While studies on the characteristics of flow states and their relation to peak performance exist, little is known about the dynamics by which flow states emerge and develop over time. The current paper qualitatively explores the necessary pre-conditions to enter flow, and the development of flow over time until its termination. Using an elicitation interview, participants were asked to recall their flow experiences in sports or music performances. The analysis resulted in the identification of the following three phases that athletes (...) and musicians experience during flow: Preparation to enter flow; Entry into the flow state and; Exit from the flow state. These three phases are characterized by several sub-themes contributing to the experience of flow. The function of emotions is crucial, as they play a core role across all three phases and regulate flow over time. The findings provide insights into the phenomenological characteristics of the transition and maintenance of the three proposed phases and the temporal dynamics of flow. (shrink)

Financial relationships and business transactions between physicians and the health care industry are common. These relationships take a variety of forms, including payments to physicians in exchange for consulting services, reimbursement of physician travel expenses when attending medical device and pharmaceutical educational conferences, physician ownership in life science company stocks, and the provision of free drug samples. Such practices are not intrinsic to medical practice, but as the Institute of Medicine described in its 2009 report, these relationships have the potential (...) to produce positive collaborations that improve patient care and public health, and most physicians view it as “ethically proper to accept items ranging from drug samples to a lucrative consultantship.”However, financial relationships between physicians and pharmaceutical, medical device and biotechnology companies can also create negative influences on physician judgment that compromise patient care and jeopardize the public’s trust. (shrink)

In our society, some aspects of life are off-limits to commerce. We prohibit the selling of children and the buying of wives, juries, and kidneys. Tainted blood is an inevitable consequence of paying blood donors; even sophisticated laboratory tests cannot supplant the gift-giving relationship as a safeguard of the purity of blood. Like blood, health care is too precious, intimate, and corruptible to entrust to the market.The hospice movement in the United States is approximately 40 years old. During these past (...) four decades, the concept of holistic, multidisciplinary care for patients who are suffering from a terminal illness has evolved from a modest, grassroots constellation of primarily volunteer-run and community-governed endeavors to a multimillion dollar industry where the surviving nonprofits compete with for-profit providers, often publicly traded, managed by M.B.A.-trained executives, and governed by corporate boards. The relatively recent emergence of for-profit hospice reflects an increasing commercialization of health care in the United States, the potentially adverse impact of which has been well documented. (shrink)

The empirical literature exploring lawyers and their moral decision making is limited despite the “crisis” of unethical and unprofessional behavior in the bar that has been well documented for over a decade. In particular we are unaware of any empirical studies that investigate the moral landscape of the health lawyer’s practice. In an effort to address this gap in the literature, an interdisciplinary team of researchers at Vanderbilt University designed an empirical study to gather preliminary evidence regarding the moral reasoning (...) of health care attorneys. The primary research question was how health lawyers respond when they encounter ethical or moral dilemmas in their practice for which the law fails to offer a bright-line solution. In exploring this question, we sought to understand better what motivations or influences guide action when health lawyers confront ethical quandaries, and whether there are specific differences, e.g., gender, experience, or religiosity, that are associated with specific responses to situations testing ethical or moral boundaries. (shrink)

"Thinking like a lawyer" is a phrase familiar to every law student, and the development of these analytical skills are, of course, essential. In this essay, however, I reflect on the value of a more expansive approach to professional formation. I argue that legal education best serves students, the bar, and the society when it takes seriously the importance of moral imagination, interpersonal relationships, and personal wellness.

