, and the projects that garner the most votes win. Pepsi awards up to $1.2 million each month for such projects.

A 2011 contest sponsored by Enterprise Rent a Car was called Giving Back. It allowed visitors to its Facebook page to decide among 10 competing charities nominated by En- terprise employees. The first-place winner received $10,000, the second-place winner received $5,000, and the third- and fourth-place winners received $2,500 each. The contest gave Enterprise Rent a Car an opportunity to promote its foun- dation, which gives 75% of its funds to employee-suggested charities.

Talking about the Dockers ‘‘Wear the Pants’’ contest, in which entrants submitted a 400-word business plan and awards were made on the basis of votes from both commu- nity members and a panel of judges, one author3 offers tips for businesses wishing to engage in social media contests:

  •  The best prizes positively affect people’s lives, creating a positive association for the company.
  •  If everyone gets something (e.g., a coupon) for partici- pating, it helps everyone feel included.
  •  Associating with a good cause generates emotional ap- peal and a reason to spread the word.
  •  Running a contest through Facebook keeps visitors there longer, interacting with the company and each other.
  • A ‘‘soft sell’’ approach that mixes branding, sales, and
    contest strategy is appropriate for social media.
  • Identifying how the contest fits into the marketing strategy, devoting sufficient resources, and defining what a successful outcome looks like are essential to thecontest’s success.

CYBER readers may be interested in the results of a recent study,4 which identified seven key components to informa- tion communication and technology (ICT) competitions:

1. Challenge goal—what sponsors hope to achieve (e.g., prompt innovative thinking);
2. Marketing—howandtowhomsponsorsspreadtheword (e.g., conferences, Web site, social networking sites);
3. Application process—how entries are submitted (most are publicly available);
4. Judging criteria—what is used to evaluate applicants (e.g., originality, economic viability);
5. Judging process—the particular mix that determines winners (e.g., external experts, crowdsourcing, presen- tations);
6. Winners—recent winners and their topics (e.g., mobile apps);
7. Supplemental support—what additional support is of- fered to winners (e.g., coaching for pitching ideas to investors).

The authors of this study concluded, ‘‘In general, contests are increasingly being used as a tool to solve society’s most entrenched problems.’’

This leads us to suggest that more government agencies follow DARPA’s lead. Why shouldn’t governments hold con- tests that let the people decide which projects are funded? This could start small, with perhaps one percent of government re- search and development funding allocated to such contests. In these days of American Idol voting and social media-based contests, we suggest that U.S. and European government agencies consider the benefits of letting the people decide.

References
1. Belfiore M. (2009) The Department of Mad Scientists: How DARPA Is Remaking Our World, from the Internet to Artificial Limbs. Washington, DC: Smithsonian.
2. Kanter RM. A promising year for technology and innovation. Harvard Business Review 2010; T19:20:43Z.

3. Cotriss D. Social Campaign Shows the Power of Contests. Small Business Trends, April 21, 2011. http://smallbiztrends.com/ 2011/04/social-campaign-shows-the-power-of-contests.html (accessed May 10, 2011).
4. Arabella Philanthropic Investment Advisors. (2009) Media, in- formation and communication contests: an analysis. Presented to John S. and James L. Knight Foundation. www.knightfoundation .org/dotAsset/356025.pdf (accessed May 10, 2011).

 

Brenda K. Wiederhold

Editor-in-Chief

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Apr 4 2011
What Will It Take to Get IRB Reform?

Although many voices are joining together to call for reform of regulations governing institutional review board (IRB) oversight of research involving human subjects— and some of those voices even agree on how the IRB process should be reformed—progress in the United States toward such reforms is glacial. Unfortunately, the foot-dragging on reform may be costing the United States its leadership role in health research.

Current U.S. regulations governing protection of human subjects have their roots in the 1960s and especially the 1970s, when the National Research Act became law in 1974, spurred by the publicity surrounding the Tuskegee Syphilis Study. In that famous study of black males observed from 1932 to 1972, investigators denied penicillin to infected men. The National Research Act prompted the creation of the National Com- mission for the Protection of Human Subjects of Biomedical and Behavioral Research.1

Now, almost 40 years after enactment of that law, the U.S. health system is evolving faster than the rules to govern it. For example, how do we best regulate comparative effectiveness research (CER)? CER is a hybrid of both clinical trial research, which requires an IRB, and quality improvement processes, which are typically IRB exempt.

