Hierarchical growth in neural networks structure: Organizing inputs by Order of Hierarchical Complexity.

Several studies demonstrate that the structure of the brain increases in hierarchical complexity throughout development. We tested if the structure of artificial neural networks also increases in hierarchical complexity while learning a developing task, called the balance beam problem. Previous simulations of this developmental task do not reflect a necessary premise underlying development: a more complex structure can be built out of less complex ones, while ensuring that the more complex structure does not replace the less complex one. In order to address this necessity, we segregated the input set by subsets of increasing Orders of Hierarchical Complexity. This is a complexity measure that has been extensively shown to underlie the complexity behavior and hypothesized to underlie the complexity of the neural structure of the brain. After segregating the input set, minimal neural network models were trained separately for each input subset, and adjacent complexity models were analyzed sequentially to observe whether there was a structural progression. Results show that three different network structural progressions were found, performing with similar accuracy, pointing towards self-organization. Also, more complex structures could be built out of less complex ones without substituting them, successfully addressing catastrophic forgetting and leveraging performance of previous models in the literature. Furthermore, the model structures trained on the two highest complexity subsets performed better than simulations of the balance beam present in the literature. As a major contribution, this work was successful in addressing hierarchical complexity structural growth in neural networks, and is the first that segregates inputs by Order of Hierarchical Complexity. Since this measure can be applied to all domains of data, the present method can be applied to future simulations, systematizing the simulation of developmental and evolutionary structural growth in neural networks.

The stage-value model: Implications for the changing standards of care.

The standard of care is a legal and professional notion against which doctors and other medical personnel are held liable. The standard of care changes as new scientific findings and technological innovations within medicine, pharmacology, nursing and public health are developed and adopted. This study consists of four parts. Part 1 describes the problem and gives concrete examples of its occurrence. The second part discusses the application of the Model of Hierarchical Complexity on the field, giving examples of how standards of care are understood at different behavioral developmental stage. It presents the solution to the problem of standards of care at a Paradigmatic Stage 14. The solution at this stage is a deliberative, communicative process based around why certain norms should or should not apply in each specific case, by the use of "meta-norms". Part 3 proposes a Cross-Paradigmatic Stage 15 view of how the problem of changing standards of care can be solved. The proposed solution is to found the legal procedure in each case on well-established behavioral laws. We maintain that such a behavioristic, scientifically based justice would be much more proficient at effecting restorative legal interventions that create desired behaviors.

Does the model of hierarchical complexity produce significant gaps between orders and are the orders equally spaced?

The model of hierarchical complexity (MHC) provides an analytic a priori measurement of the difficulty of tasks. As part of the theory of measurement in mathematical psychology, the model of hierarchical complexity (Commons and Pekker, 2008) defines a new kind of scale. It is important to note that the orders of hierarchical complexity of tasks are postulated to form an ordinal scale. A formal definition of the model of hierarchical complexity is presented along with the descriptions of its five axioms that help determine how the model of hierarchical complexity orders actions to form a hierarchy. The fourth and the fifth axioms are of particular importance in establishing that the orders of hierarchical complexity form an equally spaced ordinal scale. Previously, it was shown that Rasch-scaled items followed the same sequence as their orders of hierarchical complexity. Here, it is shown that the gaps between the highest Rasch scaled item scores at a lower order and the lowest scores at the next higher order exist. We found there was no overlap between the Rasch-scaled item scores at one order of complexity, and those of the adjoining orders. There are 'gaps' between the stages of performance on those items. Second, we tested for equal spacing between the orders of hierarchical complexity. We found that the orders of hierarchical complexity were equally spaced. To deviate significantly from the data, the orders had to deviate from linearity by over .25 of an order. This would appear to be an empirical and mathematical confirmation for the equally spaced stages of development.

Perceptions of boundaries and cultural influences in Qatar.