The Alternative Model of Personality Disorders integrates several theoretical models of personality functioning, including interpersonal theory. The interpersonal circumplex dimensions of warmth and dominance can be conceptualized as traits similar to those in AMPD Criterion B, but interpersonal theory also offers dynamic hypotheses about how these variables that change from moment to moment, which help to operationalize some of the processes alluded to in AMPD Criterion A. In the psychotherapy literature, dynamic interpersonal behaviors are thought to be critical for identifying (...) therapeutic alliance ruptures, yet few studies have examined moment-to-moment interpersonal behaviors that are associated with alliance ruptures at an idiographic level. The current study examined the concurrent and cross-lagged relationships between interpersonal behaviors and alliance ruptures within each session in the famous Gloria films. Interpersonal behaviors as well as alliance ruptures were calculated at half minute intervals for each dyad. We identified distinct interpersonal patterns associated with alliance ruptures for each session: Gloria ’s warmth was positively related with withdrawal ruptures concurrently in the session with Carl Rogers; Gloria’s dominance and coldness were related with increased confrontation ruptures in the session with Fritz Perls concurrently, while her coldness was also predicted by confrontation ruptures at previous moments; lastly, both Gloria’s dominance and Albert Ellis’s submissiveness were positively related with withdrawal ruptures. These interpersonal patterns demonstrated the promise of using AMPD dimensions to conceptualize momentary interpersonal processes related to therapy ruptures, as well as the clinical importance of attuning to repetitive, dyad-specific interpersonal cues of ruptures within each session. (shrink)

Alasdair MacIntyre described the late modern West as driven by two moral values: efficiency and effectiveness. Regardless of whether you accept MacIntyre's overarching story, it seems clear that efficiency and effectiveness have achieved a zenith in institutional health care structures, such that these two aspects of care become the final arbiters of what counts as “good” care. At the very least, they are dominant in many clinical contexts and act as the interpretative lens for the judgments of successful health care (...) managers. The drive of efficiency can also be seen in “lean” management methods (originally imported from the automotive manufacturing industry) increasingly deployed in the intensive care unit. This drive gives us pause. The high stress of the ICU is exacerbated by the enormous complexity of technological interventions designed to maintain physiological functioning as the body heals, as well as the ever‐present concerns related to cost, effectiveness, and efficiency. The ICU, therefore, provides an illustrative view of the challenges facing clinicians, as well as resource managers, in terms of delivering care. In short, the goal of technocratic efficiency often ends up at odds with humane purposes. To better understand these contemporary health care dynamics, we conducted a limited series of focus group discussions and interviews with residents experienced in the challenges of delivering care in the ICU environment. In what follows, we highlight some narrative observations drawn from these focus groups. We found a recurrent and disconcerting refrain among our informants that has not been adequately described or addressed in the literature: technocratic management techniques have crept into and bifurcated clinical care strategies in the ICU. Specifically, we highlight the influence of concerns around efficiency and effectiveness and the ways in which these foci have contributed to a bifurcation in care in the ICU along two trajectories: either compassionate care or curative care. (shrink)

In some cases people judge it morally acceptable to sacrifice one person’s life in order to save several other lives, while in other similar cases they make the opposite judgment. Researchers have identified two general factors that may explain this phenomenon at the stimulus level: (1) the agent’s intention (i.e. whether the harmful event is intended as a means or merely foreseen as a side-effect) and (2) whether the agent harms the victim in a manner that is relatively “direct” or (...) “personal”. Here we integrate these two classes of findings. Two experiments examine a novel personalness/directness factor that we call personal force, present when the force that directly impacts the victim is generated by the agent’s muscles (e.g., in pushing). Experiments 1a and b demonstrate the influence of personal force on moral judgment, distinguishing it from physical contact and spatial proximity. Experiments 2a and b demonstrate an interaction between personal force and intention, whereby the effect of personal force depends entirely on intention. These studies also introduce a method for controlling for people’s real-world expectations in decisions involving potentially unrealistic hypothetical dilemmas. (shrink)

The complexity and inefficiency of the U.S. health care system complicates the distribution of life-saving medical technologies. When the public health is at stake, however, there are alternatives. The proposal for a national PrEP program published in this issue of the Journal applies some of the lessons of the national COVID vaccine campaign to HIV prevention. In doing so, it draws on other examples of public health approaches to the financing of medical technology, from vaccines for children to hepatitis C (...) treatment. (shrink)

