In school education, teaching-learning interaction is deemed as a core process in the classroom. The fundamental neural basis underlying teaching-learning interaction is proposed to be essential for tuning learning outcomes. However, the neural basis of this process as well as the relationship between the neural dynamics and the learning outcomes are largely unclear. With non-invasive technologies such as fNIRS, hyperscanning techniques have been developed since the last decade and been applied to the field of educational neuroscience for simultaneous multi-brain (...) scanning. Hyperscanning studies suggest that the interpersonal neural synchronization during teaching-learning interaction might be an ideal neural biomarker for predicting learning outcomes. To systematically evaluate such a relationship, this meta-analysis ran on a random-effects model on 16 studies with 23 independent samples. Further moderator analyses were also performed to examine the potential influences of the style, mode, content, and the assessment method of learning outcomes. The random-effects modeling results confirmed a robust positive correlation between INS and learning outcomes. Subsequent analyses revealed that such relationship was mainly affected by both interaction style and mode. Therefore, the present meta-analysis provided a confirmatory neurocognitive foundation for teaching-learning interaction, as well as its relation to the learning outcomes, consolidated future learning and teaching studies in various disciplines including second language education with a firm methodological reference. (shrink)

Dance has traditionally been viewed from a Eurocentric perspective as a mode of self-expression that involves the human body moving through space, performed for the purposes of art, and viewed by an audience. In this Hypothesis and Theory article, we synthesize findings from anthropology, sociology, psychology, dance pedagogy, and neuroscience to propose The Synchronicity Hypothesis of Dance, which states that humans dance to enhance both intra- and inter-brain synchrony. We outline a neurocentric definition of dance, which suggests that dance (...) involves neurobehavioral processes in seven distinct areas including sensory, motor, cognitive, social, emotional, rhythmic, and creative. We explore The Synchronicity Hypothesis of Dance through several avenues. First, we examine evolutionary theories of dance, which suggest that dance drives interpersonal coordination. Second, we examine fundamental movement patterns, which emerge throughout development and are omnipresent across cultures of the world. Third, we examine how each of the seven neurobehaviors increases intra- and inter-brain synchrony. Fourth, we examine the neuroimaging literature on dance to identify the brain regions most involved in and affected by dance. The findings presented here support our hypothesis that we engage in dance for the purpose of intrinsic reward, which as a result of dance-induced increases in neural synchrony, leads to enhanced interpersonal coordination. This hypothesis suggests that dance may be helpful to repattern oscillatory activity, leading to clinical improvements in autism spectrum disorder and other disorders with oscillatory activity impairments. Finally, we offer suggestions for future directions and discuss the idea that our consciousness can be redefined not just as an individual process but as a shared experience that we can positively influence by dancing together. (shrink)

This research explored the effect of explicit Interoceptive Attentiveness manipulation on hemodynamic brain correlates during a task involving interpersonal motor coordination framed with a social goal. Participants performed a task requiring interpersonal movement synchrony with and without a social framing in both explicit IA and control conditions. Functional Near-Infrared Spectroscopy was used to record oxygenated and deoxygenated hemoglobin changes during the tasks. According to the results, the prefrontal cortex, which is involved in high-order social cognition and (...) class='Hi'>interpersonal relations processing, was more responsive when inducing the explicit focus on the breath during the socially framed motor task requiring synchronization, as indicated by increased O2Hb. In the absence of a broader social frame, this effect was not significant for the motor task. Overall, the present study suggests that when a joint task is performed and the individual focuses on his/her physiological body reactions, the brain hemodynamic correlates are “boosted” in neuroanatomical regions that support sustained attention, reorientation of attention, social responsiveness, and synchronization. Furthermore, the PFC responds significantly more as the person consciously focuses on physiological interoceptive correlates and performs a motor task requiring synchronization, particularly when the task is socially framed. (shrink)

