Lady Justice may be Blind, but is She Racist? Examining Brains, Biases, and Behaviors Using Neuro-Voir Dire.

This paper discusses the possible use of functional magnetic-resonance imaging as potentially useful in jury selection. The author suggests that neuro-voir could provide greater impartiality of trials than the standard voir, while also preserving existing privacy protections for jurors. He predicts that ability to image and understand a wide range of brain activities, most notably bias-apprehension and lie detection, will render neuro-voir dire invaluable. However currently, such neuro-solutions remain preliminary.

Body -to-head transplant; a "caputal" crime? Examining the corpus of ethical and legal issues.

Neurosurgeon Sergio Canavero proposed the HEAVEN procedure - i.e. head anastomosis venture - several years ago, and has recently received approval from the relevant regulatory bodies to perform this body-head transplant (BHT) in China. The BHT procedure involves attaching the donor body (D) to the head of the recipient (R), and discarding the body of R and head of D. Canavero's proposed procedure will be incredibly difficult from a medical standpoint. Aside from medical doubt, the BHT has been met with great resistance from many, if not most bio- and neuroethicists.Given both the known challenges and unknown outcomes of HEAVEN, several important neuroethical and legal questions have emerged should Canavero be successful, including: (1) What are the implications for transplantology in the U.S., inclusive of issues of expense, distributive justice, organizational procedures, and the cost(s) of novel insight(s)? (2) How do bioethical and neuroethical principles, and legal regulations of human subject research apply? (3) What are the legal consequences for Canavero (or any other surgeon) performing a BHT? (4) What are the tentative implications for the metaphysical and legal identity of R should they survive post-BHT? These questions are analyzed, issues are identified, and several solutions are proposed in an attempt to re-configure HEAVEN into a safe, clinically effective, and thus (more) realistically viable procedure.Notably, the permissibility of conducting the BHT in China fosters additional, important questions, focal to (1) whether Western ethics and professional norms be used to guide the BHT - or any neuroscientific research and its use - in non-Western countries, such as China; (2) if the models of responsible conduct of research are identical, similar, or applicable to the intent and conduct of research in China; and (3) what economic and political implications (for China and other countries) are fostered if/when such avant garde techniques are successful.These questions are discussed as a further impetus to develop a globally applicable neuroethical framework that would enable both local articulation and cosmopolitan inquiry and oversight of those methods and approaches deemed problematic, if and when rendered in more international settings.

Introduction of severe traumatic brain injury care protocol is associated with reduction in mortality for pediatric patients: a case study of Children's Healthcare of Atlanta's neurotrauma program.

OBJECTIVE Evidence shows mixed efficacy of applying guidelines for the treatment of traumatic brain injury (TBI) in children. A multidisciplinary team at a children's health system standardized intensive care unit-based TBI care using guidelines and best practices. The authors sought to investigate the impact of guideline implementation on outcomes. METHODS A multidisciplinary group developed a TBI care protocol based on published TBI treatment guidelines and consensus, which was implemented in March 2011. The authors retrospectively compared preimplementation outcomes (May 2009 to March 2011) and postimplementation outcomes (April 2011 to March 2014) among patients < 18 years of age admitted with severe TBI (Glasgow Coma Scale score ≤ 8) and potential survivability who underwent intracranial pressure (ICP) monitoring. Measures included mortality, hospital length of stay (LOS), ventilator LOS, critical ICP elevation time (percentage or total time that ICP was > 40 mm Hg), and survivor functionality at discharge (measured by the WeeFIM score). Data were analyzed using Student t-tests. RESULTS A total of 71 and 121 patients were included pre- and postimplementation, respectively. Mortality (32% vs 19%; p < 0.001) and length of critical ICP elevation (> 20 mm Hg; 26.3% vs 15%; p = 0.001) decreased after protocol implementation. WeeFIM discharge scores were not statistically different (57.6 vs 58.9; p = 0.9). Hospital LOS (median 19.6 days; p = 0.68) and ventilator LOS (median 10 days; p = 0.24) were unchanged. CONCLUSIONS A multidisciplinary effort to develop, disseminate, and implement an evidence-based TBI treatment protocol at a children's hospital was associated with improved outcomes, including survival and reduced time of ICP elevation. This type of ICP-based protocol can serve as a guide for other institutions looking to reduce practice disparity in the treatment of severe TBI.

Unilateral C1 Sagittal Split Fractures: An Unusual Entity Revisited.

BACKGROUND: An isolated, unilateral fracture of the C1 lateral mass is a rare condition that has been only minimally described in the literature. Historically, these fractures have predominantly been managed conservatively with either external immobilization or traction. CASE DESCRIPTION: We review the literature and present 2 patients that presented after failing conservative management, but demonstrated excellent clinical outcomes after surgical treatment. CONCLUSIONS: After failure of conservative management, unilateral sagittal split fractures may be safely and effectively managed with unilateral open reduction and placement of a lag screw.