Molecular Tumor Boards: Ethical Issues in the New Era of Data Medicine

The practice and development of modern medicine requires large amounts of data, particularly in the domain of cancer. The future of personalized medicine lies neither with “genomic medicine” nor with “precision medicine”, but with “data medicine” (DM) (big data, data mining). The establishment of this DM has required far-reaching changes, to establish four essential elements connecting patients and doctors: biobanks, databases, bioinformatic platforms and genomic platforms. The “transformation” of scientific research areas, such as genetics, bioinformatics and biostatistics, into clinical specialties has generated a new vision of care. Molecular tumor boards (MTB) are one response to these changes and are now providing better access to next-generation sequencing (NGS) and new cancer treatments to patients with inoperable or metastatic cancers, and those for whom the usual treatment has failed. However, MTB face a crucial ethical challenge: maintaining and improving the trust of patients, clinicians, researchers and industry in academic medical centers supported by private or public funding rather than providing genetic data directly to private companies. We believe that, in this era of DM, appropriate modern digital communication networks will be required to maintain this trust and to improve the organization and effectiveness of the system. There is, therefore, a need to reconsider the form and content of informed consent (IC) documents at all academic medical centers and to introduce dynamic and electronic informed consent (e-IC).     

Is two better than one? Comparing children’s narrative competence in an individual versus joint storytelling task

This research looks at the potential of peer interaction practices in improving narrative competence by analyzing the efficacy of peer learning on children’s oral narrative productions. Gains on a macro-level (structure and coherence of the narrative) and a micro-level (cohesion of the narrative) were analyzed. Fifty-six primary school children participated in this study. Each child told a narrative either individually (individual condition) or while interacting with a peer (joint condition). We explored whether children produced longer, more structured, coherent and cohesive narratives in a joint condition rather than individually, and in which condition the joint task was more beneficial for children’s narrative competence in terms of narrative scores in the individual condition, discrepancy between the members of the same pair, and quality of the interaction. The advantage of peer learning does not derive from the direct comparison of the individual versus the joint condition but depends on specific conditions: the joint condition was beneficial for individuals with lower individual competence and for pairs with a high discrepancy between individual scores. Children’s quality of interaction did not seem to influence the efficacy of peer learning on their narrative competence.     

Reduction of implicit cognitive bias with cathodal tDCS to the left prefrontal cortex

Implicit associations can interfere with cognitive operations and behavioral decisions without direct intention. Enhancement of neural activity with anodal transcranial direct current stimulation (tDCS) was proposed to reduce implicit associations by means of improved cognitive control. However, a targeted reduction of distractive implicit associations by inhibitory cathodal tDCS, recently shown in spatial–numerical associations, provides an interesting alternative approach to support goal-directed behavior with transcranial brain stimulation. To test this rationale with a sham-controlled cross-over design, a standardized Implicit Association Test (IAT) was performed by 24 healthy participants parallel to 1 mA cathodal or sham tDCS to the left prefrontal cortex. In this double-classification task, insect versus flower pictures and negative versus positive words are mapped together onto two shared response keys with crossed response assignments in separate blocks. Responses were faster when insect + negative and flower + positive stimuli required the same answer (IAT effect). Most critically, the IAT effect was reduced during cathodal tDCS as compared to sham stimulation. Thus, results are consistent with the proposed stimulation rationale, with previous observations, and complementary to previous studies using different tDCS configurations.     

How socioemotional setting modulates late-stage conflict resolution processes in the lateral prefrontal cortex

The goal-directed control of behaviour critically depends on emotional regulation and constitutes the basis of mental well-being and social interactions. Within a socioemotional setting, it is necessary to prioritize effectively the relevant emotional information over interfering irrelevant emotional information to orchestrate cognitive resources and achieve appropriate behavior. Currently, it is elusive whether and how different socioemotional stimulus dimensions modulate cognitive control and conflict resolution. Theoretical considerations suggest that interference effects are less detrimental when conflicting emotional information is presented within a “positive socioemotional setting” compared with a “negative socioemotional setting.” Using event-related potentials (ERPs) and source localization methods, we examined the basic system neurophysiological mechanisms and functional neuroanatomical structures associated with interactive effects of different interfering facial, socioemotional stimulus dimensions on conflict resolution. We account for interactive effects of different interfering socioemotional stimulus dimensions on conflict resolution, i.e., we show how the socioemotional valence modulates cognitive control (conflict processing). The data show that conflicts are stronger and more difficult to resolve in a negative emotional task-relevant setting than in a positive emotional task-relevant setting, where incongruent information barely induced conflicts. The degree of emotional conflict critically depends on the contextual emotional valence (positive or negative) in which this conflict occurs. The neurophysiological data show that these modulations were only reflected by late-stage conflict resolution processes associated with the middle (MFG) and superior frontal gyrus (SFG). Attentional selection processes and early-stage conflict monitoring do not seem to be modulated by interactive effects of different interfering socioemotional stimulus dimensions on conflict resolution.     

