Patient, Family Caregiver, and Nurse Involvement in End-of-Life Discussions During Palliative Chemotherapy: A Phenomenological Hermeneutic Study

The aim of this study was to investigate current nursing practice related to end-of-life discussions with incurable lung cancer patients and their family caregivers from the perspectives of patients, family caregivers, and nurses in an oncology outpatient clinic. This phenomenological hermeneutic study included nine patients, eight family caregivers, and 11 nurses. Data were collected using participant observation, informal and semi-structured individual or joint interviews with patients and family caregivers, and focus group interviews with nurses. A Ricoeur-inspired approach was used to analyze the data. Three themes were identified: (a) content of end-of-life discussions, (b) timing of end-of-life discussions, and (c) challenges in end-of-life discussions. End-of-life discussions were seldom initiated; when they were, it was often too late. Discussions addressed treatment, place of care, practical/economic concerns, and existential matters. The physical environment at the outpatient clinic, lack of continuity, and nurses’ instrumental task workloads and time pressure posed challenges to initiating end-of-life discussions.

Single caudate neurons encode temporally discounted value for formulating motivation for action

The term ‘temporal discounting’ describes both choice preferences and motivation for delayed rewards. Here we show that neuronal activity in the dorsal part of the primate caudate head (dCDh) signals the temporally discounted value needed to compute the motivation for delayed rewards. Macaque monkeys performed an instrumental task, in which visual cues indicated the forthcoming size and delay duration before reward. Single dCDh neurons represented the temporally discounted value without reflecting changes in the animal’s physiological state. Bilateral pharmacological or chemogenetic inactivation of dCDh markedly distorted the normal task performance based on the integration of reward size and delay, but did not affect the task performance for different reward sizes without delay. These results suggest that dCDh is involved in encoding the integrated multidimensional information critical for motivation.

Differential contributions of ventral striatum subregions to the motivational and hedonic components of the affective processing of the reward

The ventral striatum is implicated in the affective processing of the reward, which can be divided into a motivational and a hedonic component. Here, we examined whether these two components rely on distinct neural substrates within the ventral striatum in humans. We used a high-resolution fMRI protocol targeting the ventral striatum combined with a Pavlovian instrumental task and a hedonic reactivity task. Both tasks involved an olfactory reward, thereby allowing us to measure Pavlovian-triggered motivation and sensory pleasure for the same reward within the same participants. Our findings show that different subregions of the ventral striatum are dissociable in their contributions to the motivational and the hedonic component of the affective processing of the reward. Parsing the neural mechanisms and the interplay between Pavlovian incentive processes and hedonic processes might have important implications for understanding compulsive reward-seeking behaviors such as addiction, binge eating, or gambling.

The NMDA Receptor Subunit (GluN1 and GluN2A) Modulation Following Different Conditions of Cocaine Abstinence in Rat Brain Structures

Different neuronal alterations within glutamatergic system seem to be crucial for developing of cocaine-seeking behavior. Cocaine exposure provokes a modulation of the NMDA receptor subunit expression in rodents, which probably contributes to cocaine-induced behavioral alterations. The aim of this study was to examine the composition of the NMDA receptor subunits in the brain structures in rats with the history of cocaine self-administration after cocaine abstinence (i) in an enriched environment, (ii) in an isolated condition, (iii) with extinction training, or (iv) without instrumental task, as well as the Grin1 (encoding GluN1) and Grin2A (encoding GluN2A) gene expression were evaluated after 10-day extinction training in rat brain structures. In the present study, we observed changes only following cocaine abstinence with extinction training, when the increased GluN2A subunit levels were seen in the postsynaptic density fraction but not in the whole homogenate of the prelimbic cortex (PLC) and dorsal hippocampus (dHIP) in rats previously self-administered cocaine. At the same time, extinction training did not change the Grin1 and Grin2A gene expression in these structures. In conclusion, NMDA receptor subunit modulation observed following cocaine abstinence with extinction training may represent a potential target in cocaine-seeking behavior.

De complexitate mundi – What a complexful world

<p>Bare twenty years into the XXI century – and what a treat. Damaging earthquakes with regional impact, climate extremes disrupting weather cycles, water shortages in high-income regions, scarcer (and costlier) energy and mineral resources, rising population. Add a slice of global geopolitical instabilities – even where one would never expect to report them from. And, well, why not: a novel pathogen, so little yet so commanding that the world is still vying with it.</p><p>Natural hazards and anthropogenic factors interact in multiple ways and across various scales, close or afar, in time and space. They interweave a web of complexities that can appear deceitful, capricious, or otherwise overwhelming to the citizens of contemporary societies – even in statistically affluent and educated ones. There comes the role of geosciences, from paleontology to high-atmosphere physics, from energy to oceanography, from the solid to the not so solid earth. There comes their transformative, instrumental task – as new and as pressing as ever.</p><p>Geosciences are not (and will not) what they used to be, bound as they are to glean lessons learned from the past to provide insight into the future. Geoscientists were once thought to study ancient rocks, fiddle with very slow-moving tectonic plates, and bantering about invisible earth’s features, too large, or too deep, or too far away to even imagine for us earthlings. But this is no longer the case – and maybe never has been. At the core of geosciences’ interests lies Nature, for what it is – with all its grand size, seemingly slow processes that unveil sudden effects, complex interactions among forces and bodies across distances and time. These prove to be paramount tools to probe a world perceived as inscrutable, increasingly richer in risks and poorer in resources.</p><p>Therefore, tools of yesterday’s intellectual quests prove instrumental to decipher tomorrow’s societal issues, such as:</p><p>- The long records of natural events (hazards);<br>- Far-flung origins (our solar system and the universe);<br>- Far-reaching effects (feedback, periodicity, and recurrence times);<br>- Need to forecast (or at least account for) the irregular behaviors of modern phenomena (not always known or detectable by current means).</p><p>The knowledge of compounded risks of natural origin provides an outlook on where and what to call for enduring communities. This applies also to risks resulting from interaction among natural events and anthropogenic components. Since natural phenomena embed complexities due to multiple variables and intrinsic feedback, interaction among natural and non-natural ones brings novel issues, requiring a remarkably broad outlook – global and beyond. The natural consequence is then to envision natural risks against population distribution, spatial extents of natural resources, size, and time window of induced effects.</p><p>Picking a selection of examples, this talk thus tries to put into perspective:</p><p>- Hazards stemming from multiple, at times unpredictable sources;<br>- The precious role of geosciences to decipher them – and to forecast them;<br>- The complexity of natural hazards, the flexibility of human planning;<br>- Modern issues challenging societies and economies – today, tomorrow, and thereafter.</p>

