A systematic review of the effectiveness of machine learning for predicting psychosocial outcomes in acquired brain injury: Which algorithms are used and why?

Clinicians working in the field of acquired brain injury (ABI, an injury to the brain sustained after birth) are challenged to develop suitable care pathways for an individual client’s needs. Being able to predict psychosocial outcomes after ABI would enable clinicians and service providers to make advance decisions and better tailor care plans. Machine learning (ML, a predictive method from the field of artificial intelligence) is increasingly used for predicting ABI outcomes. This review aimed to examine the efficacy of using ML to make psychosocial predictions in ABI, evaluate the methodological quality of studies, and understand researchers’ rationale for their choice of ML algorithms. Nine studies were reviewed from five databases, predicting a range of psychosocial outcomes from stroke, traumatic brain injury, and concussion. Eleven types of ML were employed with a total of 75 ML models. Every model was evaluated as having high risk of bias, unable to provide adequate evidence for predictive performance due to poor methodological quality. Overall, there was limited rationale for the choice of ML algorithms and poor evaluation of the methodological limitations by study authors. Considerations for overcoming methodological shortcomings are discussed, along with suggestions for assessing the suitability of data and suitability of ML algorithms for different ABI research questions.     

Regression II. Development through regression

As shown in our previous paper (‘Regression I. Experimental approaches to regression’, JAP, 65, 2, 345-65), the common mechanism of regression can be described as reversible dedifferentiation, which is understood as a relative increase of the proportion of low-differentiated (older) systems in actualized experience. Experimental data show that regression following disease (chronic tension headache) is followed by adaptation and an increase in system differentiation in that experience domain which contains systems responsible for that adaptation. The results of mathematical modelling support the idea that reversible dedifferentiation can be one of the mechanisms for increasing the effectiveness of adaptation through learning. Reversible dedifferentiation, which is phenomenologically described as regression, is a general mechanism for restructuring the organism-environment interactions in situations where behaviours that were effective in the past become ineffective. Reversible dedifferentiation has evolved as a component of adaptation when new behaviours are formed and large-scale modifications in the existing behaviours are required in the face of changes in the external and/or internal environment. Thus, the authors believe that this article provides evidence for Jung’s view that regression is not only a ‘return’ to past forms of thinking, affects and behaviour, but that regressive processes provide a significant impetus for psychological growth and development.     

A combination of combat experience,early abduction,and severe traumatization fuels appetitive aggression and violence among abductees of rebel war in Northern Uganda

Individuals who perpetrate violence may likely perceive violence as appealing and infliction of violence to derive pleasure is termed as appetitive aggression. Individuals who were abducted as children into an armed group often experience a higher number of traumatic event types, that is traumatic load and are usually socialized in a violence-endorsing environment. This study aims to investigate the interaction between age at initial abduction with that of traumatic load, and their influence on appetitive aggression along with perpetration of violent acts by former members of an armed rebel group of both sexes. Semi-structured interviews were conducted among a target group of formerly abducted rebel-war survivors (including participants with and without combat experience) from Northern Uganda. Participants included 596 women and 570 men with N = 1,166 (M_age = 32.58, SD_age = 9.76, range: 18–80 years). We conducted robust linear regression models to investigate the influence of age at initial abduction, traumatic load, combat experience, and biological sex on appetitive aggression as well as their perpetrated violent acts. Our study shows, appetitive aggression and the number of perpetrated violent acts were specifically increased in individuals who were abducted young, experienced several traumatic events in their lifetime, and with previous combat experience. For perpetrated violence men showed increased levels whereas for appetitive aggression the association was independent of biological sex. Therefore, early abducted individuals with a higher traumatic load, who have combat experience, need to be given special intervention to prevent any further violence.     

