{"generator":"Jekyll","link":[{"@attributes":{"href":"https:\/\/srconstantin.github.io\/feed.xml","rel":"self","type":"application\/atom+xml"}},{"@attributes":{"href":"https:\/\/srconstantin.github.io\/","rel":"alternate","type":"text\/html"}}],"updated":"2021-08-05T22:30:32+00:00","id":"https:\/\/srconstantin.github.io\/feed.xml","title":"Sarah Constantin","subtitle":"Trained in math and machine learning, currently trying to solve technological problems and make sense of our world.","entry":[{"title":"Are Cancer Cells More Negatively Charged?","link":{"@attributes":{"href":"https:\/\/srconstantin.github.io\/2021\/08\/05\/electric-charge.html","rel":"alternate","type":"text\/html","title":"Are Cancer Cells More Negatively Charged?"}},"published":"2021-08-05T00:00:00+00:00","updated":"2021-08-05T00:00:00+00:00","id":"https:\/\/srconstantin.github.io\/2021\/08\/05\/electric-charge","content":"<p>Are cancer cells more negatively charged than healthy cells? Does this hold across cancer types and tissues?<\/p>\n\n<p>If so, this could prove extremely useful as a broad-spectrum cancer treatment. Simply bond something toxic to cancer cells (such as a chemotherapy drug) to a positively charged nanoparticle, and you can deliver targeted drugs that kill cancer cells but not healthy cells.<\/p>\n\n<p><strong>Electrophoretic Mobility<\/strong><\/p>\n\n<p>Cells in suspension in an electrolyte solution like saline normally have a negative surface charge and can therefore be induced to flow along an electrochemical gradient.<\/p>\n\n<p>Cell electrophoretic mobility \u2013 the ratio of cell velocity to electric field strength, in cm^2 V^(-1) s^(-1) \u2013 depends on the cell cycle stage, peaking around mitosis. So you might expect all rapidly dividing cells, including tumor cells, to have high electrophoretic mobility more of the time.[1][4]<\/p>\n\n<p>In samples from healthy patients and patients with chronic lymphocytic leukemia, n = 19, electrophoretic mobility did not significantly differ between cancer and normal lymphocytes.[2]<\/p>\n\n<p>In a study of blood cells taken from 700 patients (some healthy, some with various diseases including both blood cancers and solid tumors), all cancers significantly _reduced _the electrophoretic mobility of red blood cells, indicating that the RBCs became less negatively charged. Benign tumors had no effect.[3]<\/p>\n\n<p>Leukaemic mouse lymphocytes in saline had significantly lower electrophoretic mobility than normal mouse lymphocytes.[5]<\/p>\n\n<p>In a study of multiple human tumor samples, epithelial tumor cells did not have higher electrophoretic mobility than normal cells, but connective tissue tumor cells (sarcomas and myomas) did.[6]<\/p>\n\n<p>Another study on different cell lines found that an epithelial cancer cell line (HeLa) was not significantly different in electrophoretic mobility than normal cells, but that a carcinoma cell line (Ehrlich ascites tumor) had significantly higher electrophoretic mobility.[7]<\/p>\n\n<p>At physiologic pH, breast cancer cells have higher electrophoretic mobility (and thus more negative surface charge) than healthy fibroblasts.[13]<\/p>\n\n<p>Hamster kidney and liver tumor cells, which are carcinomas, have significantly higher electrophoretic mobility than their healthy counterparts. The MCIM sarcoma becomes more electrophoretically mobile as it gets closer to metastasis.[14]<\/p>\n\n<p>Solid tumor cells are also less adhesive than healthy cells from the same tissue type; this is what you would expect if they were more negatively charged and thus repelled each other electrostatically more. Blood cells, healthy or cancerous, are already not very adhesive, and accordingly they are more electrostatically mobile.[14]<\/p>\n\n<p><strong>Electrically Charged Nanoparticle Aggregation<\/strong><\/p>\n\n<p>Electrophoresis may not be an accurate way to measure cell surface charge. Voltages necessary to move cells are high, which will change cell function.  An alternative method is to create charged nanoparticles and observe which cells they cluster around.<\/p>\n\n<p>Iron oxide nanoparticles can be given a positive or negative electric charge.  If these are introduced into cell culture suspension and they bind to the cells, the bound cells can be captured by applying a magnetic field to one side of the vessel.<\/p>\n\n<p>Positive nanoparticle binding (as measured by % of cells captured by a magnetic field) is increasing with glucose concentration and lactic acid concentration, and decreasing with concentration of glycolysis inhibitors like DCA and 3BP, suggesting that cells undergoing glycolysis are more negatively charged.[8] Out of 22 cancer cell culture lines and 4 healthy cell lines, all cancer samples had over 50% capture by a magnetic field when mixed with positive nanoparticles; no healthy cell lines had any capture by a magnetic field when mixed with positive nanoparticles.[8]<\/p>\n\n<p>Positively charged iron oxide nanoparticles, but not negatively charged ones, were observed to aggregate around cancer cells in buffer solution. At high cell concentrations, 99% of cells can by captured by attracting the positively charged nanoparticles in a magnetic field. If blood is spiked with cancer cells, over 70% of the cancer cells can be captured in the same way.[9]<\/p>\n\n<p>In a mouse model of sarcoma[9], taking a blood sample and mixing it with positive iron oxide nanoparticles and then capturing cells with a magnetic field results in 75.8 circulating tumor cells per 100 uL being captured in the sarcoma mouse, while no cells were captured in healthy controls.<\/p>\n\n<p>Zinc oxide nanoparticles have a positive surface charge at physiologic pH. These particles have a cytotoxic effect in vitro on multiple cancer cell lines, and in particular cancer cells of lymphocytic lineage are 28-35 times as susceptible to death when treated with ZnO nanoparticles than their non-cancerous counterparts.  This is a specificity ratio much higher than that for conventional chemotherapeutic drugs.[10]<\/p>\n\n<p>Positively charged gold nanoparticles adhere 117 times more strongly to the surface of HeLa cancer cells than negatively charged gold nanoparticles.[11]<\/p>\n\n<p>Positively charged magnetite nanoparticles have higher uptake into breast cancer cells than negatively charged nanoparticles; but there is no charge-based difference in uptake on healthy embryonic cord cells.[12]<\/p>\n\n<p><strong>References<\/strong><\/p>\n\n<p>[1]Akagi, Takanori, and Takanori Ichiki. \u201cCell electrophoresis on a chip: what can we know from the changes in electrophoretic mobility?.\u201d <em>Analytical and bioanalytical chemistry<\/em> 391.7 (2008): 2433-2441.<\/p>\n\n<p>[2]Lichtman, Marshall A., and Robert I. Weed. \u201cElectrophoretic mobility and N-acetyl neuraminic acid content of human normal and leukemic lymphocytes and granulocytes.\u201d <em>Blood<\/em> 35.1 (1970): 12-22.