American health policy today faces dual problems of too little coverage at too high a cost. The mix of private and public financing leaves about one seventh of the population without any insurance coverage. At the same time, the coverage Americans do have costs an ever-larger share of our country’s productive capacity. The U.S. pays well above what other countries pay and what many people, health plans, businesses, and governments want to pay. This “paradox of excess and deprivation” results from (...) the incremental approach the U.S. has taken to promoting incompatible policy goals of increasing health insurance coverage and medical quality while trying to control costs, without squarely confronting tradeoffs. This essay examines the record of incremental developments and draws lessons for current efforts at reform. (shrink)

BackgroundReturning neuroimaging incidental findings may create a challenge to research participants’ health literacy skills as they must interpret and make appropriate healthcare decisions based on complex radiology jargon. Disclosing IF can therefore present difficulties for participants, research institutions and the healthcare system. The purpose of this study was to identify the extent of the health literacy challenges encountered when returning neuroimaging IF. We report on findings from a retrospective survey and focus group sessions with major stakeholders involved in disclosing IF.MethodsWe (...) surveyed participants who had received a radiology report from a research study and conducted focus groups with participants, parents of child participants, Institutional Review Board members, investigators and physicians. Qualitative thematic analyses were conducted using standard group-coding procedures and descriptive summaries of health literacy scores and radiology report outcomes are examined.ResultsAlthough participants reported high health literacy skills, 67 % did not seek medical care when recommended to do so; and many participants in the focus groups disclosed they could not understand the findings described in their report. Despite their lack of understanding, participants desire to have information about their radiology results, and the investigators feel ethically inclined to return findings.ConclusionsThe language in clinically useful radiology reports can create a challenge for participants’ health literacy skills and has the potential to negatively impact the healthcare system and investigators conducting imaging research. Radiology reports need accompanying resources that explain findings in lay language, which can help reduce the challenge caused by the need to communicate incidental findings. (shrink)

Background Over the last decade, the return of results (ROR) in precision medicine research (PMR) has become increasingly routine. Calls for individual rights to research results have extended the “duty to report” from clinically useful genetic information to traits and ancestry results. ROR has thus been reframed as inherently beneficial to research participants, without a needed focus on who benefits and how. This paper addresses this gap, particularly in the context of PMR aimed at increasing participant diversity, by providing investigator (...) and researcher perspectives on and questions about the assumed value of ROR in PMR.Methods Semi-structured interviews with a purposive sample of investigators and researchers across federally funded PMR studies in three national consortia, as well as observations of study activities, focused on how PM researchers conceptualize diversity and implement inclusive practices across research stages, including navigating ROR.Results Interviewees (1) validated the value of ROR as a benefit of PMR, while others (2) questioned the benefit of clinically actionable results to individuals in the absence of sufficient resources for translating findings into health care for diverse and disadvantaged populations; (3) expressed uncertainties in applying the presumed value of ROR as a benefit for non-clinical results; and (4) and debated when the promise of the value of ROR may undermine trust in PMR, and divert efforts to return value beyond ROR.Conclusions Conceptualizations of diversity and inclusion among PM researchers and investigators raise unique ethical questions where unexamined assumptions of the value of ROR inform study recruitment efforts to enroll minoritized and under-represented populations. A lack of consideration for resources and infrastructure necessary to translate ROR into actionable information may hinder trustworthy community-research relationships. Thus, we argue for a more intentional interrogation of ROR practices as an offer of benefit and for whom. (shrink)

The aim of our themed symposium is to explore the limits and possibilities of corporate reputation for enabling corporate accountability. We articulate three perspectives on corporate accountability. The communicative perspective equates accountability with disclosure and stakeholder engagement. The phenomenological perspective focuses on stakeholder expectations and reputation management. The consequential perspective focuses on effects/consequences. We then examine how corporate accountability is understood, how it relates to ideals, mission, and purpose, alternative pathways to corporate accountability, reputational consequences, and the role algorithms play (...) in relationships between corporate reputation and accountability. Using a multitude of organizational contexts, these papers advance our understanding of how corporate reputation can be used as a mechanism for creating greater corporate accountability, and for identifying alternative pathways when corporate reputation fails to do so. (shrink)