Clinical research on behavioral activation as treatment for post‐traumatic stress disorder: A brief review and meta‐analysis

Behavioral activation (BA), an effective treatment for depression, has recently been receiving attention as a possible intervention for PTSD. BA interventions could be particularly useful in treating underserved populations (i.e., individuals with lower socioeconomic status). A literature search was conducted, which identified seven outcome studies that examined the effectiveness of stand‐alone BA treatment for individuals with PTSD. All studies identified for this brief review demonstrated clinically significant reductions in PTSD symptoms using BA as an intervention. A meta‐analysis of these few studies revealed a nonsignificant effect (Cohen's d = 0.713, p = .512) despite reporting an average symptom reduction of 25.8%. Other studies utilizing BA treatment for PTSD do so in tandem with other interventions and were excluded from analysis. This brief review summarizes the literature on the use of BA as a stand‐alone treatment for PTSD and suggests that future research seek to confirm the usefulness of BA as a potential treatment modality for mental health‐care providers treating individuals with PTSD.     

睡眠剥夺对风险决策的影响机制探讨

许多行业的决策者必须在睡眠不足的状态下做出选择与判断。睡眠剥夺是睡眠不足的实验室模型, 被证明能显著影响风险决策, 但内在机制不明。基于前人研究基础提出假设模型, 即睡眠剥夺通过影响个体的反馈加工、风险感知、抑制控制、决策理性, 进而影响风险决策。拟通过实验室研究与现场研究, 采用简单赌博任务、概率折扣任务、双选择Oddball任务等研究范式, 对比睡眠剥夺前后被试在执行上述实验任务时的行为差异, 同时比较执行控制网络、奖赏网络等脑功能网络连接强度, 以及任务诱发的FRN等脑电成分在睡眠剥夺前后的变化, 进而论证上述反应被试反馈加工等心理过程的行为-脑电-脑成像指标的变化与睡眠剥夺后被试风险决策变化的关系。研究结果将科学地解释睡眠剥夺影响风险决策的内在机制, 为进一步探讨如何规避睡眠不足导致的决策失误提供理论与实证依据。     

A thematic analysis of practitioners' understanding of domestic abuse in terms of post‐traumatic stress disorder (PTSD) and complex‐PTSD (C‐PTSD)

There is a growing body of evidence suggesting that domestic abuse (DA) should be conceptualised within the complex post‐traumatic stress disorder (C‐PTSD) model. Recently, in the draft of the International Classification of Diseases, Eleventh Revision, produced by the World Health Organization (WHO), C‐PTSD was included as a separate criterion in which DA is incorporated (ICD‐11, WHO, 2018). In this study, a thematic analysis was used to explore to what extent practitioners working with DA survivors are familiar with PTSD and C‐PTSD. Research into such a prevalent and detrimental problem as DA is important to understand whether the development of theoretical knowledge about DA and C‐PTSD is addressed in practice. In a Women's Centre in South London, six semi‐structured interviews with middle‐aged female practitioners were conducted to investigate each counsellor's experiences, knowledge and reflections. Six final themes were constructed to summarise the main results. The findings demonstrate limited practitioner understanding of DA in terms of C‐PTSD, which seems to impact not only the effectiveness of treatment plans with DA survivors, but also counsellors’ own psychological and physical states. It is also indicated that DA can be conceptualised within the C‐PTSD model that corresponds with previous literature indicating the complex nature of DA. The overall results of the current research acknowledge that DA sectors should not be neglected and better funding and effective psychoeducation in this field are needed.     

Impairment in the control of coupled cyclic movements of ipsilateral hand and foot after total callosotomy

Integrity of both cerebral hemispheres is required to control in-phase or anti-phase coupling of ipsilateral hand and foot oscillations, as shown by the impairment of these tasks when performed on the healthy side of hemiplegic patients. On this basis, coupling of hand–foot movements was analysed in a right-handed subject (ME) who underwent a total resection of the corpus callosum. Oscillations of the prone hand and foot, paced by a metronome at different frequencies, as well as EMG activity in extensor carpi radialis (ECR) and tibialis anterior (TA) muscles were analysed by measuring the average phase difference between the hand and foot movements and EMG cycles.