<\/p>\n\n<p>[3]Rottino, Antonio, and John Angers. \u201cThe electrophoretic mobility of erythrocytes in carcinoma and other diseases.\u201d <em>Cancer research<\/em> 21.10 (1961): 1445-1449.<\/p>\n\n<p>[4]Mayhew, E. \u201cCellular electrophoretic mobility and the mitotic cycle.\u201d <em>The Journal of general physiology<\/em> 49.4 (1966): 717-725.<\/p>\n\n<p>[5]Cook, G. M. W., and W. Jacobson. \u201cThe electrophoretic mobility of normal and leukaemic cells of mice.\u201d <em>Biochemical Journal<\/em> 107.4 (1968): 549-557.<\/p>\n\n<p>[6]Vassar, Philip S. \u201cElectrophoretic mobility of human tumour cells.\u201d <em>Nature<\/em> 197.4873 (1963): 1215-1216.<\/p>\n\n<p>[7]Simon-Reuss, I., et al. \u201cElectrophoretic studies on some types of mammalian tissue cell.\u201d <em>Cancer research<\/em> 24.11 Part 1 (1964): 2038-2043.<\/p>\n\n<p>[8]Chen, Bingdi, et al. \u201cTargeting negative surface charges of cancer cells by multifunctional nanoprobes.\u201d <em>Theranostics<\/em> 6.11 (2016): 1887.<\/p>\n\n<p>[9]Li, Zhiming, Jun Ruan, and Xuan Zhuang. \u201cEffective capture of circulating tumor cells from an S180-bearing mouse model using electrically charged magnetic nanoparticles.\u201d <em>Journal of nanobiotechnology<\/em> 17.1 (2019): 1-9<\/p>\n\n<p>[10]Rasmussen, John W., et al. \u201cZinc oxide nanoparticles for selective destruction of tumor cells and potential for drug delivery applications.\u201d <em>Expert opinion on drug delivery<\/em> 7.9 (2010): 1063-1077..<\/p>\n\n<p>[11]Peter, Beatrix, et al. \u201cInteraction of positively charged gold nanoparticles with cancer cells monitored by an in situ label-free optical biosensor and transmission electron microscopy.\u201d <em>ACS applied materials &amp; interfaces<\/em> 10.32 (2018): 26841-26850.<\/p>\n\n<p>[12]Osaka, Tetsuya, et al. \u201cEffect of surface charge of magnetite nanoparticles on their internalization into breast cancer and umbilical vein endothelial cells.\u201d <em>Colloids and Surfaces B: Biointerfaces<\/em> 71.2 (2009): 325-330.<\/p>\n\n<p>[13]Dobrzy\u0144ska, Izabela, El\u017cbieta Skrzydlewska, and Zbigniew A. Figaszewski. \u201cChanges in electric properties of human breast cancer cells.\u201d <em>The Journal of membrane biology<\/em> 246.2 (2013): 161-166.<\/p>\n\n<p>[14]Abercrombie, M., and E. J. Ambrose. \u201cThe surface properties of cancer cells: a review.\u201d <em>Cancer research<\/em> 22.5 Part 1 (1962): 525-548.<\/p>","author":{"name":{}},"category":{"@attributes":{"term":"lit-review"}},"summary":"Are cancer cells more negatively charged than healthy cells? Does this hold across cancer types and tissues?"},{"title":"Interesting rTMS Results in Healthy People","link":{"@attributes":{"href":"https:\/\/srconstantin.github.io\/2021\/08\/05\/rTMS.html","rel":"alternate","type":"text\/html","title":"Interesting rTMS Results in Healthy People"}},"published":"2021-08-05T00:00:00+00:00","updated":"2021-08-05T00:00:00+00:00","id":"https:\/\/srconstantin.github.io\/2021\/08\/05\/rTMS","content":"<p><strong>Introduction<\/strong><\/p>\n\n<p>This is an overview of selected research on repetitive transcranial magnetic stimulation, or rTMS, which involves applying a coil that produces a rapidly fluctuating magnetic field to the outside of the head, thereby stimulating the surface of the brain beneath the coil.<\/p>\n\n<p>RTMS is an approved treatment for depression and has been investigated for various other psychiatric disorders, but it\u2019s particularly intriguing that it also seems to have effects on healthy people that include cognitive improvements above the \u201cnormal\u201d baseline.<\/p>\n\n<p><strong>Summary, by Type of Intervention<\/strong><\/p>\n\n<p>Note: stimulation of &lt;1 Hz is generally thought to have an inhibitory effect on a brain region, while stimulation of &gt;5 Hz is thought to have an excitatory effect.<\/p>\n\n<p>I only include results that have been observed in at least two studies and not been disconfirmed.<\/p>\n\n<p>I focus on studies in healthy subjects, and on improvements rather than impairments.<\/p>\n\n<p><strong>Left Dorsolateral Prefrontal Cortex, Inhibitory<\/strong><\/p>\n\n<ul>\n  <li>Increased accuracy on working memory tasks (2)<\/li>\n<\/ul>\n\n<p><strong>Left Dorsolateral Prefrontal Cortex, Excitatory<\/strong><\/p>\n\n<ul>\n  <li>Reduced addiction symptoms (2)<\/li>\n  <li>Reduced stress response to criticism (3)<\/li>\n  <li>Reduced pain (2)<\/li>\n  <li>Reduced reaction times on cognitive tasks (6)<\/li>\n  <li>Reduced impulsivity (2)<\/li>\n<\/ul>\n\n<p><strong>Right Dorsolateral Prefrontal Cortex, Inhibitory<\/strong><\/p>\n\n<ul>\n  <li>Reduced costly reciprocal fairness signaling (ultimatum game, dictator game, trade-back game with reputation) (3)<\/li>\n  <li>Increased risk-taking behavior (2)<\/li>\n<\/ul>\n\n<p><strong>Right Dorsolateral Prefrontal Cortex, Excitatory<\/strong><\/p>\n\n<ul>\n  <li>Reduced reaction times on cognitive tasks (4)<\/li>\n  <li>Increased startle &amp; distraction by threats (2)<\/li>\n<\/ul>\n\n<p><strong>Bilateral Dorsomedial Prefrontal Cortex, Excitatory<\/strong><\/p>\n\n<ul>\n  <li>Increased empathy and comfort with social interaction (3)<\/li>\n  <li>Improved fear extinction\/phobia recovery (2)<\/li>\n<\/ul>\n\n<p><strong>Left Inferior Frontal Cortex, Inhibitory<\/strong><\/p>\n\n<ul>\n  <li>Improved performance on abstract reasoning tasks such as syllogisms and artificial grammar (2)<\/li>\n<\/ul>\n\n<p><strong>M1, Excitatory<\/strong><\/p>\n\n<ul>\n  <li>Reduced pain (2)<\/li>\n<\/ul>\n\n<p><strong>Right Temporoparietal Junction, Inhibitory<\/strong><\/p>\n\n<ul>\n  <li>Reduced ingroup bias (2)<\/li>\n<\/ul>\n\n<p><strong>Left Inferior Parietal Lobule, Excitatory<\/strong><\/p>\n\n<ul>\n  <li>Improved reading accuracy (2)<\/li>\n<\/ul>\n\n<p><strong>Right Inferior Parietal Lobule, Excitatory<\/strong><\/p>\n\n<ul>\n  <li>Improved accuracy and reaction time on numerical estimation and calculation tasks (2)<\/li>\n<\/ul>\n\n<p><strong>Right Inferior Parietal Lobule, Inhibitory<\/strong><\/p>\n\n<ul>\n  <li>Shorter reaction time in bottom-up processing and visual perception tasks (4)<\/li>\n  <li>Reduced startle response to pain and loud noises (2)<\/li>\n<\/ul>\n\n<p><strong>Analogic Reasoning<\/strong><\/p>\n\n<table>\n  <tr>\n   <td><strong>Reference<\/strong>\n   <\/td>\n   <td><strong>Brain Location<\/strong>\n   <\/td>\n   <td><strong>Treatment Duration<\/strong>\n   <\/td>\n   <td><strong>Frequency<\/strong>\n   <\/td>\n   <td><strong>Machine<\/strong>\n   <\/td>\n   <td><strong>Result<\/strong>\n   <\/td>\n   <td><strong>N<\/strong>\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[6]\n   <\/td>\n   <td>Left DLPFC\n   <\/td>\n   <td>During test\n   <\/td>\n   <td>1 Hz\n   <\/td>\n   <td>Magstim Rapid2 Stimulator and 70mm figure-eight coil\n   <\/td>\n   <td>Improved response time (10% faster) on geometric shape based analogy questions\n   <\/td>\n   <td>16\n   <\/td>\n  <\/tr>\n<\/table>\n\n<p><strong>Addiction<\/strong><\/p>\n\n<table>\n  <tr>\n   <td><strong>Reference<\/strong>\n   <\/td>\n   <td><strong>Brain Location<\/strong>\n   <\/td>\n   <td><strong>Treatment Duration<\/strong>\n   <\/td>\n   <td><strong>Frequency<\/strong>\n   <\/td>\n   <td><strong>Machine<\/strong>\n   <\/td>\n   <td><strong>Result<\/strong>\n   <\/td>\n   <td><strong>N<\/strong>\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[6]\n   <\/td>\n   <td>DLPFC (F3)\n   <\/td>\n   <td>5 days\/week for 4 weeks, 30 min\/day\n   <\/td>\n   <td>15 hz\n   <\/td>\n   <td>Magpro R30 with Cool-b80 figure-8 coil\n   <\/td>\n   <td>9\/16 patients seeking treatment for cocaine use tested negative for cocaine at end of study. Big significant drops in depression and anxiety scales.