In this paper William Carroll argues that the alleged conflict between creation and science has its origin in a mistaken comprehension of the meaning of “creation”and the extent of explication that natural sciences can offer. Carroll explains that creation, a metaphysical and theological notion, affirms that everything which exists depends on one single cause which is God. But, on the other side, the object of study of natural sciences is the realm of changing things. Whereas creation speaks to (...) the cause of existence itself, evolutionary biology, cosmology and other natural sciences focus on phenomena subject to change.In contrast, creation should not be understood as the change from nothingness to something, but as a theological and metaphysical dependence in the order of being. This does not mean, however, that the theological and metaphysical approaches are incompatible with those of natural sciences. (shrink)

In this article we describe our approach to understanding wrongdoing in medical research and practice, which involves the statistical analysis of coded data from a large set of published cases. We focus on understanding the environmental factors that predict the kind and the severity of wrongdoing in medicine. Through review of empirical and theoretical literature, consultation with experts, the application of criminological theory, and ongoing analysis of our first 60 cases, we hypothesize that 10 contextual features of the medical environment (...) (including financial rewards, oversight failures, and patients belonging to vulnerable groups) may contribute to professional wrongdoing. We define each variable, examine data supporting our hypothesis, and present a brief case synopsis from our study that illustrates the potential influence of the variable. Finally, we discuss limitations of the resulting framework and directions for future research. (shrink)

Many psychological scientists and behavioral neuroscientists affirm that “emotion” influences thinking, decision-making, actions, social relationships, well-being, and physical and mental health. Yet there is no consensus on a definition of the word “emotion,” and the present data suggest that it cannot be defined as a unitary concept. Theorists and researchers attribute quite different yet heuristic meanings to “emotion.” They show considerable agreement about emotion activation, functions, and regulation. The central goal of this article is to alert researchers, students, and other (...) consumers of “emotion” research to the multiple meanings or aspects that distinguished scientists attribute to ”emotion,” increase appreciation of its interesting and challenging complexity, and sharpen perspectives on “emotion” and the associated body of literature that is of critical significance to science and society. (shrink)

Food images are useful stimuli for the study of cognitive processes as well as eating behavior. To enhance rigor and reproducibility in task-based research, it is advantageous to have stimulus sets that are publicly available and well characterized. Food Folio by Columbia Center for Eating Disorders is a publicly available set of 138 images of Western food items. The set was developed for the study of eating disorders, particularly for use in tasks that capture eating behavior characteristic of these illnesses. (...) It contains foods that are typically eaten, as well as those typically avoided, by individuals with eating disorders. Each image has now been rated across 17 different attributes by a large general United States population sample via Amazon’s Mechanical Turk. Ratings included subjective attributes as well as estimates of nutrient content. Each participant rated a subset of stimulus set food items on all 17 dimensions. Additional description of the image set is provided in terms of physical image information and accurate nutritional information. Correlations between subjective ratings were calculated and an exploratory factor analysis and exploratory cluster analysis completed. Outcomes of the factor analysis suggested foods may be described along three latent factors of healthiness, tastiness, and umami taste; the cluster analysis highlighted five distinct clusters of foods varying on these same dimensions. Descriptive outcomes indicated that the stimulus set includes a range of foods that vary along multiple dimensions and thus is likely to be useful in addressing various research questions surrounding eating behavior and cognition in healthy populations, as well as in those with eating disorders. The provision of comprehensive descriptive information allows for stimulus selection that is optimized for a given research question and promotes strong inference. (shrink)

This article suggests a way to circumvent some of the problems that follow from the lack of consensus on a definition of emotion (Izard, 2010; Kleinginna & Kleinginna, 1981) and emotion regulation (Cole, Martin, & Dennis, 2004) by adopting a conceptual framework based on discrete emotions theory and focusing on specific emotions. Discrete emotions theories assume that neural, affective, and cognitive processes differ across specific emotions and that each emotion has particular motivational and regulatory functions. Thus, efforts at regulation should (...) target the specific dysregulated emotions. The positive effects of emotion regulation are more likely to be optimized when they result from or lead to emotion utilization—the constructive use of the energy of emotion arousal. Effective processes for regulation differ for basic emotions and emotion schemas. This article identifies neural systems that facilitate emotion experiences and emotion regulation processes. It considers the implications of the developmental change from basic emotions to emotion schemas, and also briefly discusses the effects of interventions on changes in emotion knowledge, emotion regulation, and social and emotional competence. (shrink)

Many emotion researchers would probably agree that at least some aspects of discrete emotions are evolutionarily conserved (e.g., the sensation/feeling component cannot be learned). Such agreement probably extends to the notion that aspects of emotions emerge in ontogeny as a function of developmental, learning, and cultural processes. Determining when and under what circumstances they emerge seems largely a matter for empirical research, though theories differ in their predictions and in the way they describe the relevant emotional-, cognitive-, and neuro-developmental processes.

