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Detecting patients’ pain levels via their brain signals
The system could help with diagnosing and treating patients that cannot communicate.
Researchers from MIT and elsewhere have developed a system that measures a patient's pain level by analyzing brain activity from a portable neuroimaging device.
The system could help doctors diagnose and treat pain in unconscious and noncommunicative patients, which could reduce the risk of chronic pain that can occur after surgery.
Pain management is a surprisingly challenging, complex balancing act. Overtreating pain, for example, runs the risk of addicting patients to pain medication. Undertreating pain, on the other hand, may lead to long-term chronic pain and other complications. Today, doctors generally gauge pain levels according to their patients' own reports of how they're feeling. But what about patients who can't communicate how they're feeling effectively — or at all — such as children, elderly patients with dementia, or those undergoing surgery?
In a paper presented at the International Conference on Affective Computing and Intelligent Interaction, the researchers describe a method to quantify pain in patients. To do so, they leverage an emerging neuroimaging technique called functional near infrared spectroscopy (fNIRS), in which sensors placed around the head measure oxygenated hemoglobin concentrations that indicate neuron activity.
For their work, the researchers use only a few fNIRS sensors on a patient's forehead to measure activity in the prefrontal cortex, which plays a major role in pain processing. Using the measured brain signals, the researchers developed personalized machine-learning models to detect patterns of oxygenated hemoglobin levels associated with pain responses. When the sensors are in place, the models can detect whether a patient is experiencing pain with around 87 percent accuracy.
"The way we measure pain hasn't changed over the years," says Daniel Lopez-Martinez, a PhD student in the Harvard-MIT Program in Health Sciences and Technology and a researcher at the MIT Media Lab. "If we don't have metrics for how much pain someone experiences, treating pain and running clinical trials becomes challenging. The motivation is to quantify pain in an objective manner that doesn't require the cooperation of the patient, such as when a patient is unconscious during surgery."
Traditionally, surgery patients receive anesthesia and medication based on their age, weight, previous diseases, and other factors. If they don't move and their heart rate remains stable, they're considered fine. But the brain may still be processing pain signals while they're unconscious, which can lead to increased postoperative pain and long-term chronic pain. The researchers' system could provide surgeons with real-time information about an unconscious patient's pain levels, so they can adjust anesthesia and medication dosages accordingly to stop those pain signals.
Joining Lopez-Martinez on the paper are: Ke Peng of Harvard Medical School, Boston Children's Hospital, and the CHUM Research Centre in Montreal; Arielle Lee and David Borsook, both of Harvard Medical School, Boston Children's Hospital, and Massachusetts General Hospital; and Rosalind Picard, a professor of media arts and sciences and director of affective computing research in the Media Lab.
Focusing on the forehead
In their work, the researchers adapted the fNIRS system and developed new machine-learning techniques to make the system more accurate and practical for clinical use.
To use fNIRS, sensors are traditionally placed all around a patient's head. Different wavelengths of near-infrared light shine through the skull and into the brain. Oxygenated and deoxygenated hemoglobin absorb the wavelengths differently, altering their signals slightly. When the infrared signals reflect back to the sensors, signal-processing techniques use the altered signals to calculate how much of each hemoglobin type is present in different regions of the brain.
When a patient is hurt, regions of the brain associated with pain will see a sharp rise in oxygenated hemoglobin and decreases in deoxygenated hemoglobin, and these changes can be detected through fNIRS monitoring. But traditional fNIRS systems place sensors all around the patient's head. This can take a long time to set up, and it can be difficult for patients who must lie down. It also isn't really feasible for patients undergoing surgery.
Therefore, the researchers adapted the fNIRS system to specifically measure signals only from the prefrontal cortex. While pain processing involves outputs of information from multiple regions of the brain, studies have shown the prefrontal cortex integrates all that information. This means they need to place sensors only over the forehead.
Another problem with traditional fNIRS systems is they capture some signals from the skull and skin that contribute to noise. To fix that, the researchers installed additional sensors to capture and filter out those signals.
An emerging neuroimaging technique called functional near infrared spectroscopy (fNIRS) could help detect pain.
