Is It Time for a New Medical Specialty? The Medical Virtualist

Is It Time for a New Medical Specialty? The Medical Virtualist. Michael Nochomovitz; Rahul Sharma. Journal of the American Medical Association, published online November 27, 2017. DOI: 10.1001/jama.2017.17094

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Drivers of Specialty Expansion

Specialty development has been driven by advances in technology and expansion of knowledge in care delivery. Physician-led teams leverage technology and new knowledge into a structured approach for a medical discipline, which gains a momentum of its own with adoption. For instance, critical care was not a unique specialty until 30 years ago. The refinement in ventilator techniques, cardiac monitoring and intervention, anesthesia, and surgical advancements drove the development of the specialty and certification, with subsequent subspecialization (eg, neurological intensive care). The development of laparoscopic and robotic surgical equipment, with advanced imaging, spawned new specialty and subspecialty categories including colon and rectal surgery, general surgical oncology, interventional radiology, and electrophysiology.

In nonprocedural areas, unique certification was established for geriatrics and palliative care. Additional new specialties include hospitalists, laborists, and extensivists, to name a few. These clinical areas do not yet have formal training programs or certification but are specific disciplines with core competencies and measures of performance that might be likely recognized in the future.

Telemedicine and Medical Care

Telemedicine is the delivery of health care services remotely by the use of various telecommunications modalities. The expansion of web-based services, use of videoconferencing in daily communication, and social media coupled with the demand for convenience by consumers of health care are all factors driving exponential growth in telehealth.2

According to one estimate, the global telehealth market is projected to increase at an annual compounded rate of 30% between 2017 and 2022, achieving an estimated value of $12.1 billion.2 Some recent market surveys show that more than 70% of consumers would consider a virtual health care service.3 A preponderance of higher income and privately insured consumers indicate a preference for telehealth, particularly when reassured of the quality of the care and the appropriate scope of the virtual visit.3 Telemedicine is being used to provide health care to some traditionally underserved and rural areas across the United States and increased shortages of primary care and specialty physicians are anticipated in those areas.4

A New Specialty

Digital advances within health care and patients acting more like consumers have resulted in more physicians and other clinicians delivering virtual care in almost every medical discipline. Second-opinion services, emergency department express care, virtual intensive care units (ICUs), telestroke with mobile stroke units, telepsychiatry, and remote services for postacute care are some examples.

In the traditional physician office, answering services and web-based portals focused on telephone and email communication. The advent of telehealth has resulted in incremental growth of video face-to-face communication with patients by mobile phone, tablet, or other computer devices.2,3,5 In larger enterprises or commercial ventures, the scale is sufficient to “make or buy” centralized telehealth command centers to service functions across broad geographic areas including international.

Early telehealth focused on minor ailments such as coughs, colds, and rashes, but now telehealth is being used in broader applications, such as communicating imaging and laboratory results, changing medication, and most significantly managing more complex chronic disease.

The coordination of virtual care with home visits, remote monitoring, and simultaneous family engagement is changing the perception and reality of virtual health care. Commercialization is well under way with numerous start-ups and more established companies. These services are provided by the companies alone or in collaboration with physician groups.

The Medical Virtualist

We propose the concept of a new specialty representing the medical virtualist. This term could be used to describe physicians who will spend the majority or all of their time caring for patients using a virtual medium. A professional consensus will be needed on a set of core competencies to be further developed over time.

Physicians now spend variable amounts of time delivering care through a virtual medium without formal training. Training should include techniques in achieving good webside manner.5 Some components of a physical examination can be conducted virtually via patient or caregiver. Some commercial insurance carriers and institutional groups have developed training courses.5 These are neither associated with a medical specialty board or society consensus or oversight nor with an associated certification.

Contemporary care is multidisciplinary, including nurses, medical students, nurse practitioners, physician assistants, pharmacists, social workers, nutritionists, counselors, and educators. All require formal training in virtual encounters to ensure a similar quality outcome as is expected for in-person care.