Overgeneral autobiographical memory (OGM) is strongly associated with depression in adults and appears to reflect a stable cognitive bias. However, it is not known whether this bias exists in children or what factors contribute to its development. We examined the roles of age, dysphoria, and a new variable, emotion‐focusing (EF), on the production of specific autobiographical memory (AM) in children, using the standard Autobiographical Memory Test (AMT; CitationWilliams & Broadbent, 1986). Results show that older children are more specific than younger (...) children, irrespective of cue valence. Dysphoria was linked to less specific retrieval of positive memories in children. A three‐way interaction between age, valence, and dysphoria was also found, such that older dysphoric children demonstrated a difficulty in retrieving specific negative memories. In addition, emotion‐focusing was associated with specific AM recall, especially to negative cues. Results are discussed with reference to the development of depressogenic biases. (shrink)

Block's target article makes a significant contribution toward sorting the neural bases of phenomenal consciousness from the neural systems that underlie cognitive access to it. However, data from developmental science suggest that cognitive access may be only one of several ways to access phenomenology. These data may also have implications for the visual-cognitive phenomena that Block uses to support his case.

I agree with Williams that evolutionary theory provides the best account of the pain expression. We may disagree as to whether pain has an emotional dimension or includes discrete basic emotions as integral components. I interpret basic emotion expressions that occur contemporaneously with pain expression as representing separate but highly interactive systems, each with distinct adaptive functions.

This article clarifies my current and seemingly ever-changing position on issues relating to emotions. The position derives from my differential emotions theory and it changes with new empirical findings and with insights from my own and others’ thinking and writing. The theory distinguishes between first-order emotions and emotion schemas. For example, it proposes that first-order negative emotions are attributable mainly to infants and young children in distress and to older individuals in emergency or highly challenging situations. Emotion schemas are defined (...) as emotion feelings interacting with cognition in motivating the decision making and actions of everyday life. (shrink)

I am very appreciative of those who wrote comments on my article. They raised some interesting and some quite challenging questions. Their responses seem quite in synchrony with my focus and intent—to reveal some problems that we need to address in advancing emotion science. The authors of the commentaries reflected some of the same sort of differences among themselves as I found among the emotion scientists whom I surveyed in search of a definition of emotion. Like the emotion scientists who (...) responded to my survey, most of the authors of the commentaries were generally in agreement on the significance of research in the emotion domain but not in agreement on the meaning of the term emotion. I briefly discuss the noteworthy question (raised in one of the commentaries) as to whether and when discrete emotion concepts might someday share the same fate as the general term emotion and disappear from emotion science. (shrink)

How far does a researcher’s responsibility extend when an incidental finding is identified? Balancing pertinent ethical principles such as beneficence, respect for persons, and duty to rescue is not always straightforward, particularly in neuroimaging research where empirical data that might help guide decision making are lacking. We conducted a systematic survey of perceptions and preferences of 396 investigators, research participants, and Institutional Review Board members at our institution. Using the partial entrustment model as described by Richardson, we argue that our (...) data supports universal reading by a neuroradiologist of all research MRI scans for incidental findings and providing full disclosure to all participants. (shrink)

Carpendale & Lewis's (C&L's) interesting and insightful article did not integrate several potentially useful notions from emotion theory and research into their explanatory framework. I propose that emotions are indigenous elements of mind and that children's understanding of them is fundamental to their understanding of the mental life of self and others, understandings critical to the development of social and emotional competence.

Throughout the Old Testament, the stories, laws, and songs not only teach a way of life that requires individuals to be moral, but they demonstrate how. In biblical studies, character ethics has been one of the fastest-growing areas of interest. Whereas ethics usually studies rules of behavior, character ethics focuses on how people are formed to be moral agents in the world. This book presents the most up-to-date academic work in Old Testament character ethics, covering topics throughout the Torah, the (...) Prophets, and the Writings, in addition to the use of the Bible in the modern world. In addition to Carroll and Lapsley, contributors are Denise M. Ackermann, Cheryl B. Anderson, Samuel E. Balentine, William P. Brown, Walter Brueggemann, Thomas B. Dozeman, Bob Ekblad, Jose Rafael Escobar R., Theodore Hiebert, Kathleen O'Connor, Dennis T. Olson, J. David Pleins, Luis R. Rivera Rodriguez, J. J. M. Roberts, and Daniel L. Smith-Christopher. (shrink)