Electronic medical records also present a challenge. For example, the President’s Council of Advisors on Science and Technology recently released a report2 that on the one hand recommends personally determined data tagging and stres- ses the need for privacy safeguards, while on the other hand advocating the recommendation of the recent Institute of Medicine report3 to permit greater access to health data to facilitate research.

It is no wonder that the U.S. government provides incon- sistent recommendations. In addition to the Food and Drug Administration, 19 other federal agencies are involved in oversight for protection of study participants. There are more than 6,000 IRBs registered with the Department of Health and Human Services.

Inconsistent outcomes appear to be increasingly likely when the same protocol is presented to different local IRBs, as is common in a multicenter trial.4,5 One study of 88 pediatric practices found that local IRB review appears to be a barrier to participation in research, ‘‘may discourage the inclusion of minority and urban patients, and seems to result in little if any significant change’’ in the (minimal risk) protocols.6 Pogorzelska et al.7 are among the many calling for local IRB reform, including clarification of spe- cific purposes of local review (e.g., ensuring cultural ap- propriateness), assurances that IRB members are trained in regulatory requirements, as well as ethical principles of
research, and consideration of central review mechanisms. This latter is perhaps the most controversial, as national, independent IRBs have been reviewing federally funded research only since 1996.

Five concerns with using an independent IRB are: (a) a perception of increased risk to the institution; (b) possible conflicts of interest among the sponsor, site, investigator, IRB, and IRB member; (c) the importance of local knowledge; (d) logistics between the IRB and the site; and (e) the cost of administrative support. Coleman8 opines that careful evalu- ation of the following factors will lead to appropriate use of independent IRBs: ‘‘the IRB’s reputation and references; composition of the board committee(s) and qualifications of committee members; access to scientific experts; accreditation status; support staff quantity, qualifications, and training; results of regulatory inspections; approval stringency and typical letters; meeting frequency; operational metrics, such as review times; and operating procedures, such as internal auditing and error handling.’’

Regardless of whether a local or independent IRB is used, some say that IRBs concentrate on the wrong things and consequently do not do a good job of protecting the patient. A small    e-mail    survey    (N = 28)    of    principal    investigators9    re- vealed that respondent PIs felt that consent forms were in- comprehensible, that IRBs focused on minutiae, and that they were more concerned with protecting the institution than the subjects. Problem areas and solutions proposed by the In- fectious Diseases Society of America10 not referenced earlier in this editorial include:

  •  Health Insurance Portability and Accountability Act (HIPAA): Remove research from list of HIPAA-covered activities;
  •  Studies including children: Provide updated guidance for key terms, make national review outcomes available and streamline the process;
  • Office of Human Research Protection: Provide increased funding and a clear mandate to produce timely updates in guidance and review.

Another suggestion made by Kim et al.11 is to stop regu- lating minimal risk research, which represents 41% of all new protocols reviewed by U.S. medical center IRBs at a cost of about $300,000 per year for each review.
Many of the solutions suggested by our colleagues are regulatory, not requiring legislation but having the force of law when implemented. Therefore, we urge President Obama to make speedy IRB reform a priority of his administration.
References

1. Khin-Maung-Gyi F. Local and central IRBs: a single mission. Virtual Mentor 2009; 11:317–20.

2. Executive Office of the President, President’s Council of Advisors on Science and Technology. (2010) Report to the President—Realizing the full potential of health informa- tion technology to improve healthcare for Americans: the path forward. www.whitehouse.gov/sites/default/files/ microsites/ostp/pcast-health-it-report.pdf (accessed Mar. 29, 2011).

3. IOM (Institute of Medicine). (2009) Beyond the HIPAA privacy rule: enhancing privacy, improving health through research. Washington, DC: The National Academies Press.

4. Helfand BT, Mongiu AK, Roehrborn CG, et al., MIST Investigators. Variation in institutional review board re- sponses to a standard protocol for a multicenter random- ized, controlled surgical trial. Journal of Urology 2009; 181:2675–9.