BACKGROUND: Boundary issues, which regularly arise in therapy, can present dilemmas for most clinicians. There has been substantial literature on boundary excursions in clinician-patient relationships, however, very little empirical research exists and is documented. As mental health researchers, we need to investigate a wide range of sensitive topics to enhance our understanding of the many issues that arise in the psychotherapeutic frame. AIMS: We set out to empirically explore perceptions of what may constitute a boundary violation among the mental health staff in the State of Qatar and their views on the subject. RESULTS: A total of 50 participants (24 psychiatrists, 2 doctorate level psychologists, 24 psychiatric nurses) responded with a response rate of 80%. Participants rated each possible boundary violation according to its degree of harm and professional unacceptability. Three distinct groupings of boundary violations were obtained: (1) core, consisting of the most serious violations; (2) disclosure and greeting behaviour, involving disclosure of information about the therapist and greeting behaviour; and (3) separation of therapist and client lives, involving encounters between therapists and clients outside of therapy. CONCLUSIONS: It is important to ascertain these dilemmas so that these theoretical models can be integrated in clinical practice.

Differences and similarities in cross-cultural perceptions of boundaries: a comparison of results from two studies.

There has been substantial literature on boundary excursions in clinician-patient relationships; however, very little empirical research exists. Even less information exists on how perceptions of this issue might differ across cultures. Prior to this study, empirical data on various kinds of boundary excursions were collected in different cultural contexts. First, clinicians from the U.S. and Brazil were asked to rate 173 boundary excursions for both their perceived harmfulness and their professional unacceptability (Miller et al., 2006). In a second study, colleagues from Qatar administered a slightly modified version to mental health care professional staff of a hospital in Doha, Qatar (Ghuloum et al., 2011). In this paper, the results of these two separate studies are compared. The results showed some similarities and some differences in perceptions of the boundary behaviors. For example, both sets of cultures seem to agree that certain behaviors are seriously harmful and/or professionally unacceptable. These behaviors include some frankly sexual behavior, such as having sexual intercourse with a patient, as well as behavior related to doing business with the patient, and some disclosing behavior. There are also significant cultural differences in perceptions of how harmful some of the behaviors are. Qatari practitioners seemed to rate certain behaviors that within therapy mix disclosing or personal behavior with therapy as more harmful, but behaviors that involved interacting with patients outside of therapy as less serious. A factor analysis suggested that participants in U.S./Brazil saw a much larger number of behaviors as making up a set of Core Boundary Violations, whereas Qatari respondents separated sexual behaviors from others. Finally, a Rasch analysis showed that both cultures perceived a continuum of boundary behaviors, from those that are least harmful or unprofessional to those that are highly harmful or unprofessional. One interpretation is that cultural factors may be most influential on those kinds of behaviors that are perceived as relatively less serious. Implications for training and supervision are also discussed.

"Certainty" and expert mental health opinions in legal proceedings.

This pilot study addresses the legal and scientific ramifications of the "certainty" expressed by mental health professionals when functioning as expert witnesses in criminal and civil proceedings. The sporadic attention paid to "certainty" in the professional literature has typically taken the form of general policy oriented analyses as opposed to empirical, data-driven investigations. In the current study, 25 doctoral and master's level mental health professionals were provided with 53 different statements. Some statements addressed "certainty" itself in the typical fashion (e.g., "Reasonable Degree of Scientific Certainty," "Reasonable Degree of Medical Certainty," and "Reasonable Degree of Psychological Certainty"). Other statements were confined to specifically legal standards of proof (e.g., "Beyond a Reasonable Doubt," "Preponderance of the Evidence," and "Clear and Convincing"). Additional statements included those that bore at least some direct forensic relevance (e.g., "Based upon All the Data at My Disposal," "In My Medical Opinion," and "In My Clinical Judgment"), as well as those of a non-forensic nature (e.g., "I Would Bet My Life Savings," "On My Word of Honor," and "I Am Personally Convinced"). Ratings were provided on one form as if the participant had uttered the statement, and on another form as if another expert witness had uttered the statement. Overall, participants did not tend to identify traditional legal terms as expressing the highest level of "certainty," and respondents tended to ascribe more "certainty" to the same terms when uttered by themselves as opposed to when uttered by other expert witnesses. Those providing forensic testimony will do well to accommodate the court's traditional requirements while developing and preparing to justify their own notions of just what "certainty" denotes in this context.

Forensic experts' perceptions of expert bias.

