Ethical and practical considerations in managing incidental findings in functional magnetic resonance imaging

Functional magnetic resonance imaging has emerged as a powerful tool for mapping the neurologic underpinnings of sensory, motor and cognitive function. Much of this evolution carries assumptions about the subject population under study and, in particular, the neurologic status of subjects entered into studies either as healthy controls or as belonging to a specific disease group. Recent reports of incidental MRI abnormalities in normal volunteers for fMRI studies have brought to attention a variety of practical challenges and ethical dilemmas for researchers, many of whom are not physicians and most of whom have no formal radiological training. We propose a minimum standard for consenting subjects in fMRI protocols, and consider strategies over the longer term that call for expert physician participation, archiving of incidental findings including false positives, and the adoption of guidelines for handling variation in neural activations or performance that appear outside expected norms.     

The man who executed "imagined" movements: evidence for dissociable components of the body schema

We examined the nature of representations underlying motor imagery and execution in a patient (CW) with bilateral parietal lesions. When imagining hand movements, CW executed the imagined motor act but was unaware of the movements. These movements were significantly more accurate than volitional movements for the left but not right hand. CW also exhibited preserved motor imagery for the left but not right hand. Consistent with previous accounts, these findings suggest that motor imagery may normally involve the inhibition of movements. CW's unawareness of movements during motor imagery may reflect inattention or misattribution of the unexpected sensory feedback. Furthermore, in line with current models of motor control, motor imagery may depend on the integrity of a "forward model" derived from motor outflow information to generate a prediction of the consequences of a motor command. Such predictions appear to be preserved for imagery of left but not right hand movements in CW. Action may additionally depend on precise updating of effector position derived from the comparison of predicted and actual sensory information. We propose that CW's impaired volitional movements may be attributable to the degradation of such an updating mechanism.     

Action-based and vision-based selection of input: Two sources of control

In the first part of this paper we review evidence suggesting that there exists a mechanism that selects input on the basis of its similarity to the required action. This response-based input selection differs from the more established space- and object-based input selection in that it is not constrained by the structure of the input. Our evidence suggests that the two-choice Stroop effect is caused by this response-based selection mechanism. By contrast, it is known that the flanker effect is determined by the space- and object- based selection mechanisms. We explore whether the conflict resolution of the Stroop and flanker tasks is different as well by embedding these two tasks in a PRP (Psychological Refractory Period) paradigm. We show that the Stroop and the PRP effects are additive whereas the flanker and the PRP effects are underadditive, suggesting that the processes in charge of the conflict resolution in the Stroop and the flanker tasks are indeed different. We discuss possible reasons for this difference, and discuss possible ways in which the response-based mechanism can be implemented in information processing models.     

Effect of a total smoking ban in a maximum security psychiatric hospital

An archival study was performed in a maximum security forensic hospital to evaluate the effects of a total ban on smoking and all tobacco products. One hundred and forty patients were characterized as nonsmokers or light, moderate or heavy smokers. Patient records for the four weeks prior to the ban were compared with their records for the four weeks subsequent to the ban. Numbers of sick calls, total disruptive behaviors and verbal aggression declined markedly and significantly following the ban in those patients previously classified as moderate or heavy smokers. Weight increased significantly, but almost equally regardless of previous smoking status. Patients, and eventually staff, tolerated the smoking ban without significant negative effects. Patients relied very little on treatment modalities to alleviate nicotine withdrawal. Pre-ban apprehension by staff and patients dissipated with time after the smoking ban started.     

Learning where to look for danger: integrating affective and spatial information

Although not previously addressed by researchers of spatial cognition or affect, the combination of spatial and affective information is essential for many approach and avoidance behaviors, and thus for survival. We provide the first evidence that through incidental experience, people form representations that capture correlations between affective and spatial information. Participants were able to do so even when the correlation was weak, they were not told to look for the correlation, and the stimuli varied on multiple other dimensions besides valence. In addition, people were more sensitive to the presented correlation when stimuli were negative than when they were positive. This asymmetry in representation may stem from underlying differences in the activation functions for positive and negative hedonic information processing.     

The automatic evaluation of novel stimuli

From classic theory and research in psychology, we distill a broad theoretical statement that evaluative responding can be immediate, unintentional, implicit, stimulus based, and linked directly to approach and avoidance motives. This statement suggests that evaluative responses should be elicited by novel, nonrepresentational stimuli (e.g., abstract art, "foreign" words). We tested this hypothesis through combining the best features of relevant automatic–affect research paradigms. We first obtained explicit evaluative ratings of novel stimuli. From these, we selected normatively positive and negative stimuli to use as primes in a sequential priming paradigm. Two experiments using this paradigm demonstrated that briefly presented novel prime stimuli were evaluated automatically, as they facilitated responses to subsequently presented target stimuli of the same valence just as much as did pictures or names of real objects. A final experiment revealed that exposure to novel stimuli produces muscular predispositions to approach or avoid them.     

Multidimensional latent-construct analysis of children's social information processing patterns: correlations with aggressive behavior problems

Social information processing (SIP) patterns were conceptualized in orthogonal domains of process and context and measured through responses to hypothetical vignettes in a stratified sample of 387 children (50% boys; 49% minority) from 4 geographical sites followed from kindergarten through 3rd grade. Multidimensional, latent-construct, confirmatory factor analyses supported the within-construct internal consistency, cross-construct discrimination, and multidimensionality of SIP patterns. Contrasts among nested structural equation models indicated that SIP constructs significantly predicted children's aggressive behavior problems as measured by later teacher reports. The findings support the multidimensional construct validity of children's social cognitive patterns and the relevance of SIP patterns in children's aggressive behavior problems.     

Pharmacogenetics: ethical issues and policy options

Pharmacogenetics offers the prospect of an era of safer and more effective drugs, as well as more individualized use of drug therapies. Before the benefits of pharmacogenetics can be realized, the ethical issues that arise in research and clinical application of pharmacogenetic technologies must be addressed. The ethical issues raised by pharmacogenetics can be addressed under six headings: (1) regulatory oversight, (2) confidentiality and privacy, (3) informed consent, (4) availability of drugs, (5) access, and (6) clinicians' changing responsibilities in the era of pharmacogenetic medicine. We analyze each of these categories of ethical issues and provide policy approaches for addressing them.