Spanning our differences: moral psychology,physician beliefs,and the practice of medicine

Moral pluralism is the norm in contemporary society. Even the best philosophical arguments rarely persuade moral opponents who differ at a foundational level. This has been vividly illustrated in contemporary debates in bioethics surrounding contentious issues such as abortion and euthanasia. It is readily apparent that bioethics discourse lacks an empirical explanation for the broad differences about various topics in bioethics and health policy. In recent years, social and cognitive psychology has generated novel approaches for defining basic differences in moral intuitions generally. We propose that if empirical research using social intuitionist theory explains why people disagree with one another over moral issues, then the results of such research might help people debate their moral differences in a more constructive and civil manner. We illustrate the utility of social intuitionism with data from a national physician survey.     

Long-term response-stimulus associations can influence distractor-response bindings

Strong associations between target stimuli and responses usually facilitate fast and effortless reactions. The present study investigated whether long-term associations between distractor stimuli and responses modulate behavior. In particular, distractor stimuli can affect behavior due to distractor-based stimulus-response retrieval, a phenomenon called distractor-response binding: An ignored stimulus becomes temporarily associated with a response and retrieves it at stimulus repetition. In a flanker task, participants ignored left and right pointing arrows and responded to a target letter either with left and right (strongly associated) responses or with upper and lower (weakly associated) responses. Binding effects were modulated in dependence of the long-term association strength between distractors and responses. If the association was strong (arrows pointing left and right with left and right responses), binding effects emerged but only in case of compatible responses. If the long-term association between distractors and responses was weak (arrows pointing left and right with upper and lower responses), binding was weaker and not modulated by compatibility. In contrast, sequential compatibility effects were not modulated by association strength between distractor and response. The results indicate that existing long-term associations between stimuli responses may modulate the impact of an ignored stimulus on action control.     

Within-hemifield posture changes affect tactile–visual exogenous spatial cueing without spatial precision,especially in the dark

We investigated the effects of seen and unseen within-hemifield posture changes on crossmodal visual–tactile links in covert spatial attention. In all experiments, a spatially nonpredictive tactile cue was presented to the left or the right hand, with the two hands placed symmetrically across the midline. Shortly after a tactile cue, a visual target appeared at one of two eccentricities within either of the hemifields. For half of the trial blocks, the hands were aligned with the inner visual target locations, and for the remainder, the hands were aligned with the outer target locations. In Experiments 1 and 2, the inner and outer eccentricities were 17.5º and 52.5º, respectively. In Experiment 1, the arms were completely covered, and visual up–down judgments were better when on the same side as the preceding tactile cue. Cueing effects were not significantly affected by hand or target alignment. In Experiment 2, the arms were in view, and now some target responses were affected by cue alignment: Cueing for outer targets was only significant when the hands were aligned with them. In Experiment 3, we tested whether any unseen posture changes could alter the cueing effects, by widely separating the inner and outer target eccentricities (now 10º and 86º). In this case, hand alignment did affect some of the cueing effects: Cueing for outer targets was now only significant when the hands were in the outer position. Although these results confirm that proprioception can, in some cases, influence tactile–visual links in exogenous spatial attention, they also show that spatial precision is severely limited, especially when posture is unseen.     

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.