It is possible that there could be a need for physicians across multiple disciplines to become full-time medical virtualists with subspecialty differentiation. Examples could be urgent care virtualists, intensive care virtualists, neurological virtualists, and psychiatric or behavioral virtualists. This shift would not preclude virtual visits from becoming a totally integrated component of all practices to varying extents.

Based on early experience in primary care, one estimate suggests that 30% to 50% of visits could possibly be eligible for a virtual encounter.4 This could be amplified when coupled with home care and remote monitoring devices. There are varying data on the influence of telehealth on total health care services utilization and that will be determined with greater adoption. In addition, as the number of emergency department visits continues to increase nationally, health care systems must develop innovative ways to maximize efficiency and maintain high-quality standards.6

However, complete replacement of the traditional clinical encounter will not occur. “Bricks and clicks” will prevail for patients’ convenience and value. Physicians will lead teams with both in-office and remote monitoring resources at their disposal to deliver care. This model could be enhanced in the future with digital assistants or avatars.

In the surgical specialties, remote surgery has been more focused on telementoring and guiding surgeons in remote locations. There have been examples of true virtual surgeons who have operated robotically on patients hundreds of miles away.7 This approach can be expected to develop further in the coming years.

Critical Success Factors

The success of technology-based services is not determined by hardware and software alone but by ease of use, perceived value, and workflow optimization.

Medical virtualists will need specific core competencies and curricula that are beginning to develop at some institutions. In addition to the medical training for a specific discipline, the curriculum for certification should include knowledge of legal and clinical limitations of virtual care, competencies in virtual examination using the patient or families, “virtual visit presence training,” inclusion of on-site clinical measurements, as well as continuing education.

It will be necessary for early adopters, thought leaders, medical specialty societies, and medical trade associations to work with the certifying organizations to formalize curriculum, training, and certification for medical virtualists. If advances in technology continue and if rigorous evidence demonstrates that this technology improves care and outcomes and reduces cost, medical virtualists could be involved in a substantial proportion of health care delivery for the next generation.

Additional Contributions, references, etc., in the full article at the link above

They present a computable algorithm that assigns probabilities to every logical statement in a given formal language, and refines those probabilities over time

Logical Induction. Scott Garrabrant, Tsvi Benson-Tilsen, Andrew Critch, Nate Soares, and
Jessica Taylor. Machine Intelligence Research Institute. https://intelligence.org/files/LogicalInductionAbridged.pdf. Full paper: arXiv:1609.03543

Abstract: We present a computable algorithm that assigns probabilities to every logical statement in a given formal language, and refines those probabilities over time. For instance, if the language is Peano arithmetic, it assigns probabilities to all arithmetical statements, including claims about the twin prime conjecture, the outputs of long-running computations, and its own probabilities. We show that our algorithm, an instance of what we call a logical inductor, satisfies a number of intuitive desiderata, including: (1) it learns to predict patterns of truth and falsehood in logical statements, often long before having the resources to evaluate the statements, so long as the patterns can be written down in polynomial time; (2) it learns to use appropriate statistical summaries to predict sequences of statements whose truth values appear pseudorandom; and (3) it learns to have accurate beliefs about its own current beliefs, in a manner that avoids the standard paradoxes of self-reference. For example, if a given computer program only ever produces outputs in a certain range, a logical inductor learns this fact in a timely manner; and if late digits in the decimal expansion of π are difficult to predict, then a logical inductor learns to assign ≈ 10% probability to “the n th digit of π is a 7” for large n. Logical inductors also learn to trust their future beliefs more than their current beliefs, and their beliefs are coherent in the limit (whenever φ → ψ, P∞ (φ) ≤ P∞ (ψ), and so on);  and logical inductors strictly dominate the universal semimeasure in the limit.

These properties and many others all follow from a single logical induction criterion, which is motivated by a series of stock trading analogies. Roughly speaking, each logical sentence φ is associated with a stock that is worth $1 per share if φ is true and nothing otherwise, and we interpret the belief-state of a logically uncertain reasoner as a set of market prices, where Pn (φ) = 50% means that on day n, shares of φ may be bought or sold from the reasoner for 50¢. The logical induction criterion says (very roughly) that there should not be any polynomial-time computable trading strategy with finite risk tolerance that earns unbounded profits in that market over time. This criterion bears strong resemblance to the “no Dutch book” criteria that support both expected utility theory (von Neumann and Morgenstern 1944) and Bayesian probability theory (Ramsey 1931; de Finetti 1937).