5. Stark AR, Tyson JE, Hibberd PL. Variation among insti- tutional review board in evaluating the design of a multi- center randomized trial. Journal of Perinatology 2010; 30: 163–9.

6. Finch SA, Barkin SL, Wasserman RC, et al. Effects of local institutional review board review on participation in na- tional practice-based research network studies. Archives of Pediatrics & Adolescent Medicine 2009; 163:1130–4.

7. Pogorzelska M, Stone PW, Cohn EG, et al. Changes in the institutional review board submission process for multicenter

8. Coleman S. Alternative IRB review. Journal of Clinical Re- search Best Practices 2009; 5(4). http://firstclinical.com/ journal/2009/0904_Alternative.pdf (accessed Mar. 29, 2011).

9. Whitney SN, Alcser K, Schneider CE, et al. Principal inves- tigator views of the IRB system. International Journal of Medical Sciences 2008; 5:68–72.

10. Infectious Diseases Society of America. Grinding to a halt: the effects of the increasing regulatory burden on research and quality improvement efforts. Clinical & Infectious Dis- eases 2009; 49:328–35.

11. Kim S, Ubel P, De Vries R. Pruning the regulatory tree. Nature 2009; 457:534–5.

 

Brenda K. Wiederhold

Editor-in-Chief

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Mar 7 2011
Investment in Innovation: Lessons Learned from China

Investment in Innovation: Lessons Learned from China

President Obama was right to focus on innovation and job creation in his January 2011 State of the Union speech. There is a need to create and fill new jobs in an increasingly competitive global marketplace, and investments in innova- tion will enable businesses using virtual reality and other healthcare technology to be part of a new, much-needed job creation engine.

If U.S. government funding for innovation and education does not increase, China may eclipse the United States in research and development funding within the next 20 years.1 By August 2010, China’s economy had surpassed that of Ja- pan, positioning it as the second-largest economy behind the United States. Some predict that China’s economy will sur- pass that of the United States as early as 2017.2

The United States has enjoyed dominance in innovation for the past 40 years, but that landscape is changing quickly with the globalization of R&D. Not just China but Korea, India, Russia, and Brazil are all investing in R&D at higher rates than the United States, Germany, and Japan.1 Relatively high labor costs in the European Union presage low R&D invest- ments over the next decade, with southern EU states such as Greece, Italy, and Spain investing at a lower rate than their northern counterparts.

Another result of R&D globalization is a reversal of the flow of funds, now flowing from some less developed to more developed countries. For example, China has made investments outside the country in telecommunications, as has India in pharmaceuticals.1

China’s leaders understand the importance of R&D. ‘‘Eight of the nine members of China’s Standing Committee of the Political Bureau, including China’s current President Hu Jintao, have engineering degrees. Of the 15 U.S. cabinet members, only one, Secretary of Energy Steven Chu, has a technical degree—a doctorate in physics.’’3 Consequently, the Chinese government has an innovation policy designed to encourage Chinese companies to create and own tech- nologies. The policy also encourages technology transfer from abroad and establishment of Chinese R&D facilities in exchange for foreign company access to China’s high- volume markets. As a result, a number of multinational technology and pharmaceutical companies have taken ad- vantage of this policy, some transferring facilities from India.

The Chinese government owns all top-ranked academies, including universities, and has tripled its investment in ed- ucation in the past 12 years.3 Of the five million students graduating per year, about one million are research students.

Furthermore, China’s academicians file more patent appli- cations than those in any other country—16% compared to 4% in the United States.

In addition, the Chinese government plays a direct role in investing in 150 companies, providing 27% of their funding in 2007, the latest year for which data are available.3 Universities partner with industry, and about the half the universities’ R&D funding, primary in technology transfer, comes from industry.

In the United States, a recent survey shows that venture capitalists expect their industry to decline over the next 5 years.4 VCs in France, Israel, and the UK also predict a drop, while those in China, Brazil, and India expect growth. What is most discouraging for U.S. business is that most U.S. VCs expect the available amount of venture capital to decrease by at least 30%.

In the United States, small companies—those most in need of venture capital—perform 19% of the nation’s R&D.5 Over the past 25 years, the most dramatic growth in U.S. federal R&D spending has been in health, which accounted for 52% of nondefense R&D in FY2008.