Pat Greenhouse/The Boston Globe via Getty Images
Personalized pain modeling
On the machine-learning side, the researchers trained and tested a model on a labeled pain-processing dataset they collected from 43 male participants. (Next they plan to collect a lot more data from diverse patient populations, including female patients — both during surgery and while conscious, and at a range of pain intensities — in order to better evaluate the accuracy of the system.)
Each participant wore the researchers' fNIRS device and was randomly exposed to an innocuous sensation and then about a dozen shocks to their thumb at two different pain intensities, measured on a scale of 1-10: a low level (about a 3/10) or high level (about 7/10). Those two intensities were determined with pretests: The participants self-reported the low level as being only strongly aware of the shock without pain, and the high level as the maximum pain they could tolerate.
In training, the model extracted dozens of features from the signals related to how much oxygenated and deoxygenated hemoglobin was present, as well as how quickly the oxygenated hemoglobin levels rose. Those two metrics — quantity and speed — give a clearer picture of a patient's experience of pain at the different intensities.
Importantly, the model also automatically generates "personalized" submodels that extract high-resolution features from individual patient subpopulations. Traditionally, in machine learning, one model learns classifications — "pain" or "no pain" — based on average responses of the entire patient population. But that generalized approach can reduce accuracy, especially with diverse patient populations.
The researchers' model instead trains on the entire population but simultaneously identifies shared characteristics among subpopulations within the larger dataset. For example, pain responses to the two intensities may differ between young and old patients, or depending on gender. This generates learned submodels that break off and learn, in parallel, patterns of their patient subpopulations. At the same time, however, they're all still sharing information and learning patterns shared across the entire population. In short, they're simultaneously leveraging fine-grained personalized information and population-level information to train better.
The personalized models and a traditional model were evaluated in classifying pain or no-pain in a random hold-out set of participant brain signals from the dataset, where the self-reported pain scores were known for each participant. The personalized models outperformed the traditional model by about 20 percent, reaching about 87 percent accuracy.
"Because we are able to detect pain with this high accuracy, using only a few sensors on the forehead, we have a solid basis for bringing this technology to a real-world clinical setting," Lopez-Martinez says.
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Do you get worried or angry? Ever forget to tithe? One minister has bad news for you.
- A recently published article claims to identify the symptoms of "low-level atheism."
- Among these symptoms are worrying, cursing, and not tithing.
- There is a solution to all of this though, not being an atheist. Sending in money is also involved.
Are you worried about literally anything? You're an atheist now!<p>The essay begins by focusing on worrying, an all too common problem and gateway emotion to atheism:</p><p style="margin-left: 20px;"><em>"Every time we take a thought break and begin to wonder about how we will pay the stove oil bill, or the light bill, or what we are going to do if we get laid off from work in six months, we are worrying. We are actually telling the Lord, 'Jesus, you know all that stuff you said in Matthew chapter six about how you will take care of us? I don't believe it. I don't believe that you can do what you promised, so I am taking matters into my own hands; I'm going to worry about it until the situation is taken care of.'"</em></p><p>As it turns out, God plans his days around your dilemmas and will get to them in due course. So, if you are bothered about not being sure where your rent is coming form this month, you're doubting the Lord. Concerned about things like climate change? You're practically an iconoclast. Anxious at the thought that you aren't a good enough Christian? According to this, that exact worry is a sign that you aren't!</p><p>Are you feeling even more worried now? Oh, that isn't a good sign at all. You ought to be worried about that. </p>
