Which features of patients are morally relevant in ventilator triage? A survey of the UK public.

BACKGROUND: In the early stages of the COVID-19 pandemic, many health systems, including those in the UK, developed triage guidelines to manage severe shortages of ventilators. At present, there is an insufficient understanding of how the public views these guidelines, and little evidence on which features of a patient the public believe should and should not be considered in ventilator triage. METHODS: Two surveys were conducted with representative UK samples. In the first survey, 525 participants were asked in an open-ended format to provide features they thought should and should not be considered in allocating ventilators for COVID-19 patients when not enough ventilators are available. In the second survey, 505 participants were presented with 30 features identified from the first study, and were asked if these features should count in favour of a patient with the feature getting a ventilator, count against the patient, or neither. Statistical tests were conducted to determine if a feature was generally considered by participants as morally relevant and whether its mean was non-neutral. RESULTS: In Survey 1, the features of a patient most frequently cited as being morally relevant to determining who would receive access to ventilators were age, general health, prospect of recovery, having dependents, and the severity of COVID symptoms. The features most frequently cited as being morally irrelevant to determining who would receive access to ventilators are race, gender, economic status, religion, social status, age, sexual orientation, and career. In Survey 2, the top three features that participants thought should count in favour of receiving a ventilator were pregnancy, having a chance of dying soon, and having waited for a long time. The top three features that participants thought should count against a patient receiving a ventilator were having committed violent crimes in the past, having unnecessarily engaged in activities with a high risk of COVID-19 infection, and a low chance of survival. CONCLUSIONS: The public generally agreed with existing UK guidelines that allocate ventilators according to medical benefits and that aim to avoid discrimination based on demographic features such as race and gender. However, many participants expressed potentially non-utilitarian concerns, such as inclining to deprioritise ventilator allocation to those who had a criminal history or who contracted the virus by needlessly engaging in high-risk activities.

Automatic emotion and attention analysis of young children at home: a ResearchKit autism feasibility study.

Current tools for objectively measuring young children's observed behaviors are expensive, time-consuming, and require extensive training and professional administration. The lack of scalable, reliable, and validated tools impacts access to evidence-based knowledge and limits our capacity to collect population-level data in non-clinical settings. To address this gap, we developed mobile technology to collect videos of young children while they watched movies designed to elicit autism-related behaviors and then used automatic behavioral coding of these videos to quantify children's emotions and behaviors. We present results from our iPhone study Autism & Beyond, built on ResearchKit's open-source platform. The entire study-from an e-Consent process to stimuli presentation and data collection-was conducted within an iPhone-based app available in the Apple Store. Over 1 year, 1756 families with children aged 12-72 months old participated in the study, completing 5618 caregiver-reported surveys and uploading 4441 videos recorded in the child's natural settings. Usable data were collected on 87.6% of the uploaded videos. Automatic coding identified significant differences in emotion and attention by age, sex, and autism risk status. This study demonstrates the acceptability of an app-based tool to caregivers, their willingness to upload videos of their children, the feasibility of caregiver-collected data in the home, and the application of automatic behavioral encoding to quantify emotions and attention variables that are clinically meaningful and may be refined to screen children for autism and developmental disorders outside of clinical settings. This technology has the potential to transform how we screen and monitor children's development.

Rat intersubjective decisions are encoded by frequency-specific oscillatory contexts.

INTRODUCTION: It is unknown how the brain coordinates decisions to withstand personal costs in order to prevent other individuals' distress. Here we test whether local field potential (LFP) oscillations between brain regions create "neural contexts" that select specific brain functions and encode the outcomes of these types of intersubjective decisions. METHODS: Rats participated in an "Intersubjective Avoidance Test" (IAT) that tested rats' willingness to enter an innately aversive chamber to prevent another rat from getting shocked. c-Fos immunoreactivity was used to screen for brain regions involved in IAT performance. Multi-site local field potential (LFP) recordings were collected simultaneously and bilaterally from five brain regions implicated in the c-Fos studies while rats made decisions in the IAT. Local field potential recordings were analyzed using an elastic net penalized regression framework. RESULTS: Rats voluntarily entered an innately aversive chamber to prevent another rat from getting shocked, and c-Fos immunoreactivity in brain regions known to be involved in human empathy-including the anterior cingulate, insula, orbital frontal cortex, and amygdala-correlated with the magnitude of "intersubjective avoidance" each rat displayed. Local field potential recordings revealed that optimal accounts of rats' performance in the task require specific frequencies of LFP oscillations between brain regions in addition to specific frequencies of LFP oscillations within brain regions. Alpha and low gamma coherence between spatially distributed brain regions predicts more intersubjective avoidance, while theta and high gamma coherence between a separate subset of brain regions predicts less intersubjective avoidance. Phase relationship analyses indicated that choice-relevant coherence in the alpha range reflects information passed from the amygdala to cortical structures, while coherence in the theta range reflects information passed in the reverse direction. CONCLUSION: These results indicate that the frequency-specific "neural context" surrounding brain regions involved in social cognition encodes outcomes of decisions that affect others, above and beyond signals from any set of brain regions in isolation.