Sensorimotor synchronization, the coordination of physical actions in time with a rhythmic sequence, is a skill that is necessary not only for keeping the beat when making music, but in a wide variety of interpersonal contexts. Being able to attend to temporal regularities in the environment is a prerequisite for event prediction, which lies at the heart of many cognitive and social operations. It is therefore of value to assess and potentially stimulate SMS abilities, particularly in aging and (...) neurocognitive disorders, to understand intra-individual communication in the later stages of life, and to devise effective music-based interventions. While a bulk of research exists about SMS and movement-based interventions in Parkinson’s disease, a lot less is known about other types of neurodegenerative disorders, such as Alzheimer’s disease, vascular dementia, or frontotemporal dementia. In this review, we outline the brain and cognitive mechanisms involved in SMS with auditory stimuli, and how they might be subject to change in healthy and pathological aging. Globally, SMS with isochronous sounds is a relatively well-preserved skill in old adulthood and in patients with NCDs. At the same time, natural tapping speed decreases with age. Furthermore, especially when synchronizing to sequences at slow tempi, regularity and precision might be lower in older adults, and even more so in people with NCDs, presumably due to the fact that this process relies on attention and working memory resources that depend on the prefrontal cortex and parietal areas. Finally, we point out that the effect of the severity and etiology of NCDs on sensorimotor abilities is still unclear: More research is needed with moderate and severe NCD, comparing different etiologies, and using complex auditory signals, such as music. (shrink)

In 1975, Colwyn Trevarthen first presented his groundbreaking explorations into the early origins of human intersubjectivity. His influential model dictates that, during intimate and playful spontaneous face-to-face protoconversations, the emotions of both the 2–3-month-old infant and mother are nonverbally communicated, perceived, mutually regulated, and intersubjectively shared. This primordial basic interpersonal interaction is expressed in synchronized rhythmic-turn-taking transactions that promote the intercoordination and awareness of positive brain states in both. In this work, I offer an interpersonal neurobiological model (...) of Trevarthen’s intersubjective protoconversations as rapid, reciprocal, bidirectional visual-facial, auditory-prosodic, and tactile-gestural right brain-to-right brain implicit nonverbal communications between the psychobiologically attuned mother and the developing infant. These co-constructed positive emotional interactions facilitate the experience-dependent maturation of the infant’s right brain, which is in an early critical period of growth. I then address the central role of interpersonal synchrony in intersubjectivity, expressed in a mutual alignment or coupling between the minds and bodies of the mother and infant in face-to-face protoconversations, as well as how these right brain-to-right brain emotional transmissions generate bioenergetic positively charged interbrain synchrony within the dyad. Following this, I offer recent brain laterality research on the essential functions of the right temporoparietal junction, a central node of the social brain, in face-to-face nonverbal communications. In the next section, I describe the ongoing development of the protoconversation over the 1st year and beyond, and the co-creation of a fundamental energy-dependent, growth-promoting social emotional matrix that facilitates the emergence of the highly adaptive human functions of mutual play and mutual love. In the final section, I discuss the clinical applications of this interpersonal neurobiological model of intersubjectivity, which has a long history in the psychotherapy literature. Toward that end, I offer very recent paradigm-shifting hyperscanning research that simultaneously measures both the patient and therapist during a psychotherapeutic interaction. Using the Trevarthen’s two-person intersubjective model, this research demonstrates changes in both brains of the therapeutic dyad and the critical role of nonverbal communications in an emotionally-focused psychotherapy session. These studies specifically document interbrain synchronization between the right temporoparietal junction of the patient and the right temporoparietal junction of the clinician, a right brain-to-right brain nonverbal communication system in the co-constructed therapeutic alliance. Lastly, I discuss the relationship between the affect communicating functions of the intersubjective motivational system and the affect regulating functions of the attachment motivational system. (shrink)

The recognition and incorporation of evidence-based neuroscientific concepts into creative arts therapeutic knowledge and practice seem valuable and advantageous for the purpose of integration and professional development. Moreover, exhilarating insights from the field of neuroscience coincide with the nature, conceptualization, goals, and methods of Creative Arts Therapies, enabling comprehensive understandings of the clinical landscape, from a translational perspective. This paper contextualizes and discusses dynamic brain functions that have been suggested to lie at the heart of intra- and inter-personal processes. (...) Touching upon fundamental aspects of the self and self-other interaction, the state-of-the-art neuroscientific-informed views will shed light on mechanisms of the embodied, predictive and relational brain. The conceptual analysis introduces and interweaves the following contemporary perspectives of brain function: firstly, the grounding of mental activity in the lived, bodily experience will be delineated; secondly, the enactive account of internal models, or generative predictive representations, shaped by experience, will be defined and extensively deliberated; and thirdly, the interpersonal simulation and synchronization mechanisms that support empathy and mentalization will be thoroughly considered. Throughout the paper, the cross-talks between the brain and the body, within the brain through functionally connected neural networks and in the context of agent-environment dynamics, will be addressed. These communicative patterns will be elaborated on to unfold psychophysiological linkage, as well as psychopathological shifts, concluding with the neuroplastic change associated with the formulation of CATs. The manuscript suggests an integrative view of the brain-body-mind in contexts relevant to the therapeutic potential of the expressive creative arts and the main avenues by which neuroscience may ground, enlighten and enrich the clinical psychotherapeutic practice. (shrink)