Given the data cited in this editorial, it should come as no surprise that China, India, and Brazil may surpass the United States in innovative healthcare delivery over the next de- cade.6 The United States has the patient populations neces- sary for research, but the rate of growth in financial support and education of researchers has not kept pace with that of developing countries.

President Obama has declared ‘‘innovation in healthcare’’ one of three national priorities for FY2012. With Congress unlikely to approve any initiative that adds to the federal budget deficit, can he deliver on his promises of increased funds for innovation and education?

 

References
1. Battelle. 2011 Global R&D Funding Forecast. R&D Magazine 2010 (Dec), p. 24. www.rdmag.com/uploadedFiles/RD/ Featured_Articles/2010/12/GFF2010_FINAL_REV_small.pdf (accessed Jan. 30, 2011).
2. Euromonitor International. Top 10 largest economies in 2020. Euromonitor Global Market Research Blog 2010 (Jul 7). http:// blog.euromonitor.com/2010/07/special-report-top-10-largest- economies-in-2020.html (accessed Jan. 30, 2011).
3. Battelle. 2011 Global R&D Funding Forecast. R&D Magazine 2010 (Dec), pp. 27–29. www.rdmag.com/uploadedFiles/RD/ Featured_Articles/2010/12/GFF2010_FINAL_REV_small.pdf (accessed Jan. 30, 2011).
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4. Smith R. Venture capitalists in U.S. expect VC industry, funding to shrink. Local Tech Wire 2010 (Jul 14). http:// localtechwire.com/business/local_tech_wire/opinion/blog post/7959577/ (accessed Jan. 30, 2011).
5. National Science Board. Chapter 4. Research and Develop- ment: National Trends and International Linkages. In Na- tional Science Foundation, Division of Science Resources Statistics, Science and Engineering Indicators: 2010, p. 4-4.
6.
www.nsf.gov/statistics/seind10/pdf/c04.pdf (accessed Jan. 30, 2011). PwC Medical Technology Innovation Scorecard Highlights. www .pwc.com/us/en/health-industries/health-research-institute/ innovation-scorecard/index.jhtml (accessed Jan. 30, 2011).
Brenda K. Wiederhold

Editor-in-Chief

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Mar 1 2011
2011 Spring Editorial

Journal of CyberTherapy & Rehabilitation

Spring 2011, Volume 4, Issue 1

 

EDITORIAL

There is an emerging body of literature about the proliferation of social networking sites (SNS) and their effects on mental health. To date, much of it has focused on investigating the possible negative effects of SNS, such as Internet addiction. However, research also supports the benefits of SNS in mental health, addictions, stigmatized identities, trauma and violence recovery, and grief support. As clinicians and researchers, we are just beginning to harness the power of SNS to promote mental well- being.

Participation in SNS has increased dramatically over the past five years. A 2010 Pew report showed that 73% of online teens and 47% of online adults in the U.S. used SNS. Another survey conducted by Pew in April–May 2010 noted that Poland, Britain, and South Korea are close behind the U.S. in SNS usage, followed by France, Spain, Russia, and Brazil. Lower participation in other countries is due primarily to less-wired populations. No table exceptions are Germany and Japan, where Internet usage is high but SNS usage is low.

The European Union has been investing in e-Health since 2004, when outgoing Public Health and Consumer Protection Commissioner David Byrne said, “We need a … Europe where people have easy access to clear and reliable information on how to be in good health and about diseases and treatment options.” An outgrowth of the European Parliament hearing at which he testified was the creation of the ICT (information and communication technologies) for Health, enabling health service providers in different EU member states to work together to exploit these technologies. More recently, the First International E-Mental Health Summit in Amsterdam in 2009 organized by the Trimbos Institute in collaboration with the International Society for Research on Internet Interventions attracted 500 participants from more than 40 countries. In the U.S., the new healthcare reform law provides financial incentives for providers to use health information technology and electronic health records, and in March 2011 leaders in healthcare technology will share their innovations in San Diego and San Francisco, California for the Health 2.0 conference.

In one such innovation, a researcher used a GPS-enabled phone and a location-aware SNS to design a system to help trainees with cognitive impairment who felt lost to find a nearby caregiver. These individuals were enrolled in a supported employment program that provided them with a job coach to help them get to and from work for the first few weeks. The system was programmed to send text messages to the job coach and time and location alarms to help the trainee get to work on time. This type of SNS could enable parents, guardians, and caregivers to watch loved ones unobtrusively.