\n   <\/td>\n   <td>20\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[27]\n   <\/td>\n   <td>Left DLPFC\n   <\/td>\n   <td>13 min, twice daily for a week followed by weekly for 8 weeks\n   <\/td>\n   <td>15 Hz\n   <\/td>\n   <td>MagPro R30\n   <\/td>\n   <td>Significant drops in cocaine craving &amp; gambling severity scores in gambling and cocaine addicts.\n   <\/td>\n   <td>7\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[44]\n   <\/td>\n   <td>Medial PFC and anterior cingulate cortex\n   <\/td>\n   <td>15 minute sessions, every weekday for 3 weeks\n   <\/td>\n   <td>1 Hz, 10 Hz\n   <\/td>\n   <td>H7 coil and Magstim Rapid\n   <\/td>\n   <td>Significant reduction in preference for cocaine over monetary reward, among cocaine addicts in a lab environment, compared to low-frequency and sham.\n   <\/td>\n   <td>18\n   <\/td>\n  <\/tr>\n<\/table>\n\n<p><strong>Blame, Character Judgment, Intentionality Attribution<\/strong><\/p>\n\n<table>\n  <tr>\n   <td><strong>Reference<\/strong>\n   <\/td>\n   <td><strong>Brain Location<\/strong>\n   <\/td>\n   <td><strong>Treatment Duration<\/strong>\n   <\/td>\n   <td><strong>Frequency<\/strong>\n   <\/td>\n   <td><strong>Machine<\/strong>\n   <\/td>\n   <td><strong>Result<\/strong>\n   <\/td>\n   <td><strong>N<\/strong>\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[35]\n   <\/td>\n   <td>Left and right temporoparietal junction\n   <\/td>\n   <td>10 min\n   <\/td>\n   <td>1 Hz\n   <\/td>\n   <td>MagStim Rapid2\n   <\/td>\n   <td>Right TPJ inhibition increases perception of hostile intentionality in stories\n   <\/td>\n   <td>23\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[36]\n   <\/td>\n   <td>Right temporoparietal junction\n   <\/td>\n   <td>25 min\n   <\/td>\n   <td>1 Hz\n   <\/td>\n   <td>MagStim Super Rapid\n   <\/td>\n   <td>Right TPJ inhibition causes study subjects to attribute less moral blame to stories in which harm was attempted but failed. \n   <\/td>\n   <td>20\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[47]\n   <\/td>\n   <td>DMPFC\n   <\/td>\n   <td>During testing\n   <\/td>\n   <td>1 Hz\n   <\/td>\n   <td>Magstim Rapid 2 with butterfly coil\n   <\/td>\n   <td>Increased tendency to rate someone as \u201ctrustworthy\u201d when both \u201cgood\u201d and \u201cbad\u201d actions were attributed to them.\n   <\/td>\n   <td>20\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[48]\n   <\/td>\n   <td>DMPFC, right DLPFC\n   <\/td>\n   <td>During testing\n   <\/td>\n   <td>10 Hz\n   <\/td>\n   <td>Magstim Rapid 2 with butterfly coil\n   <\/td>\n   <td>Right DLPFC stimulation decreased the number of faces rated \u201ctrustworthy.\u201d  DMPFC stimulation eliminated the tendency to rate faces as more trustworthy if accompanied by \u201cbeautiful\u201d vs. \u201cugly\u201d adjectives.\n   <\/td>\n   <td>20\n   <\/td>\n  <\/tr>\n<\/table>\n\n<p><strong>Bottom-Up Processing<\/strong><\/p>\n\n<table>\n  <tr>\n   <td><strong>Reference<\/strong>\n   <\/td>\n   <td><strong>Brain Location<\/strong>\n   <\/td>\n   <td><strong>Treatment Duration<\/strong>\n   <\/td>\n   <td><strong>Frequency<\/strong>\n   <\/td>\n   <td><strong>Machine<\/strong>\n   <\/td>\n   <td><strong>Result<\/strong>\n   <\/td>\n   <td><strong>N<\/strong>\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[61]\n   <\/td>\n   <td>P3 and P4 sites (inferior parietal lobule)\n   <\/td>\n   <td>During test\n   <\/td>\n   <td>1 Hz\n   <\/td>\n   <td>Magstim Rapid 2 and butterfly coil\n   <\/td>\n   <td>Right parietal rTMS, but not left, reduced reaction times in searching for an X among many X\u2019s that has a particular angle orientation, but not for searching for a non-X line among other X\u2019s. Right IPL rTMS improves bottom-up perception.\n   <\/td>\n   <td>28\n   <\/td>\n  <\/tr>\n<\/table>\n\n<p><strong>Criticism<\/strong><\/p>\n\n<table>\n  <tr>\n   <td><strong>Reference<\/strong>\n   <\/td>\n   <td><strong>Brain Location<\/strong>\n   <\/td>\n   <td><strong>Treatment Duration<\/strong>\n   <\/td>\n   <td><strong>Frequency<\/strong>\n   <\/td>\n   <td><strong>Machine<\/strong>\n   <\/td>\n   <td><strong>Result<\/strong>\n   <\/td>\n   <td><strong>N<\/strong>\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[48]\n   <\/td>\n   <td>Left DLPFC\n   <\/td>\n   <td>One 20-min session\n   <\/td>\n   <td>20 Hz\n   <\/td>\n   <td>Magstim + figure-eight coil\n   <\/td>\n   <td>Significantly reduced salivary cortisol increase in response to negative\/critical feedback, compared to sham stimulation. \n   <\/td>\n   <td>30\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[60]\n   <\/td>\n   <td>Left and right DLPFC\n   <\/td>\n   <td>One 20-min session\n   <\/td>\n   <td>20 Hz\n   <\/td>\n   <td>\n   <\/td>\n   <td>Significantly increased heart rate variability in response to negative\/critical feedback after left DLPFC but not right DLPFC stimulation.\n   <\/td>\n   <td>38\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[105]\n   <\/td>\n   <td>Left DLPFC\n   <\/td>\n   <td>20 min\n   <\/td>\n   <td>20 Hz\n   <\/td>\n   <td>Magstim Rapid 2, figure eight coil\n   <\/td>\n   <td>Reduced cortisol response to negative\/critical feedback in treated vs. sham\n   <\/td>\n   <td>75\n   <\/td>\n  <\/tr>\n<\/table>\n\n<p><strong>Delusions<\/strong><\/p>\n\n<table>\n  <tr>\n   <td><strong>Reference<\/strong>\n   <\/td>\n   <td><strong>Brain Location<\/strong>\n   <\/td>\n   <td><strong>Treatment Duration<\/strong>\n   <\/td>\n   <td><strong>Frequency<\/strong>\n   <\/td>\n   <td><strong>Machine<\/strong>\n   <\/td>\n   <td><strong>Result<\/strong>\n   <\/td>\n   <td><strong>N<\/strong>\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[14]\n   <\/td>\n   <td>Left DLPFC (F3 and F4)\n   <\/td>\n   <td>13 sessions in 3 weeks, 37 min each\n   <\/td>\n   <td>10 hz\n   <\/td>\n   <td>Magstim Rapid and figure-8 coil\n   <\/td>\n   <td>One patient being treated for depression developed his first-ever psychotic symptoms; agitated, anxious, felt observed &amp; persecuted.