Abnormal fronto-limbic engagement in incarcerated stimulant users during moral processing.

RATIONALE: Stimulant use is a significant and prevalent problem, particularly in criminal populations. Previous studies found that cocaine and methamphetamine use is related to impairment in identifying emotions and empathy. Stimulant users also have abnormal neural structure and function of the ventromedial prefrontal cortex (vmPFC), amygdala, and anterior (ACC) and posterior cingulate (PCC), regions implicated in moral decision-making. However, no research has studied the neural correlates of stimulant use and explicit moral processing in an incarcerated population. OBJECTIVES: Here, we examine how stimulant use affects sociomoral processing that might contribute to antisocial behavior. We predicted that vmPFC, amygdala, PCC, and ACC would show abnormal neural response during a moral processing task in incarcerated methamphetamine and cocaine users. METHODS: Incarcerated adult males (N = 211) were scanned with a mobile MRI system while completing a moral decision-making task. Lifetime drug use was assessed. Neural responses during moral processing were compared between users and non-users. The relationship between duration of use and neural function was also examined. RESULTS: Incarcerated stimulant users showed less amygdala engagement than non-users during moral processing. Duration of stimulant use was negatively associated with activity in ACC and positively associated with vmPFC response during moral processing. CONCLUSIONS: These results suggest a dynamic pattern of fronto-limbic moral processing related to stimulant use with deficits in both central motive and cognitive integration elements of biological moral processes theory. This increases our understanding of how drug use relates to moral processing in the brain in an ultra-high-risk population.

Subcomponents of psychopathy have opposing correlations with punishment judgments.

Psychopathy research is plagued by an enigma: Psychopaths reliably act immorally, but they also accurately report whether an action is morally wrong. The current study revealed that cooperative suppressor effects and conflicting subsets of personality traits within the construct of psychopathy might help explain this conundrum. Among a sample of adult male offenders (N = 100) who ranked deserved punishment of crimes, Psychopathy Checklist-Revised (PCL-R) total scores were not linearly correlated with deserved punishment task performance. However, these null results masked significant opposing associations between task performance and factors of psychopathy: the PCL-R Interpersonal/Affective (i.e., manipulative and callous) factor was positively associated with task performance, while the PCL-R Social Deviance (i.e., impulsive and antisocial) factor was simultaneously negatively associated with task performance. These relationships were qualified by a significant interaction where the Interpersonal/Affective traits were positively associated with task performance when Social Deviance traits were high, but Social Deviance traits were negatively associated with task performance when Interpersonal/Affective traits were low. This interaction helped reveal a significant nonlinear relationship between PCL-R total scores and task performance such that individuals with very low or very high PCL-R total scores performed better than those with middle-range PCL-R total scores. These results may explain the enigma of why individuals with very high psychopathic traits, but not other groups of antisocial individuals, usually have normal moral judgment in laboratory settings, but still behave immorally, especially in contexts where social deviance traits have strong influence.

Neural basis of moral verdict and moral deliberation.

How people judge something to be morally right or wrong is a fundamental question of both the sciences and the humanities. Here we aim to identify the neural processes that underlie the specific conclusion that something is morally wrong. To do this, we introduce a novel distinction between "moral deliberation," or the weighing of moral considerations, and the formation of a "moral verdict," or the commitment to one moral conclusion. We predict and identify hemodynamic activity in the bilateral anterior insula and basal ganglia that correlates with committing to the moral verdict "this is morally wrong" as opposed to "this is morally not-wrong," a finding that is consistent with research from economic decision-making. Using comparisons of deliberation-locked vs. verdict-locked analyses, we also demonstrate that hemodynamic activity in high-level cortical regions previously implicated in morality--including the ventromedial prefrontal cortex, posterior cingulate cortex, and temporoparietal junction--correlates primarily with moral deliberation as opposed to moral verdicts. These findings provide new insights into what types of processes comprise the enterprise of moral judgment, and in doing so point to a framework for resolving why some clinical patients, including psychopaths, may have intact moral judgment but impaired moral behavior.