A recent study of 217 college-age participants in South Korea found that SNS network size was positively related to subjective well-being, and the results suggest that this is due to self-disclosure. In the SNS context, it is postulated that the positive association with well-being results from the self-disclosure “confession effect,” the expectation of mutual self-disclosure, and the expectation of social support.

A case study report found that deploying the Three Good Things positive psychology exercise as a Facebook ap- plication was viable, with a 1% dropout rate, which is similar to or better than other online wellness applications. In the exercise, people post three good things that happened, along with the reasons they think they happened. People found that sharing with others and viewing other’s posts were valuable, as long as they were able to choose which comments they made were public and which were private.

Specialized health SNS such as PatientsLikeMe and DailyStrength offer emotional support, social support, and
patient empowerment; some also offer physician Q&A, quantified self-tracking, and clinical trials access. PatientsLikeMe includes support for mental disorders such as anxiety, bipolar affective disorder, depression, obsessive-compulsive disorder, and Posttraumatic Stress Disorder; DailyStrength provides support for an even broader array of mental health issues. In an online SNS, inhibitions may be lowered, anxiety may be lessened, and anonymity may be increased. This presents the ideal 24/7 support for treatment of people with disorders such as depression. Indeed, the Pew report showed that teens look online for health information about issues they find are embarrassing to talk about such as drugs, sex, and depression.

Of course, there are cautions. One study found that people with depression who used an online SNS spiraled down if they had friends who were moderately or severely depressed and had a negative opinion of the SNS. The researchers concluded that the SNS could be helpful if people take a break from it if their posts elicit these reactions.

A position paper on pervasive healthcare concludes that “[provided-designed systems and services] should include help for people to access peer-to-peer social support sharing and caring in order to encourage sustained engagement with self management to build positive healthy identities for themselves.” Online health consumers are beginning to rely on “patient opinion leaders” for advice on chronic conditions such as mental disorders, and we need to be there with them. Of course, we must be mindful of issues such as privacy and data accuracy as we create tools to help SNS participants balance their needs to share information with their needs to manage self-presentation. Nonetheless, as clinicians and researchers, we should take advantage of SNS to extend the practice of evidence based medicine and mental health.

 

 

Brenda K. Wiederhold, Ph.D., MBA, BCIA

Editor-in-Chief, Journal of CyberTherapy & Rehabilitation

Virtual Reality Medical Institute

Brenda Wiederhold 0 Comments
Jan 3 2011
What Are the True Costs of Regulation

What Are the True Costs of Regulation?

 

Many researchers and clinicians working in cybertherapy create their own businesses, which allow them to protect their intellectual property. In the United States, small businesses create the majority of jobs but bear proportionally more of the cost burden of implementing laws and regulations than do larger companies. This is true primarily because larger companies enjoy economies of scale. However, estimates of the true costs of regulation vary widely.

A new study* found that companies with fewer than 20 employees pay 42% more per employee than companies with between 20 and 499 employees, and 36% more than companies with 500 or more employees. For small businesses, the average cost per employee was $10,585 compared to $7,454 for medium-sized and $7,755 for large businesses.

According to the study, environmental regulations cost 364% more in small versus large companies, and tax compliance
is 206% higher. Occupational safety and health and homeland security are other top cost drivers.

The researchers calculated that some types of industry pay more than others. For example, small manufacturers (such as small manufacturers of medical devices) pay 110% more for compliance than medium-sized manufacturers and 125% more than large manufacturers. Small health-care firms (such as cybertherapy clinics) pay 45% more than medium firms and 28% more than large firms.

The authors say the total cost of regulation is $1.75 trillion, and note that businesses must close shop, reallocate activity, absorb the cost, or pass on the costs to customers. They estimate the per-household cost of federal regulation and taxes at $37,962.

The report notes, ‘‘If federal regulations place a differentially large cost on small business, this potentially causes inefficiencies in the structure of American enterprises and the relocation of production facilities to less regulated countries, and adversely affects the international competitiveness of domestically produced American products and services.’’