\n   <\/td>\n   <td>1\n   <\/td>\n  <\/tr>\n<\/table>\n\n<p><strong>Deductive Reasoning<\/strong><\/p>\n\n<table>\n  <tr>\n   <td><strong>Reference<\/strong>\n   <\/td>\n   <td><strong>Brain Location<\/strong>\n   <\/td>\n   <td><strong>Treatment Duration<\/strong>\n   <\/td>\n   <td><strong>Frequency<\/strong>\n   <\/td>\n   <td><strong>Machine<\/strong>\n   <\/td>\n   <td><strong>Result<\/strong>\n   <\/td>\n   <td><strong>N<\/strong>\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[59]\n   <\/td>\n   <td>Right and left inferior frontal cortex (BA 45)\n   <\/td>\n   <td>10 min\n   <\/td>\n   <td>1 Hz\n   <\/td>\n   <td>Magstim Rapid with figure-8 coil, Brainsight\n   <\/td>\n   <td>Right IFC stimulation increased the \u201cbelief-bias\u201d effect, worsening accuracy at syllogism evaluation when conclusions are logically valid but unrealistic. Left IFC stimulation removed the belief-bias effect; subjects performed a bit worse on \u201cbelievable\u201d syllogisms, and better on \u201cunbelievable\u201d ones.\n   <\/td>\n   <td>72\n   <\/td>\n  <\/tr>\n<\/table>\n\n<p><strong>Empathy<\/strong><\/p>\n\n<table>\n  <tr>\n   <td><strong>Reference<\/strong>\n   <\/td>\n   <td><strong>Brain Location<\/strong>\n   <\/td>\n   <td><strong>Treatment Duration<\/strong>\n   <\/td>\n   <td><strong>Frequency<\/strong>\n   <\/td>\n   <td><strong>Machine<\/strong>\n   <\/td>\n   <td><strong>Result<\/strong>\n   <\/td>\n   <td><strong>N<\/strong>\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[15]\n   <\/td>\n   <td>Bilateral medial PFC\n   <\/td>\n   <td>15 min\n   <\/td>\n   <td>1 Hz\n   <\/td>\n   <td>Magstim Rapid and Haut-coil\n   <\/td>\n   <td>Increased self-reported empathy in low-EQ, decreased self-reported empathy in high-EQ patients. No change in cognitive empathy.\n   <\/td>\n   <td>16\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[41]\n   <\/td>\n   <td>Dorsal medial prefrontal cortex\n   <\/td>\n   <td>During test\n   <\/td>\n   <td>1 Hz\n   <\/td>\n   <td>Magstim Rapid 2 with figure-8 coil &amp; Brainstem\n   <\/td>\n   <td>Significantly (2x) more likely to misidentify anger and fear in facial expressions than controls, but not happiness or neutral.\n   <\/td>\n   <td>19\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[52]\n   <\/td>\n   <td>Right TPJ\n   <\/td>\n   <td>During test\n   <\/td>\n   <td>1 Hz\n   <\/td>\n   <td>Magstim Super Rapid, figure-eight coil, Brainsight\n   <\/td>\n   <td>rTMS to the right TPJ increases the rate of irritation after watching a sad video and decreases the rate of compassion\/sympathy.\n   <\/td>\n   <td>\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[10]\n   <\/td>\n   <td>Bilateral dorsomedial prefrontal cortex; 7 cm anterior to M1\n   <\/td>\n   <td>15 min per session; 30 10-second trains and a 20 second rest period, for two weeks, 5 days per week\n   <\/td>\n   <td>5 Hz\n   <\/td>\n   <td>HAUTcoil and Magstim Rapid\n   <\/td>\n   <td>Significantly increased \u201csocial relatedness\u201d and reduced \u201cfantasizing\u201d in treatment but not sham groups a month later, in autistic subjects\n   <\/td>\n   <td>28\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[32]\n   <\/td>\n   <td>Bilateral medial PFC\n   <\/td>\n   <td>15 min each weekday for 2 weeks\n   <\/td>\n   <td>5 Hz\n   <\/td>\n   <td>\n   <\/td>\n   <td>6 months later, autistic subject showed greater ease with eye contact, more comfortable around others, more physically affectionate, more considerate of others\n   <\/td>\n   <td>1\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[86]\n   <\/td>\n   <td>Medial prefrontal cortex\n   <\/td>\n   <td>During testing\n   <\/td>\n   <td>10 Hz\n   <\/td>\n   <td>Magstim Rapid 2, figure-8 coil, Brainsight\n   <\/td>\n   <td>Compared to control site &amp; sham, reduced reaction times in identifying emotions in the test condition; increased smiles while looking at happy faces &amp; frowns while looking at angry, sad, or disgusted faces\n   <\/td>\n   <td>16\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[104]\n   <\/td>\n   <td>Right DLPFC\n   <\/td>\n   <td>15 min\n   <\/td>\n   <td>1 Hz\n   <\/td>\n   <td>Magstim Rapid 2, figure 8 coil\n   <\/td>\n   <td>Compared to a control site, reduced reaction times at cognitive but not affective theory of mind tasks\n   <\/td>\n   <td>28\n   <\/td>\n  <\/tr>\n<\/table>\n\n<p><strong>Focus\/Attention<\/strong><\/p>\n\n<table>\n  <tr>\n   <td><strong>Reference<\/strong>\n   <\/td>\n   <td><strong>Brain Location<\/strong>\n   <\/td>\n   <td><strong>Treatment Duration<\/strong>\n   <\/td>\n   <td><strong>Frequency<\/strong>\n   <\/td>\n   <td><strong>Machine<\/strong>\n   <\/td>\n   <td><strong>Result<\/strong>\n   <\/td>\n   <td><strong>N<\/strong>\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[72]\n   <\/td>\n   <td>Left DLPFC\n   <\/td>\n   <td>20 min\n   <\/td>\n   <td>10 Hz\n   <\/td>\n   <td>Magstim  figure-8 coil\n   <\/td>\n   <td>Reduced reaction time in both congruent &amp; incongruent conditions of a Stroop task; no change in interference effect, no effect on mood\n   <\/td>\n   <td>28\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[75]\n   <\/td>\n   <td>Right DLPFC\n   <\/td>\n   <td>20 min\n   <\/td>\n   <td>10 Hz\n   <\/td>\n   <td>\n   <\/td>\n   <td>Reduced reaction time relative to sham in both congruent and incongruent conditions of a Stroop task; no effect on mood\n   <\/td>\n   <td>20\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[78]\n   <\/td>\n   <td>Left DLPFC\n   <\/td>\n   <td>5 daily sessions\n   <\/td>\n   <td>10 Hz\n   <\/td>\n   <td>\n   <\/td>\n   <td>In healthy elderly subjects, significantly reduced reaction times (but no change in accuracy) in active but not sham stimulation on the Stroop task.\n   <\/td>\n   <td>16\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[80]\n   <\/td>\n   <td>Left DLPFC\n   <\/td>\n   <td>7 consecutive days\n   <\/td>\n   <td>10 Hz\n   <\/td>\n   <td>Magstim high speed, figure-8 coil\n   <\/td>\n   <td>Significantly reduced reaction time on both congruent &amp; incongruent conditions of a Stroop task\n   <\/td>\n   <td>25\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[89]\n   <\/td>\n   <td>Left and right DLPFC\n   <\/td>\n   <td>During testing\n   <\/td>\n   <td>20 Hz\n   <\/td>\n   <td>Softaxic navigation\n   <\/td>\n   <td>Significantly reduced reaction time on action-naming task in older adults but not an object-naming task\n   <\/td>\n   <td>13\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[92]\n   <\/td>\n   <td>Right DLPFC\n   <\/td>\n   <td>20 min\n   <\/td>\n   <td>10 Hz\n   <\/td>\n   <td>MagStim + figure-8 coil\n   <\/td>\n   <td>Increased psychomotor speed, relative to sham control and left DLPFC, with right DLPFC stimulation\n   <\/td>\n   <td>36\n   <\/td>\n  <\/tr>\n<\/table>\n\n<p><strong>Grammar<\/strong><\/p>\n\n<table>\n  <tr>\n   <td><strong>Reference<\/strong>\n   <\/td>\n   <td><strong>Brain Location<\/strong>\n   <\/td>\n   <td><strong>Treatment Duration<\/strong>\n   <\/td>\n   <td><strong>Frequency<\/strong>\n   <\/td>\n   <td><strong>Machine<\/strong>\n   <\/td>\n   <td><strong>Result<\/strong>\n   <\/td>\n   <td><strong>N<\/strong>\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[24]\n   <\/td>\n   <td>Inferior frontal cortex; BA 44\/45\n   <\/td>\n   <td>20 min\n   <\/td>\n   <td>1 Hz\n   <\/td>\n   <td>Magstim  figure-8 coil\n   <\/td>\n   <td>Increased accuracy and decreased response time after stimulation in an artificial grammar learning task.