Patient outcome's variability is weakly or not related to competence, training nor adherence of therapists

Common versus specific factors in psychotherapy: opening the black box. RogerMulder, Greg Murray, Julia Rucklidge. The Lancet Psychiatry, Volume 4, Issue 12, December 2017, Pages 953-962. https://doi.org/10.1016/S2215-0366(17)30100-1

Summary: Do psychotherapies work primarily through the specific factors described in treatment manuals, or do they work through common factors? In attempting to unpack this ongoing debate between specific and common factors, we highlight limitations in the existing evidence base and the power battles and competing paradigms that influence the literature. The dichotomy is much less than it might first appear. Most specific factor theorists now concede that common factors have importance, whereas the common factor theorists produce increasingly tight definitions of bona fide therapy. Although specific factors might have been overplayed in psychotherapy research, some are effective for particular conditions. We argue that continuing to espouse common factors with little evidence or endless head-to-head comparative studies of different psychotherapies will not move the field forward. Rather than continuing the debate, research needs to encompass new psychotherapies such as e-therapies, transdiagnostic treatments, psychotherapy component studies, and findings from neurobiology to elucidate the effective process components of psychotherapy.

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Additionally, the dissemination of findings leads to further bias. Negative trials are less likely to be reported, thereby inflating effect sizes. Low-quality studies often result in larger effect sizes. Trial registration is poor, so we cannot know whether outcomes are selectively reported, particularly by groups with a strong allegiance to the treatments. Findings from a 2017 systematic review showed that only 12% of psychotherapy trials were prospectively registered with clearly defined primary outcome measures.

One obvious approach to the dodo bird problem is to test whether different therapies do lead to different outcomes. Head-to-head comparisons generally suggest small differential effects, which are smaller and non-significant after researcher allegiance is controlled for. However, this literature has substantial limitations. Most studies have investigated cognitive therapy or CBT as one of the treatment groups, so specific strengths of other approaches are poorly understood. Only a narrow range of treatment outcome measures have been systematically examined, most typically acute symptom reduction; longer-term effects, including relapse prevention measures for common chronic conditions, might differentiate some therapies for some problems. Differences might be revealed if a wider range of treatment outcome measures were used, including functioning, quality of life, and individualised measures of treatment outcome. However, such trials are expensive and rarely undertaken. Differences might also be larger if moderating factors such as individual differences between patients were accounted for in outcome modelling.

Another way to test the specific factor model is through therapist adherence. Improved adherence to theory-specified factors in evidence-supported therapies should improve patient outcomes, if these specific factors are important to the success of the therapy. However, the evidence has not generally supported this hypothesis, with findings from a meta-analysis showing that neither variability in competence nor adherence was related to patient outcome, suggesting that these variables are relatively inert therapeutic agents. The broader literature is split on this question, with some investigators finding no effect of treatment integrity on outcomes, some a positive effect, and some a negative effect (potentially due to an overly rigid application of technique, which could be detrimental to the therapeutic alliance for some clients). Extent of training might also not be relevant to outcome, as suggested by the work of Stanley and colleagues. Indeed, therapeutic alliance, a common factor, might be a more important variable to instigate change than therapeutic adherence, although even these effect sizes are modest (mean alliance–outcome correlation 0·26).

Regardless, common factor researchers argue that outcome studies do not answer the most important outstanding question in psychotherapy—namely, what are the mechanisms of change? Although the importance of specific factors has been estimated from effect sizes of targeted therapies compared with plausible controls, the importance of common factors has been estimated correlationally through the association between therapy outcomes and patient reports of rapport and engagement. Although the effect sizes of targeted therapies compared with controls permit causal correlations, correlation between therapy outcomes and patient engagement does not, and will be confounded by an overlap between the success of therapy and the client’s satisfaction with the therapist. Therapeutic alliance is fundamentally dyadic (ie, a reciprocal working relationship), which sits uncomfortably with the more medical notion of patient as recipient of the therapist’s activities.