The selected effects or ‘etiological’ theory of Proper function is a naturalistic and realist account of biological teleology. It is used to analyse normativity in philosophy of language, philosophy of mind, philosophy of medicine, and elsewhere. The theory has been developed with a simple and intuitive view of natural selection. Traits are selected because of their positive effects on the fitness of the organisms that have them. These ‘selected effects’ are the Proper functions of the traits. Proponents argue that this (...) analysis of biological teleology has the unique advantage that the selected effect function of a trait is also a causal explanation of the trait: the trait exists because it performs this function. We show, however, that selected effect functions as currently defined explain the existence of traits only under highly restrictive assumptions about evolutionary dynamics. In many common scenarios in which traits evolve by natural selection, selected effect functions do not explain those traits. This is because definitions of selected effect function extract from any evolutionary scenario only the information that would be explanatorily relevant in the simple evolutionary scenario implicit in those definitions. When applied to more complex scenarios, selected effect functions omit the key information that is explanatorily relevant in those scenarios. The assumptions required for selected effect functions to be explanatory are particularly unlikely to hold in the domain that its proponents care most about—the evolution of representation. A more adequate selected effects theory of Proper functions may be possible, but will require much greater attention to the structure of actual evolutionary explanations. (shrink)

Business ethics scholarship proposes alternatives for making companies sustainable. While these models may have advanced business practice, the alternatives rarely challenge the hegemony of the economic system. This article develops a new normative frame for sustainable business by investigating articulations of counter-hegemony and their ethical implications. Employing political discourse theory and drawing insights from a case in food production, the article finds three articulations of counter-hegemonic ethics: (1) the virtue of socio-ecological embeddedness, (2) the duty of local provisioning, and (3) (...) the utility of regeneration. These findings reflect the three generic normative ethical theories and are proposed to support advancing sustainability. As its main contribution, the study contributes to the field of business ethics by offering a novel normative foundation that challenges power relations in the society, especially those concerning the hegemonic articulations of industrial economy. (shrink)

Our primary goal was to develop and validate a task that could provide evidence about how humans learn praxis gestures, such as those involving the use of tools. To that end, we created a video-based task in which subjects view a model performing novel, meaningless one-handed actions with kinematics similar to praxis gestures. Subjects then imitated the movements with their right hand. Trials were repeated 6 times to examine practice effects. EEG was recorded during the task. As a control, subjects (...) watched videos of a model performing a well-established (over learned) tool-use gesture. These gestures were also imitated 6 times. Demonstrating convergent validity, EEG measures of task-related cortical activation were similar in topography and frequency between the novel gesture task and the overlearned, praxis gesture task. As in studies assessing motor skill learning with simpler tasks, cortical activation during novel gesture learning decreased as the same gestures were repeated. In the control condition, repetition of overlearned tool-use gestures were also associated with reductions in activation, though to a lesser degree. Given that even overlearned, praxis gestures show constriction of EEG activity with repetition, it is possible that that attentional effects drive some of the repetition effects seen in EEG measures of activation during novel gesture repetition. (shrink)

How do we thrive in our behaviors and experiences? Positive neuroscience research illuminates the brain mechanisms that enable human flourishing. Supported by the John Templeton Foundation's Positive Neuroscience Project, which Martin E. P. Seligman established in 2008, Positive Neuroscience provides an intersection between neuroscience and positive psychology.In this edited volume, leading researchers describe the neuroscience of social bonding, altruism, and the capacities for resilience and creativity. Part I describes the mechanisms that enable humans to connect with one another. Part II (...) focuses on the neural mechanisms underlying the human ability and willingness to confer costly benefits on others. Part III examines the mechanisms by which human brains overcome adversity, create, and discover. Specific topics include: a newly discovered nerve type that appears to be specialized for emotional communication; the effects of parenting on the male brain; how human altruism differs from that of other primates; the neural features of extraordinary altruists who have donated kidneys to strangers; and distinctive patterns of brain wiring that endow some people with exceptional musical abilities. Accessible to a broad academic audience, from advanced undergraduates to senior scholars, these subjects have generated a fascinating and highly convergent set of ideas and results, shaping our understanding of human nature. (shrink)