\n   <\/td>\n   <td>25\n   <\/td>\n  <\/tr>\n<\/table>\n\n<p><strong>Hypnotic Suggestibility<\/strong><\/p>\n\n<table>\n  <tr>\n   <td><strong>Reference<\/strong>\n   <\/td>\n   <td><strong>Brain Location<\/strong>\n   <\/td>\n   <td><strong>Treatment Duration<\/strong>\n   <\/td>\n   <td><strong>Frequency<\/strong>\n   <\/td>\n   <td><strong>Machine<\/strong>\n   <\/td>\n   <td><strong>Result<\/strong>\n   <\/td>\n   <td><strong>N<\/strong>\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[13]\n   <\/td>\n   <td>Left DLPFC (F3 and F4)\n   <\/td>\n   <td>20 min\n   <\/td>\n   <td>1 Hz\n   <\/td>\n   <td>?\n   <\/td>\n   <td>Significantly (p = 0.002) increased intensity of hypnotic suggestion vs. sham. Cohen\u2019s d =0.6\n   <\/td>\n   <td>23\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[26]\n   <\/td>\n   <td>Left DLPFC and right DLPFC\n   <\/td>\n   <td>4 sessions of 5 min each\n   <\/td>\n   <td>1 Hz\n   <\/td>\n   <td>Magstim Rapid 2\n   <\/td>\n   <td>right DLPFC stimulation, but not left, increased hypnotic suggestibility (Cohen\u2019s d = 0.37)\n   <\/td>\n   <td>38\n   <\/td>\n  <\/tr>\n<\/table>\n\n<p><strong>Impulsivity<\/strong><\/p>\n\n<table>\n  <tr>\n   <td><strong>Reference<\/strong>\n   <\/td>\n   <td><strong>Brain Location<\/strong>\n   <\/td>\n   <td><strong>Treatment Duration<\/strong>\n   <\/td>\n   <td><strong>Frequency<\/strong>\n   <\/td>\n   <td><strong>Machine<\/strong>\n   <\/td>\n   <td><strong>Result<\/strong>\n   <\/td>\n   <td><strong>N<\/strong>\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[56]\n   <\/td>\n   <td>cerebellum\n   <\/td>\n   <td>10 min\n   <\/td>\n   <td>1 Hz\n   <\/td>\n   <td>Magpro X100 with B-65 butterfly coil\n   <\/td>\n   <td>Raises accuracy of BPD patients on an affective go\/no-go task (measure of impulsivity) to the level of healthy controls.\n   <\/td>\n   <td>17\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[79]\n   <\/td>\n   <td>Left DLPFC\n   <\/td>\n   <td>3 blocks, 2.5 min each, before testing\n   <\/td>\n   <td>10 Hz\n   <\/td>\n   <td>Magstim 200 + figure 8 coil\n   <\/td>\n   <td>Significantly improved performance on a continuous performance task, a measure of impulsivity and response inhibition. Significant increase in negative affect relative to sham. \n   <\/td>\n   <td>17\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[90]\n   <\/td>\n   <td>Right DLPFC\n   <\/td>\n   <td>10 sessions\n   <\/td>\n   <td>10 Hz\n   <\/td>\n   <td>Magstim Rapid 2 and double air film coil\n   <\/td>\n   <td>No effect on a go\/no-go task in alcoholics\n   <\/td>\n   <td>80\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[91]\n   <\/td>\n   <td>Right DLPFC\n   <\/td>\n   <td>10 sessions\n   <\/td>\n   <td>10 Hz\n   <\/td>\n   <td>\n   <\/td>\n   <td>Improves performance in a go\/no-go task in bulimics\n   <\/td>\n   <td>39\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[102]\n   <\/td>\n   <td>Left DLPFC\n   <\/td>\n   <td>30 min\n   <\/td>\n   <td>1 Hz\n   <\/td>\n   <td>Magstim with figure-8 coil\n   <\/td>\n   <td>In a gambling game, DLPFC inhibition made players more likely to make choices with better short-term but worse long-term options.\n   <\/td>\n   <td>64\n   <\/td>\n  <\/tr>\n<\/table>\n\n<p><strong>Memory<\/strong><\/p>\n\n<table>\n  <tr>\n   <td><strong>Reference<\/strong>\n   <\/td>\n   <td><strong>Brain Location<\/strong>\n   <\/td>\n   <td><strong>Treatment Duration<\/strong>\n   <\/td>\n   <td><strong>Frequency<\/strong>\n   <\/td>\n   <td><strong>Machine<\/strong>\n   <\/td>\n   <td><strong>Result<\/strong>\n   <\/td>\n   <td><strong>N<\/strong>\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[11]\n   <\/td>\n   <td>Midline parietal site centered on the precuneus\n   <\/td>\n   <td>During test\n   <\/td>\n   <td>5 Hz, but not 1 Hz or 10 Hz\n   <\/td>\n   <td>Magstim Rapid Stimulator &amp; 8-coil\n   <\/td>\n   <td>Improved accuracy &amp; reaction time on a delayed matching task\n   <\/td>\n   <td>44\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[12]\n   <\/td>\n   <td>Right DLPFC\n   <\/td>\n   <td>10 min\n   <\/td>\n   <td>1 Hz\n   <\/td>\n   <td>Magstim Rapid Stimulator &amp; 8-coil\n   <\/td>\n   <td>Improved accuracy (by 30%) in healthy patients and by 15% in memory impaired patients\n   <\/td>\n   <td>108\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[65]\n   <\/td>\n   <td>Left DLPFC\n   <\/td>\n   <td>15 min, every weekday for 2 weeks\n   <\/td>\n   <td>10 Hz\n   <\/td>\n   <td>Magstim Super Rapid + Brainsight\n   <\/td>\n   <td>No effect compared to sham stimulation on n-back performance in healthy subjects\n   <\/td>\n   <td>20\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[66]\n   <\/td>\n   <td>Left middle occipital gyrus, BA 19\n   <\/td>\n   <td>During testing\n   <\/td>\n   <td>5 Hz\n   <\/td>\n   <td>Magstim Super Rapid\n   <\/td>\n   <td>Increased accuracy and reduced reaction time in delayed matching task after sleep deprivation, compared to controls.\n   <\/td>\n   <td>33\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[82]\n   <\/td>\n   <td>Right or left DLPFC\n   <\/td>\n   <td>During testing\n   <\/td>\n   <td>10 Hz\n   <\/td>\n   <td>Magstim Super Rapid\n   <\/td>\n   <td>Significant improvement in reaction time (p=0.01) but not accuracy on a memory task\n   <\/td>\n   <td>32\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[94]\n   <\/td>\n   <td>Left anterior temporal lobe\n   <\/td>\n   <td>10 min\n   <\/td>\n   <td>1 Hz\n   <\/td>\n   <td>Magpro with butterfly coil\n   <\/td>\n   <td>36% reduction in false memories (falsely saying they remembered having seen words previously) vs. sham\n   <\/td>\n   <td>28\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[95]\n   <\/td>\n   <td>Left inferior frontal cortex\n   <\/td>\n   <td>During testing\n   <\/td>\n   <td>7 Hz\n   <\/td>\n   <td>Cadwell + round coil; Brainsight\n   <\/td>\n   <td>Significantly increased accuracy in recognition memory for words relative to right inferior frontal cortex &amp; left parietal cortex\n   <\/td>\n   <td>12\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[96]\n   <\/td>\n   <td>Left DLPFC\n   <\/td>\n   <td>During memory encoding\n   <\/td>\n   <td>Theta bursts: 3 at 50 Hz\n   <\/td>\n   <td>Magpro X &amp; cooled figure-8 coil\n   <\/td>\n   <td>Significantly higher accuracy in recognition memory task\n   <\/td>\n   <td>18\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[112]\n   <\/td>\n   <td>Left DLPFC\n   <\/td>\n   <td>22.5 min\n   <\/td>\n   <td>TBS at 50 Hz, HF-rTMS at 20 Hz\n   <\/td>\n   <td>Magstim Rapid 2, figure 8 coil, Brainsight\n   <\/td>\n   <td>Both TBS and high-frequency rTMS mproved accuracy and reaction time in 3-back task relative to sham\n   <\/td>\n   <td>60\n   <\/td>\n  <\/tr>\n<\/table>\n\n<p><strong>Mood<\/strong><\/p>\n\n<table>\n  <tr>\n   <td><strong>Reference<\/strong>\n   <\/td>\n   <td><strong>Brain Location<\/strong>\n   <\/td>\n   <td><strong>Treatment Duration<\/strong>\n   <\/td>\n   <td><strong>Frequency<\/strong>\n   <\/td>\n   <td><strong>Machine<\/strong>\n   <\/td>\n   <td><strong>Result<\/strong>\n   <\/td>\n   <td><strong>N<\/strong>\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[8]\n   <\/td>\n   <td>Right DLPFC (F4)\n   <\/td>\n   <td>20 min\n   <\/td>\n   <td>1 Hz\n   <\/td>\n   <td>Neopulse\n   <\/td>\n   <td>Reduced self-reported anxiety 0-65 min after treatment\n   <\/td>\n   <td>12\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[30]\n   <\/td>\n   <td>Left and right PFC\n   <\/td>\n   <td>20 min\n   <\/td>\n   <td>5 Hz\n   <\/td>\n   <td>Cadwell High Speed Magnetic Stimulator\n   <\/td>\n   <td>Left prefrontal cortex stimulation made subjects more sad; right prefrontal cortex stimulation made subjects more happy\n   <\/td>\n   <td>10\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[68]\n   <\/td>\n   <td>Right parietal cortex (P4)\n   <\/td>\n   <td>20 min\n   <\/td>\n   <td>2 Hz\n   <\/td>\n   <td>Neopulse\n   <\/td>\n   <td>Reduced depressive mood in healthy subjects, less avoidance of angry faces\n   <\/td>\n   <td>8\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[29]\n   <\/td>\n   <td>Right DLPFC\n   <\/td>\n   <td>20 min\/day, 5 days\/wk, for 2 weeks\n   <\/td>\n   <td>10 Hz\n   <\/td>\n   <td>?\n   <\/td>\n   <td>reduced affective instability and anger in BPD patients\n   <\/td>\n   <td>11\n   <\/td>\n  <\/tr>\n<\/table>\n\n<p><strong>Moral Decisionmaking (Helping, Sharing, Punishing, etc)<\/strong><\/p>\n\n<table>\n  <tr>\n   <td><strong>Reference<\/strong>\n   <\/td>\n   <td><strong>Brain Location<\/strong>\n   <\/td>\n   <td><strong>Treatment Duration<\/strong>\n   <\/td>\n   <td><strong>Frequency<\/strong>\n   <\/td>\n   <td><strong>Machine<\/strong>\n   <\/td>\n   <td><strong>Result<\/strong>\n   <\/td>\n   <td><strong>N<\/strong>\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[50]\n   <\/td>\n   <td>Right DLPFC\n   <\/td>\n   <td>15 minutes\n   <\/td>\n   <td>1 Hz\n   <\/td>\n   <td>MagPro X100, butterfly coil, Eximia 2.3 MRI-guided positioning system\n   <\/td>\n   <td>rTMS group was more likely than sham group to choose \u201cutilitarian\u201d answers in moral dilemmas like the trolley problem.  (70% vs 56%)\n   <\/td>\n   <td>24\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[57]\n   <\/td>\n   <td>Right DLPFC\n   <\/td>\n   <td>\n   <\/td>\n   <td>1 Hz\n   <\/td>\n   <td>\n   <\/td>\n   <td>Right DLPFC stimulation, but not left DLPFC or sham, increased tendency to accept low offers in the Ultimatum Game (45% vs 15%). No difference in perceived unfairness.\n   <\/td>\n   <td>52\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[58]\n   <\/td>\n   <td>Right DLPFC\n   <\/td>\n   <td>15 min\n   <\/td>\n   <td>1 Hz\n   <\/td>\n   <td>\n   <\/td>\n   <td>Right DLPFC stimulation, compared to sham and left DLPFC stimulation, reduces the amount people share in a trust game with reputation, but not in the anonymous condition.\n   <\/td>\n   <td>87\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[87]\n   <\/td>\n   <td>Right and left DLPFC\n   <\/td>\n   <td>\n   <\/td>\n   <td>1 Hz\n   <\/td>\n   <td>MagPro R30, figure 8 coil, MRI navigation\n   <\/td>\n   <td>Participants played the Ultimatum Game and then the Dictator Game. Right DLPFC was more likely than the other two groups to give unfair offers in the dictator game, whether in response to fair or unfair offers.\n   <\/td>\n   <td>46\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[97]\n   <\/td>\n   <td>Right DLPFC\n   <\/td>\n   <td>12 min\n   <\/td>\n   <td>1 Hz\n   <\/td>\n   <td>Magstim Rapid with figure-8 coil\n   <\/td>\n   <td>Participants were significantly faster to accept unfair offers in the Ultimatum Game with true vs sham stimulation, but no less likely to rate the offers as unfair\n   <\/td>\n   <td>7\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[98]\n   <\/td>\n   <td>Right DLPFC\n   <\/td>\n   <td>40 sec\n   <\/td>\n   <td>5Hz theta bursts of 50 Hz pulses for 40 sec\n   <\/td>\n   <td>Magventure\n   <\/td>\n   <td>Stimulated vs. placebo participants were significantly more likely (60% vs 45%) to penalize unfair opponents in the Ultimatum Game by presenting them with a bad offer next time.\n   <\/td>\n   <td>19\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[37]\n   <\/td>\n   <td>Right TPJ\n   <\/td>\n   <td>20 min\n   <\/td>\n   <td>1 Hz\n   <\/td>\n   <td>Magstim Rapid, figure-8 coil\n   <\/td>\n   <td>Decreased tendency to pay to punish outgroup members more harshly than ingroup members (soccer fandoms)\n   <\/td>\n   <td>36\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[38]\n   <\/td>\n   <td>DLPFC\n   <\/td>\n   <td>30 min\n   <\/td>\n   <td>1 Hz\n   <\/td>\n   <td>\n   <\/td>\n   <td>Reduced punishment for culpable criminal acts but not reduced blame\n   <\/td>\n   <td>66\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[99]\n   <\/td>\n   <td>Left DLPFC, BA46\n   <\/td>\n   <td>During testing\n   <\/td>\n   <td>10 Hz\n   <\/td>\n   <td>Magstim Rapid 2, figure-8 coil, Brainsight\n   <\/td>\n   <td>Significantly more likely (relative to control &amp; sham) to be willing to help in hypothetical social situation\n   <\/td>\n   <td>25\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[100]\n   <\/td>\n   <td>Right DLPFC &amp; DMPFC\n   <\/td>\n   <td>During testing\n   <\/td>\n   <td>50 Hz cTBS\n   <\/td>\n   <td>\n   <\/td>\n   <td>Inhibiting right DLPFC increased generosity in an ultimatum game to high SES players, Cohen\u2019s d 0.95; inhibiting DMPFC increased generosity to low SES players.\n   <\/td>\n   <td>58\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[101]\n   <\/td>\n   <td>Right TPJ\n   <\/td>\n   <td>During testing\n   <\/td>\n   <td>50 Hz cTBS\n   <\/td>\n   <td>Magstim Rapid2, BrainVoyager neuronavigation from MRI images\n   <\/td>\n   <td>Sham-stimulated subjects share more in a trust game with \u201cingroup\u201d than \u201coutgroup\u201d players; TPJ inhibited subjects don\u2019t, they share more with the outgroup\n   <\/td>\n   <td>22\n   <\/td>\n  <\/tr>\n<\/table>\n\n<p><strong>Numerical &amp; Quantitative Reasoning<\/strong><\/p>\n\n<table>\n  <tr>\n   <td><strong>Reference<\/strong>\n   <\/td>\n   <td><strong>Brain Location<\/strong>\n   <\/td>\n   <td><strong>Treatment Duration<\/strong>\n   <\/td>\n   <td><strong>Frequency<\/strong>\n   <\/td>\n   <td><strong>Machine<\/strong>\n   <\/td>\n   <td><strong>Result<\/strong>\n   <\/td>\n   <td><strong>N<\/strong>\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[65]\n   <\/td>\n   <td>Inferior parietal lobule, left and right\n   <\/td>\n   <td>10 min\n   <\/td>\n   <td>5 Hz\n   <\/td>\n   <td>Magstim Super Rapid\n   <\/td>\n   <td>Untreated or control patients tend to underestimate the midpoint between two large numbers. Right IPL stimulation reduces the error.