Finally, psychotherapy research is difficult and expensive to conduct, and—without the commercial investment that occurs in pharmacotherapy research—deficits of the existing evidence base are attributable simply to the low power and small number of studies. For example, although the effectiveness of behavioural therapy for obsessive compulsive disorder is similar to that of pharmacological treatment, investigators of a meta-analysis of psychotherapy and pharmacotherapy for obsessive compulsive disorder found 15 psychotherapy trials with a total 705 patients, by contrast with 32 pharmacotherapy trials with a total of 3588 patients.

Artificial Intelligence With Undo Mechanism

Leave no Trace: Learning to Reset for Safe and Autonomous Reinforcement Learning. Benjamin Eysenbach, Shixiang Gu, Julian Ibarz, Sergey Levine. arXiv.org, https://arxiv.org/abs/1711.06782

Abstract: Deep reinforcement learning algorithms can learn complex behavioral skills, but real-world application of these methods requires a large amount of experience to be collected by the agent. In practical settings, such as robotics, this involves repeatedly attempting a task, resetting the environment between each attempt. However, not all tasks are easily or automatically reversible. In practice, this learning process requires extensive human intervention. In this work, we propose an autonomous method for safe and efficient reinforcement learning that simultaneously learns a forward and reset policy, with the reset policy resetting the environment for a subsequent attempt. By learning a value function for the reset policy, we can automatically determine when the forward policy is about to enter a non-reversible state, providing for uncertainty-aware safety aborts. Our experiments illustrate that proper use of the reset policy can greatly reduce the number of manual resets required to learn a task, can reduce the number of unsafe actions that lead to non-reversible states, and can automatically induce a curriculum.

Covered nude photographs inferential sexual cognition –– covered models were indeed perceived as nude models

Do Covered Nude Photographs in the Internet Induce Sexual Cognition –– A Study of Event-related Potential. Lei Hanet al. Computers in Human Behavior, https://doi.org/10.1016/j.chb.2017.11.039

Abstract: A number indecent photos depicting models whose genital areas have been censored or covered have been widely disseminated on the Internet and proved to be extremely popular. The question is whether these “incomplete nudes” on the Internet can induce sexual cognition. To answer this question, this study presented 25 male college students with 4 types of images. Results found that pictures of females induced larger positive potential (P2) amplitudes and shorter latencies than did pictures of males, and that pictures of nude females induced larger negative potential (N2) amplitudes than did pictures of nude males. Moreover, pictures of covered or nude females evoked larger P300 waves than did pictures of fully-dressed or underwear-wearing females. Pictures of nude models also evoked larger PSW than did other types of pictures. These results suggested that P2 and N2 reflect early gender processing and early sexual cognition, respectively, while P300 reflect inferential sexual cognition which meant that covered models were indeed perceived as nude models. This study revealed that censored (covered) sexual information disseminated through the Internet could still evoke inferential sexual cognition.

Keywords: gender processing; sexual cognition; inferential sexual cognition; event-related potentials

Jokes are more interesting and surprising when repetition at the beginning creates a pattern, which is broken in a contrasting end

Loewenstein, J. and Heath, C. (2009), The Repetition-Break Plot Structure: A Cognitive Influence on Selection in the Marketplace of Ideas. Cognitive Science, 33: 1–19. doi:10.1111/j.1551-6709.2008.01001.x

Abstract: Using research into learning from sequences of examples, we generate predictions about what cultural products become widely distributed in the social marketplace of ideas. We investigate what we term the Repetition-Break plot structure: the use of repetition among obviously similar items to establish a pattern, and then a final contrasting item that breaks with the pattern to generate surprise. Two corpus studies show that this structure arises in about a third of folktales and story jokes. An experiment shows that jokes with this structure are more interesting than those without the initial repetition. Thus, we document evidence for how a cognitive factor influences the cultural products that are selected in the marketplace of ideas.