Crowd behaviour challenges our fundamental understanding of social phenomena. Involving complex interactions between multiple temporal and spatial scales of activity, its governing mechanisms defy conventional analysis. Using 1.5 million Twitter messages from the 15M movement in Spain as an example of multitudinous self-organization, we describe the coordination dynamics of the system measuring phase-locking statistics at different frequencies using wavelet transforms, identifying 8 frequency bands of entrained oscillations between 15 geographical nodes. Then we apply maximum entropy inference methods to describe Ising (...) models capturing transient synchrony in our data at each frequency band. The models show that all frequency bands of the system operate near critical points of their parameter space and while fast frequencies present only a few metastable states displaying all-or-none synchronization, slow frequencies present a diversity of metastable states of partial synchronization. Furthermore, describing the state at each frequency band using the energy of the corresponding Ising model, we compute transfer entropy to characterize cross-scale interactions between frequency bands, showing a cascade of upward information flows in which each frequency band influences its contiguous slower bands and downward information flows where slow frequencies modulate distant fast frequencies. (shrink)

Synchronization of neural activity in oscillatory neural networks is a general principle of information processing in the brain at both preattentional and attentional levels. This is confirmed by a model of attention based on an oscillatory neural network with a central element and models of feature binding and working memory based on multi-frequency oscillations.

The strong coupling of binding to cross-correlations is methodologically problematic. A completely unstructured network of neurons can produce cross-correlations very similar to the measured ones, and yet they have little dynamic effect.

The fundamental assumption of compensation for visual delays states that, since delays are dealt with, there must be compensatory mechanisms. These mechanisms are taken to be internal models. Alternatives for delay compensation exist, suggesting that this assumption may not be fundamental, and nor should the existence of internal models be assumed. Delays may even be employed in their own compensation.

We propose three extensions of the theory developed by Juslin & Vll (J&V). First, motion should be considered as an additional mechanism. Second, synchronization plays a role in eliciting emotion. And, third, the spectrum of musical affect or feelings is denser and broader than the spectrum of emotions, suggesting an expansion of the scope of the theory beyond emotions.

Functional roles for cortical synchronization in self-organizing neural networks are described. These properties are best understood by models that link brain to behavior. Synchrony can express itself differently in cortical circuits that perform different behavioral tasks. Cortical temporal properties that seem inexplicable by synchrony are also mentioned.

Our work supports synchronization for binding within Phillips & Singer's “contextual field” (CF) as well as the type of its lateral interaction they propose. Both firmly agree with our “association field” (AF) and its modulatory influences (Eckhorn et al. 1990). However, the CF connections seem to produce anticorrelation among assemblies representing unrelated structures, whereas experimental evidence indicates decoupling. Finally, it is unclear how the cortex can have access to the logistic function used in the “coherent infomax” approach.

Interpersonal neurobiology (IPNB) is a burgeoning interdisciplinary field that focuses on ways in which relationships shape and transform the architecture and functioning of the human brain. IPNB points to four specific conditions that appear to encourage the emergence of empathy. Further, these conditions, when gathered together, may constitute the core components of a spirituality of compassion. Following definitions and a discussion of interdisciplinary method, this essay delineates IPNB's main tenets and demonstrates ways in which IPNB sheds light on (...) important aspects of human empathy and compassion. Drawing on this analysis, it introduces the four conditions that encourage the emergence of empathy in individuals and groups and shows why they may be central elements of a spirituality of compassion. A case study, in which the Native American Ojibwe practice of the talking circle is described and assessed through the lens of the IPNB-derived spirituality of compassion, demonstrates the evaluative usefulness of this set of conditions. (shrink)

