How (not) to think of the ‘dead-donor’ rule

Although much has been written on the dead-donor rule (DDR) in the last twenty-five years, scant attention has been paid to how it should be formulated, what its rationale is, and why it was accepted. The DDR can be formulated in terms of either a Don’t Kill rule or a Death Requirement, the former being historically rooted in absolutist ethics and the latter in a prudential policy aimed at securing trust in the transplant enterprise. I contend that the moral core of the rule is the Don’t Kill rule, not the Death Requirement. This, I show, is how the DDR was understood by the transplanters of the 1960s, who sought to conform their practices to their ethics—unlike today’s critics of the DDR, who rethink their ethics in a question-begging fashion to accommodate their practices. A better discussion of the ethics of killing is needed to move the debate forward.     

Patients’ Views of Treatment-Focused Genetic Testing (TFGT): Some Lessons for the Mainstreaming of <Emphasis Type="Italic">BRCA1</Emphasis> and <Emphasis Type="Italic">BRCA2</Emphasis> Testing

This paper explores patients’ views and experiences of undergoing treatment-focused BRCA1 and BRCA2 genetic testing (TFGT), either offered following triaging to clinical genetics (breast cancer) or as part of a mainstreamed care pathway in oncology (ovarian cancer). Drawing on 26 in-depth interviews with patients with breast or ovarian cancer who had undergone TFGT, this retrospective study examines patients’ views of genetic testing at this point in their care pathway, focusing on issues, such as initial response to the offer of testing, motivations for undergoing testing, and views on care pathways. Patients were amenable to the incorporation of TFGT at an early stage in their cancer care irrespective of (any) prior anticipation of having a genetic test or family history. While patients were glad to have been offered TFGT as part of their care, some questioned the logic of the test’s timing in relation to their cancer treatment. Crucially, patients appeared unable to disentangle the treatment role of TFGT from its preventative function for self and other family members, suggesting that some may undergo TFGT to obtain information for others rather than for self.     

Development and Pilot Testing of a Decision Aid for Genomic Research Participants Notified of Clinically Actionable Research Findings for Cancer Risk

Germline genomic testing is increasingly used in research to identify genetic causes of disease, including cancer. However, there is evidence that individuals who are notified of clinically actionable research findings have difficulty making informed decisions regarding uptake of genetic counseling for these findings. This study aimed to produce and pilot test a decision aid to assist participants in genomic research studies who are notified of clinically actionable research findings to make informed choices regarding uptake of genetic counseling. Development was guided by published literature, the International Patient Decision Aid Standards, and the expertise of a steering committee of clinicians, researchers, and consumers. Decision aid acceptability was assessed by self-report questionnaire. All 19 participants stated that the decision aid was easy to read, clearly presented, increased their understanding of the implications of taking up research findings, and would be helpful in decision-making. While low to moderate levels of distress/worry were reported after reading the booklet, a majority of participants also reported feeling reassured. All participants would recommend the booklet to others considering uptake of clinically actionable research findings. Results indicate the decision aid is acceptable to the target audience, with potential as a useful decision support tool for genomic research participants.     

Seeing structure: Shape skeletons modulate perceived similarity

An intrinsic part of seeing objects is seeing how similar or different they are relative to one another. This experience requires that objects be mentally represented in a common format over which such comparisons can be carried out. What is that representational format? Objects could be compared in terms of their superficial features (e.g., degree of pixel-by-pixel overlap), but a more intriguing possibility is that they are compared on the basis of a deeper structure. One especially promising candidate that has enjoyed success in the computer vision literature is the shape skeleton—a geometric transformation that represents objects according to their inferred underlying organization. Despite several hints that shape skeletons are computed in human vision, it remains unclear how much they actually matter for subsequent performance. Here, we explore the possibility that shape skeletons help mediate the ability to extract visual similarity. Observers completed a same/different task in which two shapes could vary either in their skeletal structure (without changing superficial features such as size, orientation, and internal angular separation) or in large surface-level ways (without changing overall skeletal organization). Discrimination was better for skeletally dissimilar shapes: observers had difficulty appreciating even surprisingly large differences when those differences did not reorganize the underlying skeletons. This pattern also generalized beyond line drawings to 3-D volumes whose skeletons were less readily inferable from the shapes’ visible contours. These results show how shape skeletons may influence the perception of similarity—and more generally, how they have important consequences for downstream visual processing.

     

It's a great big universe: Astrobiology and future trends for an astrotheology

Despite the awe and wonder that discoveries related to astrobiology inspire, the sheer volume and diversity of new discoveries related to space science can become overwhelming without meaningful frames of reference by which to organize our understanding of these phenomena. I suggest that a critical feature of the future of “astrotheology” relates to how it serves as an organizing correlate to astrobiology and space research. Considering that the prefix astro‐ has an amplicative and abductive effect on the fields of study to which it is applied, I contend that astrotheology implies a creative and constructive shift in how we conceptualize meaningful human being for theology that parallels how astrobiology effects a creative and constructive shift in how we conceptualize living systems.     

Prospective Associations of Coping Styles With Depression and Suicide Risk Among Psychiatric Emergency Patients

Suicide is the second leading cause of death for those ages 13–25 in the United States. Coping is a mediator between stressful life events and adverse outcomes, and coping skills have been incorporated into interventions (e.g., cognitive-behavioral therapy, dialectical behavior therapy, safety-planning interventions) for suicidal populations. However, longitudinal research has not directly examined the prospective associations between multiple coping styles and suicide-related outcomes in high-risk samples. This study identified cross-sectional and 4-month longitudinal associations of coping styles with suicide risk factors (i.e., depression, suicidal ideation, suicidal behavior) in a sample of 286 adolescent and young adult psychiatric emergency patients. Positive reframing was the coping style most consistently associated with positive outcomes, whereas self-blame and disengagement were consistently associated with negative outcomes. Active coping protected against suicidal behavior for males, but not for females. This was the first study to examine longitudinal relationships between coping and suicide-related outcomes in a high-risk clinical sample. Findings suggest that clinical interventions with suicidal adolescents and young adults may benefit from a specific focus on increasing positive reframing and reducing self-blame.     

Discounting: A practical guide to multilevel analysis of choice data

Multilevel modeling provides the ability to simultaneously evaluate the discounting of individuals and groups by examining choices between smaller sooner and larger later rewards. A multilevel logistic regression approach is advocated in which sensitivity to relative reward magnitude and relative delay are considered as separate contributors to choice. Examples of how to fit choice data using multilevel logistic models are provided to help researchers in the adoption of these methods.