\n   <\/td>\n   <td>14\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[92]\n   <\/td>\n   <td>Left anterior temporal lobe\n   <\/td>\n   <td>15 min\n   <\/td>\n   <td>1 Hz\n   <\/td>\n   <td>Medtronic MagPro\n   <\/td>\n   <td>Significantly improved ability to guess the number of shapes without counting (savant-like skill)\n   <\/td>\n   <td>12\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[103]\n   <\/td>\n   <td>Intraparietal sulcus, left and right\n   <\/td>\n   <td>10 min\n   <\/td>\n   <td>1 Hz\n   <\/td>\n   <td>Magstim Rapid w\/ Brainsight\n   <\/td>\n   <td>Right IPL stimulation, relative to sham, speeded up reaction times on a number and dot estimation task; left IPL stimulation slowed it down.\n   <\/td>\n   <td>36\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[106]\n   <\/td>\n   <td>Left and right supramarginal gyrus\n   <\/td>\n   <td>During testing\n   <\/td>\n   <td>10 Hz\n   <\/td>\n   <td>Magstim Rapid2 w\/ Brainsight\n   <\/td>\n   <td>Right SMG stimulation reduced reaction time on a mental arithmetic task; left SMG stimulation increased it\n   <\/td>\n   <td>20\n   <\/td>\n  <\/tr>\n<\/table>\n\n<p><strong>Pain<\/strong><\/p>\n\n<table>\n  <tr>\n   <td><strong>Reference<\/strong>\n   <\/td>\n   <td><strong>Brain Location<\/strong>\n   <\/td>\n   <td><strong>Treatment Duration<\/strong>\n   <\/td>\n   <td><strong>Frequency<\/strong>\n   <\/td>\n   <td><strong>Machine<\/strong>\n   <\/td>\n   <td><strong>Result<\/strong>\n   <\/td>\n   <td><strong>N<\/strong>\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[73]\n   <\/td>\n   <td>Right M1, right DLPFC\n   <\/td>\n   <td>15 min\n   <\/td>\n   <td>10 Hz\n   <\/td>\n   <td>MagProX100, figure-8 coil\n   <\/td>\n   <td>Both right M1 and DLPFC stimulation, relative to sham, reduced sensitivity to cold pain, but not heat pain or cold\/heat detection\n   <\/td>\n   <td>52\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[74]\n   <\/td>\n   <td>Left DLPFC\n   <\/td>\n   <td>10 sessions, 20 minutes\/session\n   <\/td>\n   <td>10 Hz\n   <\/td>\n   <td>NeoPulse NeoTonus with a solid coil\n   <\/td>\n   <td>Significantly more pain improvement (p&lt;0.01, 20% drop) with real vs. sham stimulation in fibromyalgia patients\n   <\/td>\n   <td>20\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[76]\n   <\/td>\n   <td>M1 contralateral to pain side\n   <\/td>\n   <td>3 sessions, 3 weeks apart: sham, hotspot, and neuronavigated\n   <\/td>\n   <td>10 Hz\n   <\/td>\n   <td>MagPro X100 and Excimia neuronavigation system\n   <\/td>\n   <td>Significantly reduced (17%, p &lt; 0.0001) pain score in chronic neuropathic pain patients\n   <\/td>\n   <td>66\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[77]\n   <\/td>\n   <td>Left DLPFC\n   <\/td>\n   <td>10 daily sessions\n   <\/td>\n   <td>10 Hz\n   <\/td>\n   <td>Neuronetics Neopulse with figure-8 coil &amp; Brainsight\n   <\/td>\n   <td>Reduced pain in neuropathic chronic pain patients relative to sham\n   <\/td>\n   <td>4\n   <\/td>\n  <\/tr>\n<\/table>\n\n<p><strong>Perceptual Illusions<\/strong><\/p>\n\n<table>\n  <tr>\n   <td><strong>Reference<\/strong>\n   <\/td>\n   <td><strong>Brain Location<\/strong>\n   <\/td>\n   <td><strong>Treatment Duration<\/strong>\n   <\/td>\n   <td><strong>Frequency<\/strong>\n   <\/td>\n   <td><strong>Machine<\/strong>\n   <\/td>\n   <td><strong>Result<\/strong>\n   <\/td>\n   <td><strong>N<\/strong>\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[32]\n   <\/td>\n   <td>Cerebellum\n   <\/td>\n   <td>20 min\n   <\/td>\n   <td>1 Hz\n   <\/td>\n   <td>Neotonus\n   <\/td>\n   <td>Illusion of falling or drifting\n   <\/td>\n   <td>1\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[64]\n   <\/td>\n   <td>Right inferior parietal lobule\n   <\/td>\n   <td>10 min\n   <\/td>\n   <td>1 Hz\n   <\/td>\n   <td>\n   <\/td>\n   <td>Illusion of time dilation\n   <\/td>\n   <td>10\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[84]\n   <\/td>\n   <td>Right anterior temporal lobe\n   <\/td>\n   <td>5 days\/week for two weeks\n   <\/td>\n   <td>1 Hz\n   <\/td>\n   <td>Cadwell\n   <\/td>\n   <td>A patient with post-head-injury music hallucinations was treated with rTMS\n   <\/td>\n   <td>1\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[88]\n   <\/td>\n   <td>M1\n   <\/td>\n   <td>During testing\n   <\/td>\n   <td>1 Hz\n   <\/td>\n   <td>\n   <\/td>\n   <td>Motor cortex inhibition increases the \u201csense of effort\u201d in a force-matching task\n   <\/td>\n   <td>10\n   <\/td>\n  <\/tr>\n<\/table>\n\n<p><strong>Phobias and Fear Conditioning<\/strong><\/p>\n\n<table>\n  <tr>\n   <td><strong>Reference<\/strong>\n   <\/td>\n   <td><strong>Brain Location<\/strong>\n   <\/td>\n   <td><strong>Treatment Duration<\/strong>\n   <\/td>\n   <td><strong>Frequency<\/strong>\n   <\/td>\n   <td><strong>Machine<\/strong>\n   <\/td>\n   <td><strong>Result<\/strong>\n   <\/td>\n   <td><strong>N<\/strong>\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[43]\n   <\/td>\n   <td>Medial PFC\n   <\/td>\n   <td>20 min\n   <\/td>\n   <td>10 Hz\n   <\/td>\n   <td>Medtronic MagPro X100 with round coil \n   <\/td>\n   <td>Increased reductions in anxiety and avoidance of heights after an exposure therapy program, relative to sham stimulation.\n   <\/td>\n   <td>39\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[45]\n   <\/td>\n   <td>Medial PFC\n   <\/td>\n   <td>20 min\n   <\/td>\n   <td>10 Hz\n   <\/td>\n   <td>Medtronic MagPro X100 with round coil\n   <\/td>\n   <td>More rapid extinction of a conditioned fear eyeblink startle response &amp; skin conduction response when the conditioned stimulus was removed, than with sham stimulation.\n   <\/td>\n   <td>85\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[71]\n   <\/td>\n   <td>Intraparietal sulcus\n   <\/td>\n   <td>During test \n   <\/td>\n   <td>1 Hz\n   <\/td>\n   <td>Magventure Magpro 100\n   <\/td>\n   <td>Reduced blink startle response in reaction to predictable and unpredictable scary stimuli (loud sounds)\n   <\/td>\n   <td>25\n   <\/td>\n  <\/tr>\n<\/table>\n\n<p><strong>Planning &amp; Sequencing<\/strong><\/p>\n\n<table>\n  <tr>\n   <td>[29]\n   <\/td>\n   <td>Right DLPFC\n   <\/td>\n   <td>20 min\/day, 5 days\/wk, for 2 weeks\n   <\/td>\n   <td>10 Hz\n   <\/td>\n   <td>?