Although the neural systems that underlie spoken language are well-known, how they adapt to evolving social cues during natural conversations remains an unanswered question. In this work we investigate the neural correlates of face-to-face conversations between two individuals using functional near infrared spectroscopy and acoustical analyses of concurrent audio recordings. Nineteen pairs of healthy adults engaged in live discussions on two controversial topics where their opinions were either in agreement or disagreement. Participants were matched according to their a priori opinions (...) on these topics as assessed by questionnaire. Acoustic measures of the recorded speech including the fundamental frequency range, median fundamental frequency, syllable rate, and acoustic energy were elevated during disagreement relative to agreement. Consistent with both the a priori opinion ratings and the acoustic findings, neural activity associated with long-range functional networks, rather than the canonical language areas, was also differentiated by the two conditions. Specifically, the frontoparietal system including bilateral dorsolateral prefrontal cortex, left supramarginal gyrus, angular gyrus, and superior temporal gyrus showed increased activity while talking during disagreement. In contrast, talking during agreement was characterized by increased activity in a social and attention network including right supramarginal gyrus, bilateral frontal eye-fields, and left frontopolar regions. Further, these social and visual attention networks were more synchronous across brains during agreement than disagreement. Rather than localized modulation of the canonical language system, these findings are most consistent with a model of distributed and adaptive language-related processes including cross-brain neural coupling that serves dynamic verbal exchanges. (shrink)

A key emergent property of group social dynamic is synchrony–the coordination of actions, emotions, or physiological processes between group members. Despite this fact and the inherent nested structure of groups, little research has assessed physiological synchronization between group members from a multi-level perspective, thus limiting a full understanding of the dynamics between members. To address this gap of knowledge we re-analyzed a large dataset comprising physiological and psychological data that were collected in two laboratory studies that involved two different (...) social group tasks. In both studies, following the group task, members reported their experience of group cohesion via questionnaires. We utilized a non-linear analysis method-multidimensional recurrence quantification analysis that allowed us to represent physiological synchronization in cardiological interbeat intervals between group members at the individual-level and at the group-level. We found that across studies and their conditions, the change in physiological synchrony from baseline to group interaction predicted a psychological sense of group cohesion. This result was evident both at the individual and the group levels and was not modified by the context of the interaction. The individual- and group-level effects were highly correlated. These results indicate that the relationship between synchrony and cohesion is a multilayered construct. We re-affirm the role of physiological synchrony for cohesion in groups. Future studies are needed to crystallize our understanding of the differences and similarities between synchrony at the individual-level and synchrony at the group level to illuminate under which conditions one of these levels has primacy, or how they interact. (shrink)

The relationship of climate and monetary resources to various freedoms can be enriched if the conceptual links psychobehavioral adaptations are conceptualized more broadly as reflections of a richer cultural context that involves multiple physical and psychological resources, as proposed by social resource theory and a number of models of the emergence of social meaning.

Crick and Koch’s 1990 “neurobiological theory of consciousness” sparked the race for the physical correlates of subjective experience. 30 years later, cognitive sciences trend toward consideration of the brain’s electromagnetic field as the primary seat of consciousness, the “to be” of the individual. Recent advancements in laboratory tools have preceded an influx of studies reporting a synchronization between the neuronally generated EM fields of interacting individuals. An embodied and enactive neuroscientific approach has gained traction in the wake of (...) these findings wherein consciousness and cognition are theorized to be regulated and distributed beyond the individual. We approach this frontier to extend the implications of person-to-person synchrony to propose a process of combination whereby coupled individual agents merge into a hierarchical cognitive system to which they are subsidiary. Such is to say, the complex mammalian consciousness humans possess may not be the tip of the iceberg, but another step in a succeeding staircase. To this end, the axioms and conjectures of General Resonance Theory are utilized to describe this phenomenon of interpersonal resonant combination. Our proposal describes a coupled system of spatially distributed EM fields that are synchronized through recurrent, entraining behavioral interactions. The system, having achieved sufficient synchronization, enjoys an optimization of information flow that alters the conscious states of its merging agents and enhances group performance capabilities. In the race for the neurobiological correlates of subjective experience, we attempt the first steps in the journey toward defining the physical basis of “group consciousness.” The establishment of a concrete account of the combination of consciousness at a scale superseding individual human consciousness remains speculation, but our suggested approach provides a framework for empirical testing of these possibilities. (shrink)

Tomasello et al. provide a convincing account of the origins of cultural cognition. I highlight how emotionally grounded sharing of experiences (not merely or predominantly intentions) is critical for the development of interpersonal understanding and perspective-sensitive thinking. Such sharing is specifically human in quality as well as motivation, and entails forms of self–other connectedness and differentiation that are essential to communication and symbolic functioning.