BackgroundThe U.S. Food and Drug Administration traditionally has kept confidential significant amounts of information relevant to the approval or non-approval of specific drugs, devices, and biologics and about the regulatory status of such medical products in FDA’s pipeline.ObjectiveTo develop practical recommendations for FDA to improve its transparency to the public that FDA could implement by rulemaking or other regulatory processes without further congressional authorization. These recommendations would build on the work of FDA’s Transparency Task Force in 2010.MethodsIn 2016-2017, we convened (...) a team of academic faculty from Harvard Medical School, Brigham and Women’s Hospital, Yale Medical School, Yale Law School, and Johns Hopkins Bloomberg School of Public Health to develop recommendations through an iterative process of reviewing FDA’s practices, considering the legal and policy constraints on FDA in expanding transparency, and obtaining insights from independent observers of FDA.ResultsThe team developed 18 specific recommendations for improving FDA’s transparency to the public. FDA could adopt all these recommendations without further congressional action.FundingThe development of the Blueprint for Transparency at the U.S. Food and Drug Administration was funded by the Laura and John Arnold Foundation. (shrink)

It’s an honour to have so many major contributors to the literature respond to our article and we thank them for their thoughtful responses. There are clear shared themes across these commentaries,...

Autism spectrum disorders (ASD) are thought to result in part from altered cortical excitatory-inhibitory balance; this pathophysiology may impact the generation of oscillations on EEG. We investigated premotor-parietal cortical physiology associated with praxis, which has strong theoretical and empirical associations with ASD symptomatology. 25 children with high-functioning ASD (HFA) and 33 controls performed a praxis task involving the pantomiming of tool use, while EEG was recorded. We assessed task-related modulation of signal power in alpha and beta frequency bands. Compared with (...) controls, subjects with HFA showed 27% less left central (motor/premotor) beta (18-22 Hz) event-related desynchronization (ERD) (p = 0.030), as well as 24% less left parietal alpha (7-13 Hz) ERD (p = 0.046). Within the HFA group, blunting of central ERD attenuation was associated with impairments in clinical measures of praxis imitation (r = -0.4; p = 0.04) and increased autism severity (r = 0.48; p = 0.016). The modulation of central beta activity is associated, among other things, with motor imagery, which may be necessary for imitation. Impaired imitation has been associated with core features of ASD. Altered modulation of oscillatory activity may be mechanistically involved in those aspects of motor network function that relate to the core symptoms of ASD. (shrink)

Over the past several decades, psychological essentialism has been an important topic of study, incorporating research from multiple areas of psychology, philosophy and linguistics. At its most basic level, essentialism is the tendency to represent certain concepts in terms of a deeper, unobservable property that is responsible for category membership. Originally, this concept was used to understand people’s reasoning about natural kind concepts, such as TIGER and WATER, but more recently, researchers have identified the emergence of essentialist-like intuitions in a (...) number of other contexts, including people’s representation of concepts like SCIENTIST or CHRISTIAN. This paper develops an account that aims to capture how essentialism may operate across these varied cases. In short, we argue that while there is diversity in the forms essentialism can take, these varied cases reflect the same underlying cognitive structure. (shrink)

Many recent evolutionary psychology and human behavioral ecology studies have tested hypotheses by examining correlations between variables measured at a group level (e.g., state, country, continent). In such analyses, variables collected for each aggregation are often taken to be representative of the individuals present within them, and relationships between such variables are presumed to reflect individual-level processes. There are multiple reasons to exercise caution when doing so, including: (1) the ecological fallacy, whereby relationships observed at the aggregate level do not (...) accurately represent individual-level processes; (2) non-independence of data points, which violates assumptions of the inferential techniques used in null hypothesis testing; and (3) cross-cultural non-equivalence of measurement (differences in construct validity between groups). We provide examples of how each of these gives rise to problems in the context of testing evolutionary hypotheses about human behavior, and we offer some suggestions for future research. (shrink)

The present study investigates the importance of emotional disclosure and vulnerability in the production of hegemonic masculinities. Of particular interest is the role that silence and invisibility play in how men talk about recent stressful life events. One-on-one interviews with men who experienced a stressful life event in the past year illustrate how men often talk about these events in simultaneously visible and invisible ways. We use the term “cloudy visibility” to describe this engagement, identified both in terms of what (...) men articulate in relation to their past stressful experiences and how they articulate these experiences within the present moment of the interview. The conversational consequences of these linguistic devices are analyzed to illustrate how men obscure their inner emotional lives, thus reproducing hegemonic masculine ideals of staying strong and stoic in the face of adversity, while they also seek to make aspects of their inner lives seen and heard to an interviewer. (shrink)

Aggleton & Brown have built a convincing case that hippocampus-related circuits may be involved in thalamic amnesia. It remains to be established, however, that their model represents a distinct neurological system, that the distinction between recall and familiarity captures the roles of these pathways in episodic memory, or that there are no other systems that contribute to the signs of amnesia associated with thalamic disease.

