John Van

The use of do not resuscitate (DNR) orders in Dutch hospitals was studied as part of a nationwide study on medical decisions concerning the end of life. DNR decisions are made in 6 per cent of all admissions, and 61 per cent of all in-hospital deaths were preceded by a DNR decision. We found that in only 14 per cent of the cases had the patients been involved in the DNR decision (32 per cent of competent patients). The concept of futility is analysed as these findings are discussed. We conclude that determining the effectiveness of resuscitation is a medical judgement whereas determining the proportionality (burden/benefit ratio) of it requires a discussion between doctor and patient (or his or her surrogates). Since the respondents in the cases without patient involvement gave many reasons for their decision that went beyond determining effectiveness, we conclude that more patient involvement would have been desirable

The relation between testosterone levels and aggressive behavior is well established. From an evolutionary viewpoint, testosterone can explain at least part of the sex differences found in aggressive behavior. This explanation, however, is mediated by factors such as prenatal testosterone levels and basal levels of cortisol. Especially regarding sex differences in aggression during adolescence, these mediators have great influence. Based on developmental brain structure research we argue that sex differences in aggression have a pre-pubertal origin and are maintained during adolescence. Evidence of prenatal, adolescent, and adult levels of testosterone in relation to aggression taken together, support Archer's argument for sexual selection as the driver of sex differences in aggression

Approach–avoidance generally describes appetitive motivation and fear of punishment. In a social context approach motivation is, however, also expressed as social aggression and dominance. We therefore link approach–avoidance to dominance–submissiveness, and provide a neural framework that describes how the steroid hormone testosterone shifts reflexive as well as deliberate behaviors towards dominance and promotion of social status. Testosterone inhibits acute fear at the level of the basolateral amygdala and hypothalamus and promotes reactive dominance through upregulation of vasopressin gene expression in the central-medial amygdala. Finally, the hormone can, depending on social context and prenatal hormone exposure, promote both pro- and antisocial behaviors and decisions through its effects on prefrontal–amygdala interactions. All these effects of testosterone, however, serve to increase and maintain social status

Recent accounts on the global workspace theory suggest that consciousness involves transient formations of functional connections in thalamo-cortico-cortical networks. The level of connectivity in these networks is argued to determine the state of consciousness. Emotions are suggested to play a role in shaping consciousness, but their involvement in the global workspace theory remains elusive. In the present study, the role of emotion in the neural workspace theory of consciousness was scrutinized by investigating, whether unconscious and conscious display of emotional compared to neutral facial expressions would differentially modulate EEG coherence. EEG coherence was measured by means of computing an average EEG coherence value between the frontal, parietal, and midline scalp sites. Objective awareness checks evidenced that conscious identification of the masked facial expressions was precluded. Analyses revealed reductions in EEG coherence in the lower frequency range for the masked as compared to unmasked neutral facial expressions. Crucially, a decline in EEG coherence was not observed for the emotional facial expressions. In other words, the level of EEG coherence did apparently vary as a function of awareness, but not when emotion was involved. The current finding suggests that EEG coherence is modulated by unconscious emotional processes, which extends common views on the global workspace architecture of consciousness