Body movement is a primary nonverbal communication channel in humans. Coordinated social behaviors, such as dancing together, encourage multifarious rhythmic and interpersonally coupled movements from which observers can extract socially and contextually relevant information. The investigation of relations between visual social perception and kinematic motor coupling is important for social cognition. Perceived coupling of dyads spontaneously dancing to pop music has been shown to be highly driven by the degree of frontal orientation between dancers. The perceptual salience of other aspects, (...) including postural congruence, movement frequencies, time‐delayed relations, and horizontal mirroring remains, however, uncertain. In a motion capture study, 90 participant dyads moved freely to 16 musical excerpts from eight musical genres, while their movements were recorded using optical motion capture. A total from 128 recordings from 8 dyads maximally facing each other were selected to generate silent 8‐s animations. Three kinematic features describing simultaneous and sequential full body coupling were extracted from the dyads. In an online experiment, the animations were presented to 432 observers, who were asked to rate perceived similarity and interaction between dancers. We found dyadic kinematic coupling estimates to be higher than those obtained from surrogate estimates, providing evidence for a social dimension of entrainment in dance. Further, we observed links between perceived similarity and coupling of both slower simultaneous horizontal gestures and posture bounding volumes. Perceived interaction, on the other hand, was more related to coupling of faster simultaneous gestures and to sequential coupling. Also, dyads who were perceived as more coupled tended to mirror their pair's movements. (shrink)

Modeling emotion processes remains a conceptual and methodological challenge in affective sciences. In responding to the other target articles in this special section on “Emotion and the Brain” and the comments on our article, we address the issue of potentially separate brain networks subserving the functions of the different emotion components. In particular, we discuss the suggested role of component synchronization in producing information integration for the dynamic emergence of a coherent emotion process, as well as the (...) links between incentive salience and concern-relevance in the elicitation of emotion. (shrink)

Recent imaging results suggest that individuals automatically share the emotions of others when exposed to their emotions. We question the assumption of the automaticity and propose a contextual approach, suggesting several modulatory factors that might influence empathic brain responses. Contextual appraisal could occur early in emotional cue evaluation, which then might or might not lead to an empathic brain response, or not until after an empathic brain response is automatically elicited. We propose two major roles for empathy; (...) its epistemological role is to provide information about the future actions of other people, and important environmental properties. Its social role is to serve as the origin of the motivation for cooperative and prosocial behavior, as well as help for effective social communication. (shrink)

Our recent work suggests that (1) the purpose of human conscious thought is participation in social and cultural groups, and (2) logical reasoning depends on conscious thought. These mesh well with the argument theory of reasoning. In broader context, the distinctively human traits are adaptations for culture and inner processes serve interpersonal functions.

The article discusses the evolutionary development of horror and fear in animals and humans, including in regard to cognition and physiological aspects of the brain. An overview of the social aspects of emotions, including the role that emotions play in interpersonal relations and the role that empathy plays in humans' ethics, is provided. An overview of the psychological aspects of monsters, including humans' simultaneous repulsion and interest in horror films that depict monsters, is also provided.

If education is to make a difference it is widely acknowledged that we must aim to educate for understanding, but this means being clear about what we mean by understanding. This paper argues for a concept of personal understanding, recognising both the commonality and individuality of each pupil's understandings, and the relationship between understanding and interpretation, analysis and synopsis, and the quest for meaning. In supporting this view, the paper advocates an emergentist notion of person‐hood, and considers the neurophysiological reasons (...) for asserting the individuality of human minds, brains, and the creation of personal meanings. The notion of personal meanings would, however, seem to run counter to the post‐modern denial of the autonomous self, and the tradition in philosophy, most recently stemming from Wittgenstein, that insists that meanings and understandings are essentially social, and not personal—a view also advocated by John White in regard to education. In contrast, this paper argues that meanings and understandings are both social (interpersonal) and personal. Once we reinstate the notion of personal minds and personal understandings, alongside the social, we may see more clearly what it means to educate for understanding, and why this might begin to make a difference. (shrink)

This commentary describes some extensions of the Phillips & Singer model of contextual interactions to cater for the contrast- and extent-dependency of surround facilitation and suppression. I also comment briefly on some semantic problems with what exactly the role of synchronization might be: input preprocessing or output postprocessing?