While infant fearfulness, and its expression via crying, may have been adaptive in our evolutionary history, for modern parents, crying can be challenging to respond to. We discuss how and why prolonged crying can raise the risk for difficulties with adult care. Given that crying is the most-reported trigger for shaking, its potential to elicit maladaptive responses should not be overlooked.

Past research has identified a number of asymmetries based on moral judgments. Beliefs about what a person values, whether a person is happy, whether a person has shown weakness of will, and whether a person deserves praise or blame seem to depend critically on whether participants themselves find the agent's behavior to be morally good or bad. To date, however, the origins of these asymmetries remain unknown. The present studies examine whether beliefs about an agent's “true self” explain these observed (...) asymmetries based on moral judgment. Using the identical materials from previous studies in this area, a series of five experiments indicate that people show a general tendency to conclude that deep inside every individual there is a “true self” calling him or her to behave in ways that are morally virtuous. In turn, this belief causes people to hold different intuitions about what the agent values, whether the agent is happy, whether he or she has shown weakness of will, and whether he or she deserves praise or blame. These results not only help to answer important questions about how people attribute various mental states to others; they also contribute to important theoretical debates regarding how moral values may shape our beliefs about phenomena that, on the surface, appear to be decidedly non-moral in nature. (shrink)

When reading, orthographic information is extracted not only from the word the reader is looking at, but also from adjacent words in the parafovea. Here we examined, using the recently introduced OB1‐reader computational model, how orthographic information can be processed in parallel across multiple words and how orthographic information can be integrated across time and space. Although OB1‐reader is a model of text reading, here we used it to simulate single‐word recognition experiments in which parallel processing has been shown to (...) play a role by manipulating the surrounding context in flanker and priming paradigms. In flanker paradigms, observers recognize a central word flanked by other letter strings located left and right of the target and separated from the target by a space. The model successfully accounts for the finding that such flankers can aid word recognition when they contain bigrams of the target word, independent of where those flankers are in the visual field. In priming experiments, in which the target word is preceded by a masked prime, the model accounts for the finding that priming occurs independent of whether the prime and target word are in the same location or not. Crucial to these successes is the key role that spatial attention plays within OB1‐reader, as it allows the model to receive visual input from multiple locations in parallel, while limiting the kinds of errors that can potentially occur under such spatial pooling of orthographic information. (shrink)

Over the course of development, children acquire adult-like thinking about social categories such as race, which in turn informs their perceptions, attitudes, and behavior. However, children’s developing perceptions of race have been understudied particularly with respect to their potential influence on cross-race egalitarianism. Specifically, the acquisition of racial constancy, defined as the perception that race is a concrete and stable category, has been associated with increased awareness of racial stereotypes and group status differences. Yet, little work has investigated behavioral outcomes (...) stemming from the acquisition of racial constancy beliefs. Here, we investigate whether the presence or absence of racial constancy beliefs differentially predicts inequality aversion with racial ingroup versus outgroup members for young children. White children ( N = 202; ages 3–8) completed three sticker resource-allocation games with either a White or a Black partner shown in a photograph, after which racial constancy was measured. Results revealed that the acquisition of racial constancy interacted with partner race to predict inequality aversion outcomes in one game; however, age and gender also exerted strong effects. (shrink)

This volume is a collection of essays by various contributors in honor of the late Laurence Berns, Richard Hammond Elliot Tutor Emeritus at St. John's College, Annapolis. The essays address the literary, political, theological, and philosophical themes of his life's work as a scholar, teacher, and constant companion of the "great books.".