Distinct role of nucleus accumbens D2-MSN projections to ventral pallidum in different phases of motivated behavior

The nucleus accumbens (NAc) is a key region in motivated behaviors. NAc medium spiny neurons (MSNs) are divided into those expressing dopamine receptor D1 or D2. Classically, D1- and D2-MSNs have been described as having opposing roles in reinforcement but recent evidence suggests a more complex role for D2-MSNs.Here we show that optogenetic modulation of D2-MSN to ventral pallidum (VP) projections during different stages of motivated behavior has contrasting effects in motivation. Activation of D2-MSN-VP projections during a reward-predicting cue results in increased motivational drive, whereas activation at reward delivery results in decreased motivation; optical inhibition has the opposite behavioral effect. In addition, in a free choice instrumental task, animals prefer the lever that originates one pellet in opposition to pellet plus D2-MSN-VP optogenetic activation, and vice versa for optogenetic inhibition.In summary, D2-MSN-VP projections play different (and even opposing) roles in distinct phases of motivated behavior.

Alcohol Dependence Differentially Alters Action and Outcome Related Orbitofrontal Cortex Activity

Alcohol dependence results in long-lasting deficits in decision-making and behavioral control. Neurobiological investigations have identified orbitofrontal cortex (OFC) as important for value contributions to decision-making as well as action control, and alcohol dependence induces long-lasting changes to OFC function that persist into protracted withdrawal. However, it is unclear which contributing OFC computations are disrupted in alcohol dependence. Here, we combined a well-validated mouse model of alcohol dependence with in vivo extracellular recordings during an instrumental task in which lever press duration serves as the contingency, and lever pressing is sensitive to outcome devaluation. We found prior alcohol dependence did not impair use of duration contingency control but did reduce sensitivity to outcome devaluation. Further, alcohol dependence increased OFC activity associated with lever-pressing but decreased OFC activity during outcome-related epochs. Hence, alcohol dependence induces a long-lasting disruption to OFC function such that activity associated with actions is enhanced, but OFC activity in relation to outcomes is diminished. This has important implications for hypotheses regarding compulsive and habitual phenotypes observed in addiction.

Dopamine neurons of the VTA encode active conspecific interaction and promote social learning through social reward prediction error

Social interactions motivate behavior in many species, facilitating learning, foraging and cooperative behavior. However, how the brain encodes the reinforcing properties of social interactions remains elusive. Here using in vivo recording in freely moving mice, we show that Dopamine (DA) neurons of the Ventral Tegmental Area (VTA) increase their activity during active interactions with unfamiliar conspecific. Using a social instrumental task, we then show that VTA DA neuron activity signals social reward prediction error and drives social reinforcement learning. Thereby, our findings propose that VTA DA neurons are a neural substrate for a social learning signal driving motivated behavior.One Sentence SummaryDA neurons are a substrate for social reward learning through the Social Reward Prediction Error.

Single caudate neurons encode temporally discounted value for formulating motivation for action

Temporal discounting captures both choice preferences and motivation for delayed rewards. While temporally discounted value for choice is represented in brain areas including the dorsolateral prefrontal cortex (DLPFC) and the striatum, the neural process of motivation for delayed rewards remains unidentified. Here we show that neuronal activity of the dorsal part of the primate caudate head (dCDh) — a striatal region receiving projection from the DLPFC — signals temporally discounted value essential for computing motivation for delayed rewards. Macaque monkeys performed an instrumental task, in which a visual cue indicated the forthcoming size and delay duration before reward. Single dCDh neurons represented the temporally discounted value without reflecting changes in the animal’s physiological state. Bilateral pharmacological or chemogenetic inactivation of dCDh specifically distorted a normal motivational performance based on the integration of reward size and delay. These results suggest a major contribution of dCDh to encoding a temporally discounted value, the integrated multidimensional information critical for formulating the motivation for action.

Playback: An Investigation of the Discursive Implications and the Pragmatic Functions of Repetition in Traditional Chinese Medical Consultations

The current study examined a role-related difference in the use of playback (one form of repetition) in medical discourse. We adopted a language and social psychology approach and invoked communication accommodation theory (CAT) to explore this discourse. Thirty doctor/older adult dyads were recorded and transcribed verbatim. Findings suggested that the deployment of repetition is a strategy used by the addresser to either complement or converge to the other interlocutor, in order to ensure that the medical instrumental task is efficiently accomplished and interpersonal rapport is established. Our results show that discourse management is the dominant strategy used by speakers when playing back the other’s utterances. Our analysis also demonstrates that CAT strategies work interdependently. We conclude that CAT is a valuable framework to elucidate the dynamics of, and the social psychological processes underlying, the practice of repetition in medical interviews.