How do expert witnesses perceive the possible biases of their fellow expert witnesses? Participants, who were attendees at a workshop at the American Academy of Psychiatry and Law were asked to rate for their biasing potential a number of situations that might affect the behavior of an opposing expert. A Rasch analysis produced a linear scale as to the perceived biasing potential of these different kinds of situations from the most biasing to the least biasing. Working for only one side in both civil and criminal cases had large scaled values and also were the first factor. In interesting contrast, a) an opposing expert also serving as the litigant's treater and b) an opposing expert being viewed as a "hired gun" (supplying an opinion only for money) were two situations viewed as not very biasing. Order of Hierarchical Complexity also accounted for items from the 1st, 2nd and 3rd factors. The result suggests that the difficulty in understanding the conceptual basis of bias underlies the perception of how biased a behavior or a situation is. The more difficult to understand the questionnaire item, the less biasing its behavior or situation is perceived by participants.

Do forensic practitioners distinguish between testifying and consulting experts? A pilot study.

Forensic mental health professionals (n=44) reviewed a series of statements that an attorney might make to a consulting or testifying expert. Each statement was rated for its degree of appropriateness to either the consulting or the testifying role. In light of increasing attention paid to this topic in the forensic practice literature, as well as long-standing distinctions recognized by the legal profession, it was originally hypothesized that participants would differentiate clearly between these roles; however, results of this pilot study indicate that forensic practitioners do not possess a consistent sense of which activities rest most comfortably within testimonial as opposed to consulting duties.

Clinicians imagine a patient's view: Rating disclosures of confidential information.

Consent to disclosure of confidential information is a cornerstone of the clinician-patient relationship; however, changes in the legal, regulatory, and technological landscape affecting patient confidentiality have brought increasing conflict between ethics-based commitments and the realities of practice. In this pilot study, 119 mental-health clinicians completed a questionnaire that measured levels of disapproval of disclosures of confidential information to various third parties. Clinicians were asked to respond as though they were patients whose information was to be disclosed. Clinicians, taking a patient's perspective, most disapproved of disclosures to anyone who wanted the information and to entities that marketed pharmaceutical, medical, or other products. They were progressively less uncomfortable with disclosures to family members, for educational use without consent but with de-identification, to insurance companies, to pharmacists, to journals, for educational purposes in training other clinicians, and for research. They were least disapproving of disclosures to other clinicians. Based on this initial study of clinicians taking a patient's perspective, clinicians will do well to inform patients about disclosure practices at least as fully as they themselves would want to be informed.

Concrete, abstract, formal, and systematic operations as observed in a "Piagetian" balance-beam task series.

We performed a Rasch analysis of cross-sectional developmental data gathered from children and adults who were presented with a task series derived from Inhelder's and Piaget's balance beam. The partial credit model situates both participants and items along a single hierarchically ordered dimension. As the Model of Hierarchical Complexity predicted, order of hierarchical complexity accurately predicted item difficulty, with notable exceptions at the formal and systematic levels. Gappiness between items was examined using the saltus model. A two level saltus model, which examined the gap between the concrete/abstract and formal/systematic items, was a better predictor of performance than the Rasch analysis (chi square = 71.91, df = 4, p < .01).

Using Rasch scaled stage scores to validate orders of hierarchical complexity of balance beam task sequences.

These studies examine the relationship between the analytic basis underlying the hierarchies produced by the Model of Hierarchical Complexity and the probabilistic Rasch scales that places both participants and problems along a single hierarchically ordered dimension. A Rasch analysis was performed on data from the balance-beam task series. This yielded scaled stage of performance for each of the items. The items formed a series of clusters along this same dimension, according to their order of hierarchical complexity. We sought to ascertain whether there was a significant relationship between the order of hierarchical complexity (a task property variable) of the tasks and the corresponding Rasch scaled difficulty of those same items (a performance variable). It was found that The Model of Hierarchical Complexity was highly accurate in predicting the Rasch Stage scores of the performed tasks, therefore providing an analytic and developmental basis for the Rasch scaled stages.

A pilot Rasch scaling of lawyers' perceptions of expert bias.