Sleep and metabolism: role of hypothalamic neuronal circuitry.

Sleep and metabolism are intertwined physiologically and behaviorally, but the neural systems underlying their coordination are still poorly understood. The hypothalamus is likely to play a major role in the regulation sleep, metabolism, and their interaction. And increasing evidence suggests that hypocretin cells in the lateral hypothalamus may provide particularly important contributions. Here we review: 1) direct interactions between biological arousal and metabolic systems in the hypothalamus, and 2) indirect interactions between these two systems mediated by stress or reward, emphasizing the role of hypocretins. An increased understanding of the mechanisms underlying these interactions may provide novel approaches for the treatment of patients with sleep disorders and obesity, as well as suggest new therapeutic strategies for symptoms of aging, stress, or addiction.

Hemispheric Asymmetries during Processing of Immoral Stimuli.

Evolutionary approaches to dissecting our psychological architecture underscore the importance of both function and structure. Here we focus on both the function and structure of our neural circuitry and report a functional bilateral asymmetry associated with the processing of immoral stimuli. Many processes in the human brain are associated with functional specialization unique to one hemisphere. With respect to emotions, most research points to right-hemispheric lateralization. Here we provide evidence that not all emotional stimuli share right-hemispheric lateralization. Across three studies employing different paradigms, the processing of negative morally laden stimuli was found to be highly left-lateralized. Regions of engagement common to the three studies include the left medial prefrontal cortex, left temporoparietal junction, and left posterior cingulate. These data support the hypothesis that processing of immoral stimuli preferentially engages left hemispheric processes and sheds light on our evolved neural architecture.

The brain hypocretins and their receptors: mediators of allostatic arousal.

The hypocretins (abbreviated 'Hcrts' - also called 'orexins') are two neuropeptides secreted exclusively by a small population of neurons in the lateral hypothalamus. These peptides bind to two receptors located throughout the brain in nuclei associated with diverse cognitive and physiological functions. Initially, the brain Hcrt system was found to have a major role in the regulation of sleep/wake transitions. More recent studies indicate Hcrts may play a role in other physiological functions, including food intake, addiction, and stress. Taken together, these studies suggest a general role for Hcrts in mediating arousal, especially when an organism must respond to unexpected stressors and challenges in the environment.

Infection, incest, and iniquity: investigating the neural correlates of disgust and morality.

Disgust, an emotion related to avoiding harmful substances, has been linked to moral judgments in many behavioral studies. However, the fact that participants report feelings of disgust when thinking about feces and a heinous crime does not necessarily indicate that the same mechanisms mediate these reactions. Humans might instead have separate neural and physiological systems guiding aversive behaviors and judgments across different domains. The present interdisciplinary study used functional magnetic resonance imaging (n = 50) and behavioral assessment to investigate the biological homology of pathogen-related and moral disgust. We provide evidence that pathogen-related and sociomoral acts entrain many common as well as unique brain networks. We also investigated whether morality itself is composed of distinct neural and behavioral subdomains. We provide evidence that, despite their tendency to elicit similar ratings of moral wrongness, incestuous and nonsexual immoral acts entrain dramatically separate, while still overlapping, brain networks. These results (i) provide support for the view that the biological response of disgust is intimately tied to immorality, (ii) demonstrate that there are at least three separate domains of disgust, and (iii) suggest strongly that morality, like disgust, is not a unified psychological or neurological phenomenon.

Motor experience with graspable objects reduces their implicit analysis in visual- and motor-related cortex.