Consumers told their organic food experience would be shared with others had more pleasantness ratings, felt more joyful and hopeful. Favoring organic foods can be viewed as a costly signaling trait, leading to flaunting about one's prosocial tendencies.

Sweet taste of prosocial status signaling: When eating organic foods makes you happy and hopeful. Petteri Puska et al. Appetite, https://doi.org/10.1016/j.appet.2017.11.102

Abstract: As the current research suggests that there are links between prosocial acts and status signaling (including sustainable consumer choices), we empirically study (with three experiments) whether food consumers go green to be seen. First, we examine how activating a motive for status influences prosocial organic food preferences. Then, we examine how the social visibility of the choice (private vs. public) affects these preferences. We found that when consumers' desire for status was elicited, they preferred organic food products significantly over their nonorganic counterparts; making the choice situation visible created the same effect. Finally, we go beyond consumers' evaluative and behavioral domains that have typically been addressed to investigate whether this (nonconscious) “going green to be seen” effect is also evident at the level of more physiologically-driven food responses. Indeed, status motives and reputational concerns created an improved senso-emotional experience of organic food. Specifically, when consumers were led to believe that they have to share their organic food taste experiences with others, an elevation could be detected not only in the pleasantness ratings but also in how joyful and hopeful they felt after eating a food sample. We claim that the reason for this is that a tendency to favor organic foods can be viewed as a costly signaling trait, leading to flaunting about one's prosocial tendencies. According to these findings, highlighting socially disapproved consumption motives, such as reputation management, may be an effective way to increase the relatively low sales of organic foods and thereby promote sustainable consumer behavior.

Keywords: Organic food; Prosocial signaling; Status; Motivational priming; Senso-emotional experience; Nonconscious behavior

This study finds that with the increase of agreeableness, women tend to be Republicans, but men tend to be Democrats

Gender Differences in the Effects of Personality Traits on Party Identification in the US. Ching-Hsing Wang.  Journal of Women, Politics & Policy. Volume 38, 2017 - Issue 3, Pages 335-362. https://doi.org/10.1080/1554477X.2016.1219591

ABSTRACT: This study examines whether the Big Five personality traits have different effects on male and female party identification in the United States. Research has found associations between personality traits and partisanship in the United States. However, there is solid evidence of gender differences in personality traits, and past studies have not yet considered whether personality-partisanship relationship might be gender-differentiated. This study finds that with the increase of agreeableness, women tend to be Republicans, but men tend to be Democrats. Furthermore, as openness to experience increases, women are more likely to be strong partisans, but men are more likely to be independents or leaning partisans. To sum up, this study provides evidence that the effects of the Big Five personality traits on party identification vary by gender and suggests that it is wrong to assume that the Big Five personality traits have the same impacts on male and female party identification.

KEYWORDS: Personality, gender differences, party identification, Big Five

Predicting Personality from Book Preferences with User-Generated Content Labels

Predicting Personality from Book Preferences with User-Generated Content Labels. Ng Annalyn, Maarten W. Bos, Leonid Sigal, and Boyang Li. IEEE Transactions On Affective Computing, 2017. https://arxiv.org/abs/1707.06643

Abstract—Psychological studies have shown that personality traits are associated with book preferences. However, past findings are based on questionnaires focusing on conventional book genres and are unrepresentative of niche content. For a more comprehensive measure of book content, this study harnesses a massive archive of content labels, also known as ‘tags’, created by users of an online book catalogue, Goodreads.com. Combined with data on preferences and personality scores collected from Facebook users, the tag labels achieve high accuracy in personality prediction by psychological standards. We also group tags into broader genres, to check their validity against past findings. Our results are robust across both tag and genre levels of analyses, and consistent with existing literature. Moreover, user-generated tag labels reveal unexpected insights, such as cultural differences, book reading behaviors, and other non-content factors affecting preferences. To our knowledge, this is currently the largest study that explores the relationship between personality and book content preferences.

