Neuroscience and Brain Death Controversies: The Elephant in the Room

The conception and the determination of brain death continue to raise scientific, legal, philosophical, and religious controversies. While both the President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research in 1981 and the President’s Council on Bioethics in 2008 committed to a biological definition of death as the basis for the whole-brain death criteria, contemporary neuroscientific findings augment the concerns about the validity of this biological definition. Neuroscientific evidentiary findings, however, have not yet permeated discussions about brain death. These findings have critical relevance (scientifically, medically, legally, morally, and religiously) because they indicate that some core assumptions about brain death are demonstrably incorrect, while others lack sufficient evidential support. If behavioral unresponsiveness does not equate to unconsciousness, then the philosophical underpinning of the definition based on loss of capacity for consciousness as well as the criteria, and tests in brain death determination are incongruent with empirical evidence. Thus, the primary claim that brain death equates to biological death has then been de facto falsified. This conclusion has profound philosophical, religious, and legal implications that should compel respective authorities to (1) reassess the philosophical rationale for the definition of death, (2) initiate a critical reappraisal of the presumed alignment of brain death with the theological definition of death in Abrahamic faith traditions, and (3) enact new legislation ratifying religious exemption to death determination by neurologic criteria.     

Anxiety and Depression During Childhood and Adolescence: Testing Theoretical Models of Continuity and Discontinuity

The present study sought to clarify the trajectory (i.e., continuous vs. discontinuous) and expression (i.e., homotypic vs. heterotypic) of anxiety and depressive symptoms across childhood and adolescence. We utilized a state-of-the-science analytic approach to simultaneously test theoretical models that describe the development of internalizing symptoms in youth. In a sample of 636 children (53% female; M _age = 7.04; SD _age = 0.35) self-report measures of anxiety and depression were completed annually by youth through their freshman year of high school. For both anxiety and depression, a piecewise growth curve model provided the best fit for the data, with symptoms decreasing until age 12 (the “developmental knot”) and then increasing into early adolescence. The trajectory of anxiety symptoms was best described by a discontinuous homotypic pattern in which childhood anxiety predicted adolescent anxiety. For depression, two distinct pathways were discovered: A discontinuous homotypic pathway in which childhood depression predicted adolescent depression and a discontinuous heterotypic pathway in which childhood anxiety predicted adolescent depression. Analytical, methodological, and clinical implications of these findings are discussed.     

Looming Threats and Animacy: Reduced Responsiveness in Youth with Disrupted Behavior Disorders

Theoretical models have implicated amygdala dysfunction in the development of Disruptive Behavior Disorders (DBDs; Conduct Disorder/Oppositional Defiant Disorder). Amygdala dysfunction impacts valence evaluation/response selection and emotion attention in youth with DBDs, particularly in those with elevated callous-unemotional (CU) traits. However, amygdala responsiveness during social cognition and the responsiveness of the acute threat circuitry (amygdala/periaqueductal gray) in youth with DBDs have been less well-examined, particularly with reference to CU traits. 31 youth with DBDs and 27 typically developing youth (IQ, age and gender-matched) completed a threat paradigm during fMRI where animate and inanimate, threatening and neutral stimuli appeared to loom towards or recede from participants. Reduced responsiveness to threat variables, including visual threats and encroaching stimuli, was observed within acute threat circuitry and temporal, lateral frontal and parietal cortices in youth with DBDs. This reduced responsiveness, at least with respect to the looming variable, was modulated by CU traits. Reduced responsiveness to animacy information was also observed within temporal, lateral frontal and parietal cortices, but not within amygdala. Reduced responsiveness to animacy information as a function of CU traits was observed in PCC, though not within the amygdala. Reduced threat responsiveness may contribute to risk taking and impulsivity in youth with DBDs, particularly those with high levels of CU traits. Future work will need to examine the degree to which this reduced response to animacy is independent of amygdala dysfunction in youth with DBDs and what role PCC might play in the dysfunctional social cognition observed in youth with high levels of CU traits.     

Caring: A Pluralist Account

In this paper, I argue that care ethics should be understood as a form of value pluralism. Writers on the ethics of care tend not explicitly to address issues in the theory of value, although much of what has been written about care ethics may be taken to suggest that it endorses some form of value monism. I argue against this conception of care ethics by showing that the practical reality of caregiving is more accurately represented by a pluralist account of value. Practices of care are plausibly guided by a number of distinct and potentially conflicting values. These include quality of life, autonomy, dignity, personal development, and the value of nurturant relationships. Whilst caring takes each of these values to be important in its own right, they are not always jointly realisable, and carers are sometimes forced to promote one such value at the expense of another. The possibility of conflict between values is, of course, precisely what a pluralist conception of value tells us to expect. In this respect, then, value pluralism more faithfully reflects the reality of caregiving than does value monism, and care ethicists ought for this reason to endorse it.     

A Comparative Effectiveness Study of Two High-Frequency Word Interventions: Traditional Drill and WordSheets

Traditional drill and practice (TDP) has been shown to be both effective and efficient for increasing word recognition. WordSheets (WS) is a novel drill procedure similar to TDP with two key differences: (a) WS increases opportunities to respond, which may increase efficiency and (b) WS present instructional stimuli in a context that more closely resembles actual reading passages, which may enhance generalization to connected text. The study sought to compare the effectiveness and efficiency of TDP and WS in a sample of first-grade students (n = 27) identified by their teachers as struggling readers. Results indicated that, although WS led to significantly more opportunities to respond, it was both less effective and efficient than TDP with regard to cumulative retention. However, there were no significant differences across interventions in regard to the maintenance or generalization of treatment gains. Limitations and implications of the current study for school-based professionals are discussed.     