Affordances in Interaction: The Case of Aikido

Our title can be read as trivially true, namely, that perceived affordances shape real-time interaction dynamics. A less trivial reading suggests that affordances themselves interact in a shared dyadic field, such that the number and quality of As and Bs affordances are dynamically coupled with bidirectional causality. In dance, martial arts, or team sports agents strategically comodulate each other's affordances while pursuing their aims. In Aikido, where agents try to break their opponents' balance, this trade-off globally approximates a zero-sum game—the better A's affordances are, the lousier B's affordances get. The agents are subject to ceaseless cross-causation in this shared field. They seek to obstruct their opponents' options while strategically enabling, augmenting, and sculpting their own by employing subtle perceptual manipulation skills, redirecting force, brinkmanship, and switching techniques opportunistically. To overcome static views, we conceptualize affordances as cascading and having fluid onsets; we also identify nested affordances in goal hierarchies and describe a spectrum of affordance functions. Ultimately, we suggest rethinking the ontology of affordances as being sensitive to dynamic engagements, hence defined relative to interpersonal emergence.     

Reappraisal inventiveness: impact of appropriate brain activation during efforts to generate alternative appraisals on the perception of chronic stress in women*

Background and objectives: Previous research indicated that more left-lateralized prefrontal activation during cognitive reappraisal efforts was linked to a greater capacity for generating reappraisals, which is a prerequisite for the effective implementation of cognitive reappraisal in everyday life. The present study examined whether the supposedly appropriate brain activation is relevant in terms of more distal outcomes, i.e., chronic stress perception.

Design and methods: Prefrontal EEG alpha asymmetry was recorded while female participants were generating reappraisals for stressful events and was correlated with their self-reported chronic stress levels in everyday life (n?=?80).

Results: Women showing less left-lateralized brain activity in the ventrolateral prefrontal cortex during cognitive reappraisal efforts reported experiencing more stress in their daily lives. This effect was independent of self-efficacy beliefs in managing negative emotions.

Conclusion: These findings underline the practical relevance of individual differences in appropriate brain activation during emotion regulation efforts and the assumedly related basic capacity for the generation of cognitive reappraisals to the feeling of being stressed. Implications include the selection of interventions for the improvement of coping with stress in women in whom the capability for appropriate brain activation during reappraisal efforts may be impaired, e.g., due to depression or old age.     

The Development,Pilot, and Process Evaluation of a Parent Mental Health Literacy Intervention Through Community Sports Clubs

The mental health literacy of parents may be critical in facilitating positive child and adolescent mental health outcomes. The purpose of this study was to develop, pilot, and evaluate a targeted parent mental health literacy intervention through community sports clubs. Sixty six parents (M_age?=?44.86?±?5.2 years) participated in either a brief mental health literacy intervention workshop delivered through community sporting clubs (n?=?42) or a community-matched control group (n?=?24). Participants’ mental health literacy was assessed at baseline, post-intervention and at 1 month follow-up. A mixed methods process evaluation was conducted with intervention participants to determine the acceptability and feasibility of the intervention. Participants in the experimental group showed greater increases in depression literacy, anxiety literacy, knowledge of help seeking options and confidence to assist an adolescent experiencing a mental health disorder, compared to those in the control group. Post-intervention changes in the experimental group were maintained at 1 month follow-up. A mixed methods process evaluation revealed that parents found the intervention content engaging, relevant to their needs, and practically useful in terms of actively supporting adolescent mental health. Findings provide evidence that a brief, targeted intervention through community sports clubs might be a particularly useful method of improving parental mental health literacy and facilitating positive youth mental health outcomes.     

Advancing Ego Development in Adulthood Through Study of the Enneagram System of Personality

A rapidly growing number of working professionals, academic communities, and businesses have applied the Enneagram personality system of nine types to enhance psychological growth in their personal and professional lives. However, there are no existing studies that measure the effects of the application of Enneagram training programs to promote ego development. This study examined if ego development took place among individuals enrolled in Enneagram training programs in the Narrative Tradition. Two groups of participants (N?=?122) were assessed using the Washington University Sentence Completion Test (WUSCT) at baseline (pretest) before the training began and then again 18 months later (posttest); one of the groups participated in Enneagram Intensive training programs (n?=?73) and the other group participated in introductory Enneagram trainings (n?=?49). Data revealed an advancement in ego development among some of the participants who received at least 40–50 h of training. The findings suggest that Enneagram Intensive trainings may be beneficial for promoting psychological growth and ego development. Clinical applications and future research directions are discussed.     

Emotional reactivity following surgery to the prefrontal cortex

We aimed to elicit emotion in patients with surgically circumscribed lesions of the prefrontal cortex (PFC) in order to elucidate the precise functional roles in emotion processing of the discrete subregions comprising the ventromedial PFC, including the medial PFC and orbitofrontal cortex (OFC). Three components of emotional reactivity were measured: subjective experience, behaviour, and physiological response. These included measures of self‐reported emotion, observer‐rated facial expression of emotion and measurements of heart rate and heart rate variability (HRV) during film viewing, and a measure of subjective emotional change since surgery. Patients with lesions to the ventromedial PFC demonstrated significant differences compared with controls in HRV during the film clips, suggesting a shift to greater dominance of sympathetic input. In contrast, patients with lesions restricted to the OFC showed significant differences in HRV suggesting reduced sympathetic input. They also showed less facial expression of emotion during positive film clips, and reported more subjective emotional change since surgery compared with controls. This human lesion study is important for refining theoretical models of emotion processing by the ventromedial PFC, which until now have primarily been based on anatomical connectivity, animal lesion, and human functional neuroimaging research. Such theories have implications for the treatment of a wide variety of emotional disorders.