How seriously do attorneys consider the biases of their retained mental health experts? Participants in this pilot study included 40 attorneys, randomly selected from a pool of members of the Pennsylvania Bar Institute, who rated-for their biasing potential-several situations that might affect the behavior of an expert. A Rasch analysis produced a linear scale as to the perceived biasing potential of these different items from most to least biasing. Among other results, the study suggests that attorneys do view mental health experts who work on both sides of cases as being more balanced in their testimony. However, they also indicated that they have a preference for using individuals who repeatedly testify for one side. Working for only one side in both civil and criminal cases yielded large scaled values. Additional comments offered by respondents indicated that: (1) an opposing expert also serving as the litigant's treater and (2) an opposing expert being viewed as a "hired gun" (supplying an opinion only for money) were viewed by subjects as not being very biased. A discussion of the results raises the need for future research in this area.

Clinicians' perceptions of boundaries in Brazil and the United States.

Although there has been considerable discussion of boundary excursions in clinician-patient relationships, little empirical research exists. This pilot study adds to the existing theoretical discussion by comparing perceptions by mental health professionals in Brazil and the United States of what may constitute boundary violations. Participants rated each possible boundary violation according to its degree of harm and professional unacceptability. Three distinct groupings of boundary violations were found: (1) core, consisting of the most serious violations; (2) separation of therapist and client lives, involving encounters between therapists and clients outside of therapy; and (3) disclosure and greeting behavior, involving disclosure of information about the therapist and greeting behavior. The U.S. and Brazilian perceptions were found to be surprisingly similar, with only a few differences.

Expert witness perceptions of bias in experts.

A pilot study of perceptions of different sources of expert bias, as well as of personal investment in case outcomes, was performed among attendees at a workshop at an annual meeting of the American Academy of Psychiatry and the Law. Participants were asked to rate hypothetical responses by experts to various case outcomes and the biasing potential of different kinds of situations for opposing or other experts. A factor analysis produced two factors. Factor 1 included questions about situations that were obviously biasing (such as working only for the defense). Factor 2 included questions assessing the potential of certain situations to cause bias in experts, or how likely experts thought other experts were to be biased. In general, experts identified only four areas to be overtly biasing. All occurred within situations in which experts worked only for one or the other side of civil or criminal cases. Experts otherwise thought other experts were reasonably bias free and well able to compensate for any bias when it occurred. The data suggest that experts may deal with bias by turning down cases that may cause them personal discomfort.

Stress and the forensic psychiatrist: a pilot study.

What are the sources of perceived occupational stress, and how troublesome are they to forensic psychiatrists? To examine these questions 1,800 90-item questionnaires were sent to the membership of AAPL. The questions explored what experiences forensic psychiatrists found most stressful and the degree of stress experienced. Three hundred seventy-two questionnaires were returned. On average, individuals rated the stress in their overall forensic practices as relatively low. Certain situations, however, were found to be highly stressful. Five of the most stressful aspects of forensic practice in this sample were: (1) fear of not being able to defend an opinion during cross-examination (63%); (2) fear of the prospect of disclosure of one's own content-related personal history (53%); (3) working with short deadlines (49%); (4) testifying while physically ill (43%); (5) stress from a retaining attorney's attempts to coerce an opinion (43%). An awareness of these matters may give guidance to people who are considering becoming forensic psychiatrists and may facilitate the management of stress.

Recognizing specialized terminology presented through different modes.

In the present study, the authors examined how previous experience and modes of presenting information affect the recognition of terms in new, specialized terminologies. The specialized terminology used was related to orienteering. Orienteering concepts representing features found in the woods may be communicated verbally (as definitions or words) or symbolically. There were 225 participants (101 reported no orienteering experience and 122 reported varying amounts of orienteering experience; 2 did not respond to that question) who tried to identify which of 5 entities was an orienteering definition, word, or symbol. Those with orienteering experience found that recognizing the specialized terminology was significantly easier than for those without experience. Recognizing symbols was significantly more difficult than recognizing definitions or words, particularly for non-orienteers. Performance of the orienteers was similar for the three modes. Within the orienteering group, the number of years of experience and usual course difficulty attempted were significant predictors of overall test success. Applications to training of both low-level specialized terminology (e.g., used in algebra), and higher level terminology (e.g., used in computer science) are discussed.