Swearing and occasionally being angry, now signs of metaphysical distress!<p>According to Lindley:</p><p style="margin-left: 20px;"><em>"I have only sworn two times since receiving the Holy Ghost. The Lord has the power to change our attitudes and habits. I wish I could say that I never get angry anymore either, but that is not the case. Just like you, I struggle with atheistic tendencies.</em></p><p style="margin-left: 20px;"><em>"Every time something doesn't go the way we want it to and we get angry, we are telling the world, 'I am losing my temper, because this problem is so messed up that not even God can sort it out.' When we slam doors, swear, yell, break dishes, speed, or shake our fist at somebody we are in the grip of an atheism attack. </em></p><p style="margin-left: 20px;"><em>"You see the Bible very clearly states that there is nothing too hard for God to fix.</em> <em>'And we know that all things work together for good to those who love God, to those who are called according to his purpose.' </em>(Romans 8:28 NKJV) <em>This is why a person who has been born again can hit their thumb with a hammer and not swear. This is why the sincere Christian can look at a flat tire and say, 'I guess God needs to slow me down, because he has someone he needs me to cross paths with today.' Swearing and getting angry only says, 'There is absolutely no way that God can turn this flat tire into a blessing!'"</em><em></em></p><p>Well, shit. It seems that being angry with things, including things that might seem to be perfectly reasonable things to be mad at, is admitting that you think God is useless.</p><p>How exactly this reconciles with Jesus getting pissed off at <a href="https://en.wikipedia.org/wiki/Cleansing_of_the_Temple" target="_blank">the moneylenders in the temple</a> and <a href="https://www.biblegateway.com/passage/?search=Mark+3&version=NIV" target="_blank">healers that refused to save lives on Sunday</a> is unclear. Neither of these incidents seem to be the things that happen to somebody without bursts of anger, though I do suppose it is possible Christ had fits of atheism multiple times in his life. </p><p>Sometimes I don't believe in myself either. </p>
Stinginess, now coming to a den of heathens near you!<p>Lindley points out the final, most advanced symptom of atheism last: Not sending God money. He writes:</p><p style="margin-left: 20px;">"<em>Some people are so greedy that they actually rob God.</em> <em>'…In what way have we robbed God? In tithes and offerings</em>.' (Malachi 3:8 NKJV)) <em>To those who would hold back the tithe the Lord has a challenge</em>: <em>'Bring all the tithes into the storehouse, that there may be food in My house, and try Me now in this' says the Lord of hosts, 'If I will not open for you the windows of heaven and pour out for you such blessing that there will not be room enough to receive it.' </em>(3:10 NKJV)"</p><p>While the God of Abraham is well known not to need money on account of his transcendental nature, it seems that he is still owed ten percent of everybody's earnings. This is not paid to him, of course, but to his helpers. In exchange for this, God will make good things happen. If you don't send money in addition to swearing or occasionally being grouchy, the minister assures us that <em>"you are at extreme risk for very serious complications from your atheism."</em></p><p>While this may look remarkably similar to a concept used by the mafia, <a href="https://en.wikipedia.org/wiki/Protection_racket" target="_blank">the protection racket</a>, it is an utterly different operation. In the case of the mob, the threat of punishment is used as a way to force people into paying part of their earnings to a larger organization. In return, they are promised the protection of that organization from vague threats, often including that organization. <br> <br> In this holy case, vague are threats used to show people the wisdom of paying part of their earnings to the church. In exchange for their payments, they are offered kickbacks from God and protection from vague threats made by the people telling them they need to send in money. </p><p>Luckily, Lindley suggests a solution for all three problems, especially the last one: Don't be an atheist! In particular, start praying and sending God money. This will resolve the third symptom automatically and the first two eventually.</p><p><a href="https://www.youtube.com/watch?v=UhnsHvz7UL8" target="_blank">It's an offer you can't refuse.</a> </p>
And now, the serious part.<div class="rm-shortcode" data-media_id="SuG8OGad" data-player_id="FvQKszTI" data-rm-shortcode-id="9e1bfda7981ed1abe9eb979157ea0496"> <div id="botr_SuG8OGad_FvQKszTI_div" class="jwplayer-media" data-jwplayer-video-src="https://content.jwplatform.com/players/SuG8OGad-FvQKszTI.js"> <img src="https://cdn.jwplayer.com/thumbs/SuG8OGad-1920.jpg" class="jwplayer-media-preview" /> </div> <script src="https://content.jwplatform.com/players/SuG8OGad-FvQKszTI.js"></script> </div> <p>While it is fun to mock the often-ludicrous positions of those who misunderstand atheism, that very misunderstanding is an all too common and all too real issue for the millions of Americans who are not religious. Atheists in the United States face <a href="https://en.wikipedia.org/wiki/Discrimination_against_atheists#United_States" target="_blank">discrimination</a>,<strong></strong> are not <a href="https://psycnet.apa.org/record/2011-25187-001" target="_blank">trusted</a>, and are barred from <a href="https://en.wikipedia.org/wiki/Discrimination_against_atheists#Atheists_eligible_to_hold_office" target="_blank">running for office </a>in several states.