Index Terms—Personality Profiling, Narrative Preferences, Social Media, Behavioural Footprints

The Political Economy of Famine: the Ukrainian Famine of 1933

The Political Economy of Famine: the Ukrainian Famine of 1933. Natalya Naumenko. Job Market Paper, 2017. http://sites.northwestern.edu/nnl504

Abstract: The famine of 1932–1933 in Ukraine killed as many as 2.6 million people out of the population of approximately 30 million. Three main explanations have been offered: negative weather shock, poor economic policies, and genocide. This paper uses variation in exposure to poor government policies and in ethnic composition within Ukraine to study the impact of policies on mortality, and the relationship between ethnic composition and mortality. It documents that (1) bad government policies (collectivization and the lack of favored industries) significantly increased mortality; (2) collectivization increased mortality due to drop in production on collective farms and not due to overextraction from collectives (although the evidence is indirect); (3) back-of-the-envelope calculations show that collectivization raised total 1933 death toll by at least 19%; (4) controlling for exposure to poor Soviet economic policies, Ukrainians seem more likely to die (although this result is underpowered); (5) Ukrainians were more exposed to policies that later led to mortality (collectivization and the lack of favored industries); (6) conditional on being exposed to the same bad economic policy, Ukrainians are not more likely to die (e.g., there is no evidence that collectivization was enforced more harshly on Ukrainians). These results provide several important takeaways. Most importantly, the evidence is consistent with both sides of the debate. (1) – (3) support those who argue that mortality was due to bad policy. (4) is consistent with those who argue that ethnic Ukrainians were targeted. For (5) and (6) to support genocide, it has to be the case that Stalin had the foresight that his policies would fail and lead to famine mortality years after they were introduced (and therefore disproportionately exposed Ukrainians to them).

A change in woman's behavior: Demand of male escorts for women, couples grows

Male escorts for women, couples demand grows: global survey. Queensland University Press Release. Phys.org, Nov 22 2017. https://phys.org/news/2017-11-male-escorts-women-couples-demand.html

A quarter of Australia's 516 male escorts cater to women and couples, a global survey of the 61 countries which host online male escort websites has found.

But Australia is well behind the United Kingdom in sites catering for women or couples where more than 50 per cent of the 5487 male escorts cater to women and couples, the survey, conducted by by Professor John Scott and Adjunct Professor Victor Minichiello from QUT's Crime and Justice Research Centre and researchers from The Kirby Institute at the University of New South Wales, found.

"Uganda and Argentina are the only other countries that have more male escorts seeking females and couples than solely male clients," Professor Scott, from QUT School of Justice, said.

"It's assumed that men are the primary market for male escorts, and while it is true that most escorts target male clients, our survey suggests a significant emerging market for women who pay for sexual services from men.

"While more than 57 per cent of identified websites catered to male customers only, 11 per cent were specifically for female clients and a similar number of sites were for couples, most of the opposite sex.

"As expected, we found twice as many male escorts had male clients only (72,106) as against the 32,948 escorts for women or couples."

The results of the survey are contained in the blog About Male Escorts [https://research.qut.edu.au/aboutmaleescorting/2017/11/01/number-of-online-male-escorts-by-nation-2/] and will be published as a book chapter in Male Sex Work and Society (Volume II), to be released in 2018. The survey found a total of 324,852 profiles of male escorts online but after eliminating duplications (many male sex workers list on multiple sites) there were 105,009 male escorts.

Professor Scott said Mexico's nine websites led the table in this emerging aspect of the sex industry.

"Mexico had 14,531 male escorts prepared to cater to women and couples; Brazil (6892) the United States (3481), the United Kingdom (2926), Spain (2357), Germany (359), and Japan (327) followed.

"Other countries with a high percentage of escorts for women and couples include Chile (41 per cent), Germany (42 per cent), Hungary (45 per cent) and Malaysia (46.5 per cent)."

Professor Scott said even traditional, socially conservative societies hosted male escort websites with escorts who advertised online as catering for women and couples.

"Malaysia has 88 escorts on its nine sites and 41 of them provide for women and couples, and the United Arab Emirates has 124 escorts for women or couples out of 337 male escorts," he said.