Some say that the above numbers are inflated and the study methodology is questionable, pointing to the annual report of the Office of Management and Budget (OMB) on the costs and benefits of regulation for a truer picture of the cost of regulation.

The OMB report notes that ‘‘The estimated annual benefits of major Federal regulations reviewed by OMB from October 1, 1999, to September 30, 2009, for which agencies estimated and monetized both benefits and costs, are in the aggregate between $128 billion and $616 billion, while the estimated annual costs are in the aggregate between $43 billion and $55 billion,’’ and that ‘‘Most rules have net benefits, but some rules have net costs.’’

Regardless of which of these estimates is closer to the true cost of regulation, the truth is that many regulatory costs are fixed: they are the same whether a company has 20 employees or 20,000. And the 89% of U.S. companies that have fewer than 20 employees produce a significant number of innovations. As President Obama has said, ‘‘Small businesses are the heart of the American economy.’’

In fall 2010, President Obama signed the Small Business Jobs Act, designed to help small businesses have easier access to credit and to provide more tax breaks. While a worthy effort, it does nothing to stem the tide of ever more regulation coming out of Washington.

Regulation per se is neither good nor bad. Rather, regulation in which the benefit outweighs the cost is good; regulation in which the cost outweighs the benefit is bad. Not all benefits can be quantified, which further complicates the picture.

It is time to start a serious dialog about the true cost of regulation, one that uses methodologically sound benefit–cost ratios as a starting point. I encourage readers to become involved in commenting on proposed regulations, so that only those regulations that pass the benefit–cost test are implemented. It is important to do so: the very future of innovation in health technology is at stake.

                                                                                                                                                                                                         Brenda K. Wiederhold

                                                                                                                                                                                                                      Editor-in-Chief

Brenda Wiederhold 0 Comments
Dec 6 2010
2010 Winter Editorial

Journal of CyberTherapy & Rehabilitation

Winter 2010, Volume 3, Issue 4

 

  EDITORIAL

Let me take this opportunity to welcome readers to the Winter 2010 issue of the Journal of CyberTherapy & Re- habilitation (JCR). Our peer-reviewed academic journal continues to promote and explore advanced technologies for therapy, training, education, prevention and rehabil- itation. With the end of 2010 drawing to a close, we take this time to reflect on the advancement and recognition JCR has received. We have seen our exposure grow, partly as a result of newly acquired indexing with Scopus and Embase, Cabell’s, Gale, EBSCO and PsycINFO. JCR continues to reach an ever-expanding number of readers around the globe, both as subscribers and at var- ious academic conferences.

In the first article of this issue, Cho and Lee describe the creation and implementation of a virtual optokinetic stimulation program to treat pseudoneglect in healthy individuals. Results and whether the program might be applicable in a clinical setting are addressed as well.

In the second paper, Valtchanov and Ellard explore physiological and affective responses to immersion in Virtual Reality (VR) to determine which environments, natural versus urban, have the most soothing effects on stress.

Next, Lister, Piercey, and Joordens discuss the effective- ness of VR to treat fear of public speaking and expound on future areas of application.

The following paper by Kündiger et al. addresses an online counseling system to treat eating disorders, and how it can complement more traditional methods of treatment and therapy. Level of acceptance for patients is discussed and ways in which to make the program more effective and user-friendly.

An interesting study by Wiederhold, Gavshon, and Wiederhold explores the combination of psychodynamic psychotherapy and VR. Often VR is used in combination with cognitive behavioral therapy, but its use with other types of therapy have found success as well.

A final paper by Santos-Ruiz et al. explores whether the Trier Social Stress Test can be integrated with VR environments to effectively measure levels of stress and anx- iety.

I would like to send a sincere thanks to contributing au- thors for their inspiring work and dedication to this field of research. I also want to thank JCR’s Associate Editors – Professors Botella, Bouchard, Gamberini and Riva for their continued leadership and hard work, as well as or internationally renowned Editorial Board for their contributions. Our board continues to grow, representing diverse disciplines, countries, and areas of expertise.

We continue to strive to provide readers with engaging, informative material, as well as extra supplements, including the newly added continuing education quizzes and book reviews. As always, we welcome your input and suggestions on ways to strengthen JCR’s scientific rigor and visibility. As well as input and recommendations, we welcome new submissions from scholars, researchers, and academics, instructions for which can be found in the back of the journal.