Do Mothers Spend More on Daughters While Fathers Spend More on Sons?

Do parents favor some children over others? The overwhelming majority of parents state that they treat their children equally, but parents rarely track their spending on each child. We investigate in four studies whether mothers and fathers favor specific children depending on the biological sex of the child. Evidence from the field, laboratory, and community (online panel) showed that parents exhibit systematic biases when forced to choose between spending on sons and daughters. Mothers consistently favored daughters, whereas fathers consistently favored sons. For example, parents were more likely to choose a real prize and give a real U.S. Treasury bond to the child of the same sex as themselves. These parenting biases were found in two different cultures and appear to be driven by parents identifying more strongly with children of the same sex as the parent.     

Effects of computer‐aided instruction on the implementation of the MSWO stimulus preference assessment

This study evaluated a self‐instructional online training package to teach students and staff to conduct a stimulus preference assessment using the multiple‐stimulus without replacement procedure. The training package included a self‐instructional manual and video modeling and was delivered online. Training was evaluated using a multiple‐probe design across a total of six university students and four staff members. Overall, students improved from a mean of 35% correct in baseline to a mean of 94% correct following training, and staff improved from a mean of 23% correct in baseline to a mean of 87% correct following training. During retention and generalization simulated assessments conducted from 7 to 17 days following training, all participants performed considerably above baseline. The online delivery of the self‐instructional manual plus video modeling has tremendous potential for providing an effective method for teaching individuals to conduct stimulus preference assessments without face‐to‐face instruction.     

Psychometric assessment of the processes of change scale for sun protection

The fourteen-factor Processes of Change Scale for Sun Protection assesses behavioral and experiential strategies that underlie the process of sun protection acquisition and maintenance. Variations of this measure have been used effectively in several randomized sun protection trials, both for evaluation and as a basis for intervention. However, there are no published studies, to date, that evaluate the psychometric properties of the scale. The present study evaluated factorial invariance and scale reliability in a national sample (N = 1360) of adults involved in a Transtheoretical model tailored intervention for exercise and sun protection, at baseline. Invariance testing ranged from least to most restrictive: Configural Invariance (constraints only factor structure and zero loadings); Pattern Identity Invariance (equal factor loadings across target groups); and Strong Factorial Invariance (equal factor loadings and measurement errors). Multi-sample structural equation modeling tested the invariance of the measurement model across seven subgroups: age, education, ethnicity, gender, race, skin tone, and Stage of Change for Sun Protection. Strong factorial invariance was found across all subgroups. Internal consistency coefficient Alpha and factor rho reliability, respectively, were .83 and .80 for behavioral processes, .91 and .89 for experiential processes, and .93 and .91 for the global scale. These results provide strong empirical evidence that the scale is consistent, has internal validity and can be used in research interventions with population-based adult samples.     

Predictors of adherence to aerobic exercise in rectal cancer patients during and after neoadjuvant chemoradiotherapy

This pilot study explored predictors of adherence to exercise during and after neoadjuvant chemoradiotherapy (NACRT) in rectal cancer patients. Eighteen rectal cancer patients were prescribed three supervised aerobic exercise sessions/week during NACRT followed by ≥150 min/week of unsupervised aerobic exercise after NACRT. Although not statistically significant, adherence to supervised exercise during NACRT was meaningfully better for patients who were women (d = .82; P = .12), younger (d = ?.62; P = .30), married (d = .62; P = .42), with better mental health (r = .32; P = .21), fewer diarrhea symptoms (r = .48; P = .052), and higher anticipated enjoyment (r = .31; P = .23), support (r = .32; P = .22), and motivation (r = .31; P = .23). After NACRT, adherence was significantly better for patients who reported worse mental health (r = ?.56; P = .046) and meaningfully better for patients who were women (d = .54; P = .38), better educated (d = .77; P = .22), had no comorbidities (d = ?.63; P = .17), and exercised at baseline (d = 1.05; P = .12). Demographics, tumor side effects, and motivational variables may predict adherence to exercise during and after NACRT.     

Training and transfer effects of response inhibition training in children and adults

Response inhibition is crucial for mental and physical health but studies assessing the trainability of this type of inhibition are rare. Thirty‐nine children aged 10‐12 years and 46 adults aged 18‐24 years were assigned to an adaptive go/no‐go inhibition training condition or an active control condition. Transfer of training effects to performance on tasks assessing response inhibition, interference control, working memory updating, task‐switching, and non‐verbal fluid intelligence were assessed during 3‐ and 6‐month follow‐up sessions and/or an immediate post‐training session. Significant training improvements and positive transfer effects to a similar response inhibition task with other stimuli were observed for both children and adults. Reliable albeit short‐lived transfer effects were only found for the children, specifically to working memory updating and task switching. These results suggest some potential for response‐inhibition training programs to enhance aspects of cognitive functioning in children but not adults.