Recent models of psychopathology and psychotherapy highlight the importance of interpersonal factors. The current review offers a biological perspective on these interpersonal processes by examining inter-brain synchrony—the coupling of brain activity between people interacting with one another. High inter-brain synchrony is associated with better relationships in therapy and in daily life, while deficits in the ability to achieve inter-brain synchrony are associated with a variety of psychological and developmental disorders. The review suggests that therapy (...) improves patients’ ability to achieve such synchrony through inter-brain plasticity—a process by which recurring exposure to high inter-brain synchrony leads to lasting change in a person’s overall ability to synchronize. Therapeutic sessions provide repeated situations with high inter-brain synchrony. This can lead to a long-term increase in the ability to synchronize, first with the therapist, then generalized to other interpersonal relationships, ultimately leading to symptom reduction. The proposed inter-brain plasticity model offers a novel biological framework for understanding relational change in psychotherapy and its links to various forms of psychopathology and provides testable hypotheses for future research. Understanding this mechanism may help improve existing psychotherapy methods and develop new ones. (shrink)

Ainslie is correct in arguing that the force of commitments partly depends on the predictive role of present action, but this claim can be supported independently of the analogy with interpersonal bargaining. No matter whether we conceive of the parties involved in the bargaining as interests or transient selves, the picture of the will as a competitive interaction among these parties is unconvincing.

Recent findings indicate that complex cognitive functions are organized at a global level in the brain and rely on large-scale information processing requiring functional integration of multiple disparate neural assemblies. The critical question of the integration of distributed brain activities is whether the essential integrative role can be attributed to a specific structure in the brain or whether this ability is inherent to the cognitive network as a whole. The results of the present study show that mean (...) values of the running correlation function in frontal-temporal EEG pairs with one electrode in the anterior cingulate cortex are significantly higher than the same values in other frontal-temporal pairs. These findings indicate a particular role of the ACC in large-scale communication, which could reflect its unique integrative functions in cognitive processing. (shrink)

Based on the theoretical analysis of self-consciousness concepts, we hypothesized that the spatio-temporal pattern of functional connectivity within the default-mode network (DMN) should persist unchanged across a variety of different cognitive tasks or acts, thus being task-unrelated. This supposition is in contrast with current understanding that DMN activated when the subjects are resting and deactivated during any attention-demanding cognitive tasks. To test our proposal, we used, in retrospect, the results from our two early studies ([Fingelkurts, 1998] and [Fingelkurts et al., (...) 2003]). In both studies for the majority of experimental trails we indeed found a constellation of operationally synchronized cortical areas (indexed as DMN) that was persistent across all studied experimental conditions in all subjects. Furthermore, we found three major elements comprising this DMN: two symmetrical occipito-parieto-temporal and one frontal spatio-temporal patterns. This new data directly supports the notion that DMN has a specific functional connotation – it provides neurophysiologic basis for self-processing operations, namely first-person perspective taking and an experience of agency. (shrink)

The concept of brain death as equivalent to cardiopulmonary death was initially conceived following developments in neuroscience, critical care, and transplant technology. It is now a routine part of medicine in Western countries, including the United States. In contrast, Eastern countries have been reluctant to incorporate brain death into legislation and medical practice. Several countries, most notably China, still lack laws recognizing brain death and national medical standards for making the diagnosis. The perception is that Asians are (...) less likely to approve of brain death or organ transplant from brain dead donors. Cultural and religious traditions have been referenced to explain this apparent difference. In the West, the status of the brain as home to the soul in Enlightenment philosophy, combined with pragmatism and utilitarianism, supports the concept of brain death. In the East, the integration of body with spirit and nature in Buddhist and folk beliefs, along with the Confucian social structure that builds upon interpersonal relationships, argues against brain death. However, it is unclear whether these reasoning strategies are explicitly used when families and medical providers are faced with acknowledging brain death. Their decisions are more likely to involve a prioritization of values and a rationalization of intuitive responses. Why and whether there might be differences between East and West in the acceptance of the brain death concept requires further empirical testing, which would help inform policy-making and facilitate communication between providers and patients from different cultural and ethnic backgrounds. (shrink)