We look forward to providing our readers with cutting-edge studies and information in the upcoming year, and thank you for your continued support.

 

 

Brenda K. Wiederhold, Ph.D., MBA, BCIA

Editor-in-Chief, Journal of CyberTherapy & Rehabilitation

Virtual Reality Medical Institute

Brenda Wiederhold 0 Comments
Mar 1 2010
2010 Spring Editorial

Journal of CyberTherapy & Rehabilitation

Spring 2010, Volume 3, Issue 1

 

EDITORIAL

Welcome, readers and researchers, to the Spring 2010 issue of the Journal of CyberTherapy & Rehabilitation (JCR). Our peer-reviewed quarterly academic journal continues to explore and support the uses of advanced technologies for therapy, training, education, preven- tion and rehabilitation. JCR is unique in the fact that it focuses on the rapidly expanding worldwide trend of applying ground-breaking technology towards the field of healthcare, with an emphasis on the fields of psychi- atry, psychology, physical medicine and rehabilitation, neurorehabilitation, oncology, obesity, eating disorders and autism.

With a growing international base of readers and sup- porters driven by a similar goal of advancing the use of technology in the healthcare sector, JCR has re- ceived positive attention from peers, international in- stitutions and international conferences. To keep readers abreast of new developments, within this issue of JCR we present comprehensive articles submitted by preeminent scholars in the field, featuring such top- ics as combining physical activity with learning in an augmented reality setting, including the sense of ol- faction more commonly in VR, and how communica- tion is used in virtual worlds like Second Life.

In the first article Voorhees et al. study the relationship between attitude and adherence to treatment in adoles- cents with sub-threshold depression in order to improve public health strategies to prevent depressive disorders.

Next, Baus and Bouchard address the sense of olfaction and ways in which it can further and enrich VR any ad- vocate the growth of the field while discussing possible applications in virtual environments.

In an attempt to merge learning and physical activity in the classroom, Hsiao next looks at using augmented re- ality and VR applications to provide more effective teaching methods and increase retention, while provid- ing much-needed exercise to the younger population at the same time.

In the fourth article, Alquda et al. use Virtual Humans to look at how race and sex can affect how people interpret others’ pain, pain coping skills, related mood, and other factors.

Lastly, Park discusses the use of Second Life as an ex- ample of how activities in virtual worlds might be used as a communication environment to better understand each other, with an emphasis in this study on gender.

As well as continuing to provide our readers with the latest studies presented in an informative and engaging medium, we will be offering one Continuing Education quiz per issue as a further added service to our sub- scribers and others interested in supporting their educa- tion. For more information, see page 95.

I would like to sincerely thank the contributing authors for their inspiring work and dedication to this field of research. I also want to thank JCR’s Associate Editors – Professor Botella, Professor Bouchard, Professor Gamberini and Professor Riva for their leadership and hard work, as well as or internationally renowned Edi- torial Board for their contributions. I would also like to take this opportunity to welcome new Board members – Linda A. Jackson of Michigan State University, Julian Dooley of Edith Cowan University, Wijnand IJsselsteijn from the Eindhoven University of Technology, Joshua Fogel from the University of New York, and XiaoXiang Zheng of Zhejiang University – whose diverse back- ground and placement around the globe will bring added richness to our board. We encourage readers and sub- scribers to contact us with ideas and we welcome sub- missions. Your input continues to enrich our publication.

With the start of a new year, new possibilities abound and we will continue to promote the growth of the di- verse field of advanced technologies for healthcare in Europe and worldwide. We are happy to count you as a part of this movement and thank you for your continued support.

 

 

Brenda K. Wiederhold, Ph.D., MBA, BCIA

Editor-in-Chief, Journal of CyberTherapy & Rehabilitation

Virtual Reality Medical Institute

Brenda Wiederhold 0 Comments
Dec 1 2009
2009 Winter Editorial

Journal of CyberTherapy & Rehabilitation

Winter 2009, Volume 2, Issue 4

 

EDITORIAL

Welcome to the Winter 2009 issue of the Journal of Cy- berTherapy & Rehabilitation (JCR). We are pleased to bring this special issue of our publication to readers, critics and researchers around the world. Our peer-re- viewed academic journal explores the uses of advanced technologies for therapy, training, education, prevention and rehabilitation. JCR is a quarterly published aca- demic journal, unique in the fact that it focuses on the rapidly expanding worldwide trend of applying ground- breaking technology towards the field of healthcare. Psychiatry, psychology, physical medicine and rehabil- itation, neurorehabilitation, oncology, obesity, eating disorders and autism continue to be main areas of inter- est studied by JCR.