Vigil's socio-relational framework of sex differences in emotion-expressive behavior has a number of interesting aspects, especially the principal concepts of reciprocity potential and perceived attractiveness and trustworthiness. These are attractive and potentially heuristic ideas. However, some of his arguments and claims are not well grounded in research on early development. Three- to five-year-old children did not show the sex differences in emotion-expressive behavior discussed in the target article. Our data suggest that Vigil may have underestimated the roles of epigenetic and (...) cultural factors in shaping emotion-expressive behavior. (shrink)

The amygdala is a key brain area regulating responses to stress and emotional stimuli, so improving our understanding of how it is regulated could offer novel strategies for treating disturbances in emotion regulation. As we review here, a growing body of evidence indicates that the gut microbiota may contribute to a range of amygdala-dependent brain functions from pain sensitivity to social behavior, emotion regulation, and therefore, psychiatric health. In addition, it appears that the microbiota is necessary for normal development of (...) the amygdala at both the structural and functional levels. While further investigations are needed to elucidate the exact mechanisms of microbiota-to-amygdala communication, ultimately, this work raises the intriguing possibility that the gut microbiota may become a viable treatment target in disorders associated with amygdala dysregulation, including visceral pain, post-traumatic stress disorder, and beyond. Also see the video abstract here: https://youtu.be/O5gvxVJjX18 The amygdala plays a central role in regulating many aspects of behavior in rodents and humans, from pain responding to social interaction and psychiatric function. Accumulating evidence suggests microbiota-to-amygdala communication along the gut-brain axis is a key modulator of these amygdala-dependent behaviors, with critical implications for health and disease. (shrink)

Randomized controlled trial trial designs exist on an explanatory-pragmatic spectrum, depending on the degree to which a study aims to address a question of efficacy or effectiveness. As conceptualized by Schwartz and Lellouch in 1967, an explanatory approach to trial design emphasizes hypothesis testing about the mechanisms of action of treatments under ideal conditions, whereas a pragmatic approach emphasizes testing effectiveness of two or more available treatments in real-world conditions. Interest in, and the number of, pragmatic trials has grown substantially (...) in recent years, with increased recognition by funders and stakeholders worldwide of the need for credible evidence to inform clinical decision-making. This increase has been accompanied by the onset of learning healthcare systems, as well as an increasing focus on patient-oriented research. However, pragmatic trials have ethical challenges that have not yet been identified or adequately characterized. The present study aims to explore the views of key stakeholders with respect to ethical issues raised by the design and conduct of pragmatic trials. It is embedded within a large, four-year project that seeks to develop guidance for the ethical design and conduct of pragmatic trials. As a first step, this study will address important gaps in the current empirical literature with respect to identifying a comprehensive range of ethical issues arising from the design and conduct of pragmatic trials. By opening up a broad range of topics for consideration within our parallel ethical analysis, we will extend the current debate, which has largely emphasized issues of consent, to the range of ethical considerations that may flow from specific design choices. Semi-structured interviews with key stakeholders, across multiple jurisdictions, identified based on their known experience and/or expertise with pragmatic trials. We expect that the study outputs will be of interest to a wide range of knowledge users including trialists, ethicists, research ethics committees, journal editors, regulators, healthcare policymakers, research funders and patient groups. All publications will adhere to the Tri-Agency Open Access Policy on Publications. (shrink)

Unwarranted, by NYU law professor Barry Friedman, offers a diagnosis of some of the contemporary ills of American policing and a prescribed cure. Between 2014 and 2016, incidents of fatal shootings...

Mazur & Booth present an intriguing model of the relationship between circulating testosterone levels and dominance behaviour in man, but their review of studies on testosterone–behaviour relationships in man is selective. Much of the evidence they cite is correlational in nature. Placebo-controlled manipulations of testosterone levels are required to test their hypothesis that dominance levels are testosterone-dependent in man. The changes in testosterone level that follow behavioural experience may be a consequence of stress. Testosterone levels in man are determined by (...) a wide variety of factors, and a multivariate approach is required. (shrink)

Lewis makes a strong case for the interdependence and integration of emotion and cognitive processes. Yet, these processes exhibit considerable independence in early life, as well as in certain psychopathological conditions, suggesting that the capacity for their integration emerges as a function of development. In some circumstances, the concept of highly interactive emotion and cognitive systems seems a viable alternative hypothesis to the idea of systems integration.