</p><p> In my experience, many of these tend to come from a fundamental misunderstanding of what atheism <em>is</em>. I, at various times, have been accused of being a Satanist, a pagan, or an amoralist, among other things. It is little wonder why a person who doesn't understand what atheism <em>is</em> would find a variety of issues arising from it. </p><p>The minister in this case makes a similar mistake: He begins by thinking that atheism is something other than the proposition that there are no gods and then works forward. In this case, he seems to presume it is some kind of psychological condition which manifests as a hybrid of anxiety, Tourette's syndrome, and kleptomania. His use of the word "symptoms" is revealing. </p><p>While it is true that atheism can be anxiety-inducing, this falls more under the category of "<a href="https://en.wikipedia.org/wiki/Existentialism#Angst_and_dread" target="_blank">existential dread</a>" than psychosis. John-Paul Sartre, the atheistic philosopher who made Existentialism popular, wrote on this extensively. In his essay <em>"</em><a href="http://www.mrsmoser.com/uploads/8/5/0/1/8501319/english_11_ib_-_no_exit_-_existentialism_is_a_humanism_-_sartre.pdf" target="_blank">Existentialism is a Humanism</a><em>," </em>he explains:</p><p style="margin-left: 20px;"><em>"What do we mean by saying that existence precedes essence? We mean that man first of all exists, encounters himself, surges up in the world—and defines himself afterwards. If man as the existentialist see him is not definable, it is because to begin with he is nothing. He will not be anything until later, and then he will be what he makes of himself. Thus, there is no human nature, because there is no God to have a conception of himself … what do we mean by anguish? The existentialist frankly states that man is in anguish. His meaning is as follows: When a man commits himself to anything, fully realizing that he is not only choosing what he will be, but is thereby at the same time a legislator deciding for the whole of mankind—in such a moment a man cannot escape from the sense of complete and profound responsibility."</em><em></em></p><p>If choosing what you are and what meaning your life will have doesn't give you anxiety, Sartre would suggest you're doing something wrong. </p><p>However, this anxiety isn't necessarily cured by belief. <a href="https://plato.stanford.edu/entries/kierkegaard/" target="_blank">Soren Kierkegaard</a>, the founder of Existentialism, wrote extensively on the topics of angst, dread, anxiety, and regretting all of your life choices while being a thoroughly devoted Christian. While he argues that the leap of faith can help, he also argues that we are still fundamentally alone and responsible for our choices when it comes to making that anxiety-inducing <a href="https://en.wikipedia.org/wiki/The_Concept_of_Anxiety" target="_blank">leap</a>.</p><p>The minister's point about swearing as a result of lacking faith is bizarre enough to be left alone. Ten minutes in any bar in the middle section of the country on a Friday night should be enough to convince anybody that any sincere believer can swear while remaining a believer. </p><p>Furthermore, the minister presumes that a believer is going to be of the kind that thinks God is very engaged in human life. While he may suppose God was involved in his tire going flat, many other approaches to the divine reject that idea. Deists, who tend to think that there is a God who created the cosmos but leaves it <a href="https://en.wikipedia.org/wiki/Deism#Aspects_of_contemporary_deism" target="_blank">alone</a>, would be an example. </p><p>All in all, the essay described above is an unintentionally hilarious look at what some people think being an atheist is like. It is hardly the <a href="https://www.scientificamerican.com/article/can-atheist-be-in-awe-of-universe/" target="_blank">first</a>, and it won't be the last. Anxiety about atheism has a history going back to <a href="https://en.wikipedia.org/wiki/Apology_(Plato)#Accusers_of_Socrates" target="_blank">ancient Greece</a>—studies demonstrate the continued <a href="https://bigthink.com/ideafeed/atheists-threaten-believers-with-mortality" target="_blank">existence</a> of Christian anxiety about atheists—and this essay is another example of people being unduly concerned about it. </p><p>I'd accuse the minister of worrying too much about atheism, but then he'd be <a href="https://www.youtube.com/watch?v=39Bnk6VU53Y" target="_blank">one of us</a>. </p>
The coronavirus pandemic has brought out the perception of selfishness among many.
- Selfish behavior has been analyzed by philosophers and psychologists for centuries.
- New research shows people may be wired for altruistic behavior and get more benefits from it.
- Crisis times tend to increase self-centered acts.
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