Since our inaugural issue, JCR has received interna- tional attention from peers, international institutions and international conferences. A common thirst for new knowledge and application of cutting-edge technolo- gies to better the lives of others brings this diverse group of people towards a similar goal. Advanced tech- nologies, such as robotics, adaptive displays, E-health, virtual reality (VR) and non-invasive physiological monitoring are now applied to many diverse fields of healthcare. As this body of research is added to, pa- tients, doctors and therapists can look towards a hopeful future and new ways to treat mental and physical dis- orders. Within this issue of JCR, we present compre- hensive review articles submitted by preeminent scholars in the field. The content is diverse, featuring such topics as VR immersions, the effects of video game playing and even online forums to treat sufferers of disease.

This special issue of JCR includes three full papers, as well as all presented abstracts, written by presenters from the “Beyond Brain Machine Interface: Motor, Cognitive and Virtual” pre-conference workshop, held September 2, 2009 in Minneapolis, Minnesota. The conference, co-organized by the Army Research Office, IEEE EMBS and the Interactive Media Institute, edu- cated attendees on more efficient and intuitive ways of achieving system control than manual manipulation and allowed for discourse among academics, members of the scientific community, biomedical device engineers and the clinician user community. Scientists from five different countries and ten diverse institutions gathered to discuss these technologies and developments in their fields of research, and gave formal presentations on their papers.

In this issue’s first article Cai, Milcent and Franco ex- plore the human-machine visual digest system by fo- cusing on the relationship between gaze and object. They describe ways to better utilize network bandwidth and in turn, minimize the resulting media footprint by combining human vision and machine vision.

Next, Scherer et al. discuss brain-computer interface re- search using EEG and ECoG-based paradigms that are presented to the reader, along with ways to improve in- formation transfer rates. Different BCI projects are dis- cussed, such as an anatomically correct testbed for a human hand model.

In the following article, Raspelli et al. conduct further research on the Multiple Errands Test, applying virtual reality to assess executive functions in patients suffer- ing from Parkinson’s disease and stroke.

In the fourth manuscript, Pallavicini et al. report find- ings on a study to treat sufferers of Generalized Anxiety Disorder using biofeedback, virtual reality and mobile phones. The use of mobile phones allowed patients to continue treatment in an outpatient setting and ad- dresses the classic problem associated with VR ther- apy–the lack of mobility for the treatment system.

Gras, Hummer and Hine, in the fifth manuscript, com- pare the reliability and validity of the Nintendo Wii Fit to the widely used NeuroCom EquiTest, to measure bal- ance and help rehabilitate patients.

Lastly, Cantelmi and Talli explain the psychological and psychopathological risks associated with overuse of the Internet, including the problems associated with defining a relevant syndrome, possible diagnostic cri- teria and possible therapies for treatment.

This issue of JCR will continue to explore the ways in which healthcare, in Europe and worldwide, can benefit from the applications of technology. I would like to sin- cerely thank the contributing authors for their inspiring work and dedication to this field of research. I also want to thank JCR’s Associate Editors – Professor Botella, Professor Bouchard, Professor Gamberini and Professor Riva for their leadership and hard work, as well as our internationally renowned Editorial Board for their contributions. We encourage readers and subscribers to con- tact us with ideas and manuscripts. Your input continues to enrich our publication. Looking to 2010, we are op- timistic as this diverse field continues to grow and at- tract those wishing to learn more and those already supporting and implementing new technologies. With only more room to grow, we will continue to bring you news of further developments in the upcoming year.

 

Brenda K. Wiederhold, Ph.D., MBA, BCIA

Editor-in-Chief, Journal of CyberTherapy & Rehabilitation

Virtual Reality Medical Institute

Brenda Wiederhold 0 Comments