ME performed in-phase movements (right-hand extension coupled to right-foot dorsal flexion) at frequencies up to 3 Hz, though the hand cycle progressively lagged the foot cycle as the frequency increased. At 3 Hz the hand lag reached −142° (as compared to about 25° in healthy subjects). The lag increased even further after application of an inertial load to the hand, reaching 180° at 1.8 Hz (about 50° in healthy subjects). ME's hand lag is caused by the lack of any anticipatory reaction in hand movers. In contrast to healthy subjects, which activate the ECR earlier than the TA when the frequency increases, ME activated the ECR later than TA at all frequencies higher than 0.9 Hz.

Anti-phase movements (hand extension coupled to foot plantar flexion) were performed only upto 1 Hz in unloaded conditions. At 0.6 Hz, movements were in tight phase-opposition (3°), but at 1 Hz, the hand lag reached −34° because of a delayed ECR activation. After hand loading ME was unable to couple movements in anti-phase. In contrast, normal subjects maintain a tight anti-phase coupling up to 2.0 Hz, both with an unloaded or loaded hand. Similar deficits were observed by ME when performing in-phase and anti-phase coupling on the left side, as well as when he was blindfolded.

In normal subjects, an anticipated muscular activation of hand movers compensates for hand loading. Since this compensation must depend on monitoring the hand delay induced by loading, the absence in ME of such compensatory reaction suggests that callosal division had apparently compromised the mechanisms sustaining feedback compensation for differences in the biomechanical limb properties. They also confirm and reinforce the idea that elaboration of the afferent message, aiming at controlling the phase of the movement association, needs the co-operation of both cerebral hemispheres.     

Effects of right and left hemisphere damage on performance of the "Right Hemisphere Communication Battery"

A Hebrew adaptation of Gardner and Brownell's (1986) "Right Hemisphere Communication Battery" (HRHCB) was administered to 27 right brain-damaged (RBD) patients, 31 left brain-damaged (LBD) patients, and 21 age-matched normal controls. Both patient groups showed deficits relative to controls and overall there was no difference between the two patient groups. A factor analysis of patients' scores on the HRHCB yielded two interpretable factors, a verbal and a nonverbal one. These factors were not lateralized. Performance of patients on the HRHCB correlated significantly and positively with performance on most tests of basic language functions, measured with a Hebrew adaptation of the "Western Aphasia Battery" (HWAB) and with other cognitive functions measured with standardized neuropsychological tests. There were stronger correlations of HRHCB with subtests of the HWAB in LBD patients and with nonlanguage cognitive tests in RBD patients. In the LBD group, HRHCB subtests' scores correlated negatively with lesion extent in frontal and temporal perisylvian regions. Such localization was not observed in RBD patients. The results argue against selective right hemisphere (RH) involvement in the RHCB, alleged to measure pragmatic aspects of language use, and show, instead, bilateral involvement. The results also argue against a modular organization of these functions of language use, especially in the RH.     

Neuronal changes in normal human aging and Alzheimer's disease

This article discusses age-related changes in brain weight, total number of cortical neurons, cortical dendrites, spine, and synapse density. The conclusion is that the present outlook is less grim than it was 30 years ago. Age-related reduction appears to be specific to brain region and cortical layer rather than a general feature. In addition, we describe a different pattern of changes that occur in Alzheimer's disease patients. This review concludes that the association cortices in particular are affected in aging and Alzheimer's disease and that the primary visual and somatosensory cortices are relatively spared.     

From agape to organs: religious difference between Japan and America in judging the ethics of transplant

This essay argues that Japan's resistance to the practice of transplanting organs from persons deemed "brain dead" may not be the result, as some claim, of that society's religions being not yet sufficiently expressive of love and altruism. The violence to the body necessary for the excision of transplantable organs seems to have been made acceptable to American Christians at a unique historical "window of opportunity" for acceptance of that new form of medical technology. Traditional reserve about corpse mutilation had weakened and, especially as presented by the theologian Joseph Fletcher, organ donation was touted as both expressive of agape and a way of "updating" Christianity via the ethics of Utilitarianism. Many Japanese, largely Buddhist and Confucian in their orientation, view these changed valorizations as neither necessary nor patently more ethical than those of their own traditions.