Motor-related regions of parietal and prefrontal cortices have been shown to selectively activate when observers passively view objects that afford manual grasping. Yet, it remains unknown whether these cortical responses depend on prior motor-related experience with the object being observed. To address this question, we asked participants to undergo fMRI scanning while viewing exemplars of two different categories of graspable objects: one associated with extensive motor experience (door knobs) and one associated with no self-reported motor experience (artificial rock climbing holds). Despite participants' lack of experience grasping climbing holds, these objects were found to generate a systematic response in several visuomotor-related regions of cortex-including left PMv and left AIP. Interestingly, however, the response to door knobs did not include activity in any motor-related regions, being limited instead to a comparatively small bilateral area of lateral occipital cortex, relative to the more spatially extensive response in occipital and temporal cortex that was observed for climbing holds. This result suggested that object-specific responses in both visual- and motor-related cortex may in fact negatively correlate with object-specific motor experience. To test this possibility, we repeated the experiment using participants having extensive self-reported experience grasping climbing holds (i.e., veteran indoor rock climbers). Consistent with our hypothesis, both climbing holds and door knobs generated activity limited to lateral occipital cortex. Taken together, these data support the proposal that repeated real-world motor experience with an object category may lead to reduced implicit analysis in both motor- and visual-related regions of cortex.

Consequences, action, and intention as factors in moral judgments: an FMRI investigation.

The traditional philosophical doctrines of Consequentialism, Doing and Allowing, and Double Effect prescribe that moral judgments and decisions should be based on consequences, action (as opposed to inaction), and intention. This study uses functional magnetic resonance imaging to investigate how these three factors affect brain processes associated with moral judgments. We find the following: (1) Moral scenarios involving only a choice between consequences with different amounts of harm elicit activity in similar areas of the brain as analogous non-moral scenarios; (2) Compared to analogous non-moral scenarios, moral scenarios in which action and inaction result in the same amount of harm elicit more activity in areas associated with cognition (such as the dorsolateral prefrontal cortex) and less activity in areas associated with emotion (such as the orbitofrontal cortex and temporal pole); (3) Compared to analogous non-moral scenarios, conflicts between goals of minimizing harm and of refraining from harmful action elicit more activity in areas associated with emotion (orbitofrontal cortex and temporal pole) and less activity in areas associated with cognition (including the angular gyrus and superior frontal gyrus); (4) Compared to moral scenarios involving only unintentional harm, moral scenarios involving intentional harm elicit more activity in areas associated with emotion (orbitofrontal cortex and temporal pole) and less activity in areas associated with cognition (including the angular gyrus and superior frontal gyrus). These findings suggest that different kinds of moral judgment are preferentially supported by distinguishable brain systems.

Placing a tool in the spotlight: spatial attention modulates visuomotor responses in cortex.

Visual spatial attention has long been associated with facilitatory effects on visual perception. Here, we report that spatial attention can also modulate implicit visuomotor processing in dorsal regions of human cortex. Participants underwent fMRI scanning while performing a voluntary attentional orienting task that varied the category of a task-irrelevant object in the attended location (tool vs. non-tool). Data were then analyzed as a function of the attended location (left vs. right visual field) and the object category in that location. We found that the fMRI BOLD response in two visuomotor-related regions--the supplementary motor area (SMA) and the left inferior parietal lobule (IPL)--showed an interaction between the location of attention and the location of the tool in the bilateral display. Further, these responses were statistically distinct from those regions in dorsal cortex showing activity modulated only by the tool location or only by the attended location. While the effects of attending non-foveally within the visual field have been well documented in relation to visual perception, our findings support the proposal that voluntary visuospatial attention may also have consequences for the implicit planning of object-directed actions.

Acute handling stress modulates methylphenidate-induced catecholamine overflow in the medial prefrontal cortex.

Although stress is an extensively investigated phenomenon, the effects of specific stressors on the pharmacologic activity of routinely administered drugs are less well characterized. We designed the present study to investigate the effect of handling stress on catecholaminergic responsivity following an acute methylphenidate (MP, Ritalin) challenge in the medial prefrontal cortex (mPFC). Norepinephrine (NE) and dopamine (DA) levels were simultaneously measured in 15-min samples of PFC dialysate using HPLC coupled with electrochemical detection. Sprague-Dawley rats were handled for 15 min, which produced an increase from basal extracellular DA and NE levels. Handling stress attenuates the DA response when administered 2 h prior to IP MP, whereas handling stress enhances the DA response when administered simultaneously with IG MP. These findings suggest that persistent alterations in mesocorticolimbic DA-ergic activity are induced by a short exposure to restraint stress as evidenced by the altered response to MP challenge.