"In jurisdictions where sex work or same-sex relations are heavily penalised, it is possible that escort sites are known only to participants within relatively closed social networks. They may also be listed on the 'dark web' - these sites were not included in the survey.

"If you are a woman or a couple seeking a male escort using online male escort services, you are out of luck in Costa Rica, Finland, Israel, Panama and Taiwan where the male escorts have male clients only.

"There are slim pickings in Bulgaria, China, Estonia, Uruguay and Paraguay where each country has just one male escort who has found a niche in the market and offers this service."

"The average price worldwide seems to be $200 an hour but it can be thousands of dollars for a weekend, especially among the international male escorts who list on websites around the world.

"It's important to note that websites such as Rentmen and Hourboy included escort profiles from around the world and were often hosted in countries where sex work was legal. These websites were among the largest overall and mostly cater for male clients."

Professor Scott said the survey counted only male sex workers operating online, not those in brothels or massage parlours or outdoor settings.

"The figures fluctuate over time with sex workers and websites entering and leaving the market. The fluidity makes the online marketplace appealing for many."

To check for the validity and emerging trends over time, a similar survey will be conducted annually.

Contrary to our predictions, our sample of serial murderers did not demonstrate strong evidence of psychopathy

Serial Homicide Perpetrators’ Self-Reported Psychopathy and Criminal Thinking. Scott E. Culhane, Stephannie Walker, Meagen M. Hildebrand. Journal of Police and Criminal Psychology, https://link.springer.com/article/10.1007/s11896-017-9245-x

Abstract: The current research reports 61 male serial murderers’ responses to self-report questionnaires designed to assess levels of psychopathy and criminal thinking. Three separate measures of psychopathy were included. Contrary to our predictions, results indicated that our sample of serial murderers did not demonstrate strong evidence of psychopathy. Rather, the percentage of inmates who could be classified as having psychopathic tendencies is on par with the general population of prisoners. Only half of the participants had an interpretable criminal thinking style scale. Temperament and power issues were the two factors of greatest significance for understanding the serial homicide perpetrators’ criminal cognition. In line with expectations, multiple significant correlations were observed for the measures. Implications and limitations of the research are discussed.

My commentary: May they be more intelligent and be able to lie better when writing the questionnaires? They may purposefully alter things to appear as the other inmates...

Some brain lesions make improvements...

Neural correlates of improvements in personality and behavior following a neurological event. Marcie L. King, Kenneth Manzel, Joel Bruss, Daniel Tranel. Neuropsychologia, https://doi.org/10.1016/j.neuropsychologia.2017.11.023

Highlights
•    Evidence for improvement in personality and behavior following a neurological event.
•    Improvement related to frontal polar and anterior dorsolateral prefrontal damage.
•    Both lesion location and premorbid functioning contribute to improvements.

Abstract: Research on changes in personality and behavior following brain damage has focused largely on negative outcomes, such as increased irritability, moodiness, and social inappropriateness. However, clinical observations suggest that some patients may actually show positive personality and behavioral changes following a neurological event. In the current work, we investigated neuroanatomical correlates of positive personality and behavioral changes following a discrete neurological event (e.g., stroke, benign tumor resection). Patients (N=97) were rated by a well-known family member or friend on five domains of personality and behavior: social behavior, irascibility, hypo-emotionality, distress, and executive functioning. Ratings were acquired during the chronic epoch of recovery, when psychological status was stabilized. We identified patients who showed positive changes in personality and behavior in one or more domains of functioning. Lesion analyses indicated that positive changes in personality and behavior were most consistently related to damage to the bilateral frontal polar regions and the right anterior dorsolateral prefrontal region. These findings support the conclusion that improvements in personality and behavior can occur after a neurological event, and that such changes have systematic neuroanatomical correlates. Patients who showed positive changes in personality and behavior following a neurological event were rated as having more disturbed functioning prior to the event. Our study may be taken as preliminary evidence that improvements in personality and behavior following a neurological event may involve dampening of (premorbidly) more extreme expressions of emotion.

Keywords: personality; behavior; lesion; neurological event