\n   <\/td>\n   <td>Significant improvement at 3 months in the Tower of London task\n   <\/td>\n   <td>11\n   <\/td>\n  <\/tr>\n<\/table>\n\n<p><strong>Reading<\/strong><\/p>\n\n<table>\n  <tr>\n   <td><strong>Reference<\/strong>\n   <\/td>\n   <td><strong>Brain Location<\/strong>\n   <\/td>\n   <td><strong>Treatment Duration<\/strong>\n   <\/td>\n   <td><strong>Frequency<\/strong>\n   <\/td>\n   <td><strong>Machine<\/strong>\n   <\/td>\n   <td><strong>Result<\/strong>\n   <\/td>\n   <td><strong>N<\/strong>\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[62]\n   <\/td>\n   <td>Left inferior parietal lobule (P3 and P4)\n   <\/td>\n   <td>10 min\n   <\/td>\n   <td>5 Hz\n   <\/td>\n   <td>Magstim Super Rapid with figure-8 coil\n   <\/td>\n   <td>Left IPL stimulation, but not right or control or supratemporal gyrus, reduced errors in reading non-words in normal readers\n   <\/td>\n   <td>10\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[63]\n   <\/td>\n   <td>Left inferior parietal lobule (P3 and P4)\n   <\/td>\n   <td>10 min\n   <\/td>\n   <td>5 Hz\n   <\/td>\n   <td>Magstim Super Rapid with figure-8 coil\n   <\/td>\n   <td>Left IPL stimulation increased non-word reading accuracy in dyslexics\n   <\/td>\n   <td>10\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[83]\n   <\/td>\n   <td>Left and right DLPFC\n   <\/td>\n   <td>During testing\n   <\/td>\n   <td>15 Hz\n   <\/td>\n   <td>Magstim Super Rapid with figure-8 coil\n   <\/td>\n   <td>Reduced reaction times for sentence comprehension tasks but decreased accuracy in interpreting idiomatic sentences.\n   <\/td>\n   <td>14\n   <\/td>\n  <\/tr>\n<\/table>\n\n<p><strong>Risk Aversion<\/strong><\/p>\n\n<table>\n  <tr>\n   <td><strong>Reference<\/strong>\n   <\/td>\n   <td><strong>Brain Location<\/strong>\n   <\/td>\n   <td><strong>Treatment Duration<\/strong>\n   <\/td>\n   <td><strong>Frequency<\/strong>\n   <\/td>\n   <td><strong>Machine<\/strong>\n   <\/td>\n   <td><strong>Result<\/strong>\n   <\/td>\n   <td><strong>N<\/strong>\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[29]\n   <\/td>\n   <td>Right DLPFC\n   <\/td>\n   <td>6 min\n   <\/td>\n   <td>1 Hz\n   <\/td>\n   <td>Nexstim MRI-assisted device\n   <\/td>\n   <td>Increased rate of hitting the ceiling in a ball game where the aim is to get as close as possible without touching the ceiling. Cohen\u2019s d = 0.98\n   <\/td>\n   <td>12\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[98]\n   <\/td>\n   <td>Right DLPFC\n   <\/td>\n   <td>15 min\n   <\/td>\n   <td>1 Hz\n   <\/td>\n   <td>Magstim, figure-8 coil\n   <\/td>\n   <td>Increased high-risk choices and worse overall performance in a gambling task, relative to sham and left DLPFC\n   <\/td>\n   <td>27\n   <\/td>\n  <\/tr>\n<\/table>\n\n<p><strong>Self-Other Discrimination<\/strong><\/p>\n\n<table>\n  <tr>\n   <td><strong>Reference<\/strong>\n   <\/td>\n   <td><strong>Brain Location<\/strong>\n   <\/td>\n   <td><strong>Treatment Duration<\/strong>\n   <\/td>\n   <td><strong>Frequency<\/strong>\n   <\/td>\n   <td><strong>Machine<\/strong>\n   <\/td>\n   <td><strong>Result<\/strong>\n   <\/td>\n   <td><strong>N<\/strong>\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[5]\n   <\/td>\n   <td>Right inferior parietal lobule\n   <\/td>\n   <td>20 min, before test\n   <\/td>\n   <td>1 Hz\n   <\/td>\n   <td>Magstim Rapid Stimulator\n   <\/td>\n   <td>Increased tendency to identify images of others\u2019 faces as own\n   <\/td>\n   <td>8\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[34]\n   <\/td>\n   <td>M1, primary motor cortex\n   <\/td>\n   <td>20 min\n   <\/td>\n   <td>1 Hz\n   <\/td>\n   <td>Magstim Rapid 2\n   <\/td>\n   <td>Rubber hand illusion was strengthened, only when stimulation was on the opposite side\u2019s motor cortex\n   <\/td>\n   <td>32\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[52][53]\n   <\/td>\n   <td>Right temporoparietal junction\n   <\/td>\n   <td>30 min\/day for 3 weeks\n   <\/td>\n   <td>1 Hz\n   <\/td>\n   <td>Magstim Super Rapid\n   <\/td>\n   <td>50% of subjects with depersonalization disorder had at least a 25% improvement on a severity score, especially in symptoms related to \u201canomalous body experiences\u201d (50% mean improvement, p = 0.008)\n   <\/td>\n   <td>12\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[54]\n   <\/td>\n   <td>Right temporoparietal junction (MNI coordinates (62, -34, 30)\n   <\/td>\n   <td>During testing\n   <\/td>\n   <td>Theta burst stimulation, triplets at 30 Hz (inhibitory)\n   <\/td>\n   <td>Magpro x100  with MC-B70 butterfly coil\n   <\/td>\n   <td>Decreased the sense of agency relative to control stimulation\n   <\/td>\n   <td>15\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[65]\n   <\/td>\n   <td>Posterior parietal cortex\n   <\/td>\n   <td>During testing\n   <\/td>\n   <td>Theta burst stimulation, triplets at 50 Hz (inhibitory)\n   <\/td>\n   <td>Magstim 200\n   <\/td>\n   <td>Decreased phantom sensations in spinal cord injury patients during session\n   <\/td>\n   <td>5\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[70]\n   <\/td>\n   <td>Inferior parietal cortex (MNI coordinates (44, -54, 38)\n   <\/td>\n   <td>During testing\n   <\/td>\n   <td>10 Hz\n   <\/td>\n   <td>Magstim Rapid, custom figure-8 coil, Brainsight\n   <\/td>\n   <td>Reduced sense of agency in participant-controlled movements on computer screen\n   <\/td>\n   <td>14\n   <\/td>\n  <\/tr>\n<\/table>\n\n<p><strong>Social Attention<\/strong><\/p>\n\n<table>\n  <tr>\n   <td><strong>Reference<\/strong>\n   <\/td>\n   <td><strong>Brain Location<\/strong>\n   <\/td>\n   <td><strong>Treatment Duration<\/strong>\n   <\/td>\n   <td><strong>Frequency<\/strong>\n   <\/td>\n   <td><strong>Machine<\/strong>\n   <\/td>\n   <td><strong>Result<\/strong>\n   <\/td>\n   <td><strong>N<\/strong>\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[69]\n   <\/td>\n   <td>Posterior parietal cortex\n   <\/td>\n   <td>During test\n   <\/td>\n   <td>10 Hz, dual pulse (inhibitory)\n   <\/td>\n   <td>Two Magstim Mode 200\n   <\/td>\n   <td>Increased reaction time when distracted by pointing hands in a task involving a pointing arrow\n   <\/td>\n   <td>14\n   <\/td>\n  <\/tr>\n<\/table>\n\n<p><strong>Sensory Perception<\/strong><\/p>\n\n<table>\n  <tr>\n   <td><strong>Reference<\/strong>\n   <\/td>\n   <td><strong>Brain Location<\/strong>\n   <\/td>\n   <td><strong>Treatment Duration<\/strong>\n   <\/td>\n   <td><strong>Frequency<\/strong>\n   <\/td>\n   <td><strong>Machine<\/strong>\n   <\/td>\n   <td><strong>Result<\/strong>\n   <\/td>\n   <td><strong>N<\/strong>\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[3]\n   <\/td>\n   <td>Index finger region of primary somatosensory cortex\n   <\/td>\n   <td>During test\n   <\/td>\n   <td>5 Hz\n   <\/td>\n   <td>Magstim Rapid Stimulator &amp; 8-coil\n   <\/td>\n   <td>Improved tactile acuity; lowered discrimination threshold\n   <\/td>\n   <td>33\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[21]\n   <\/td>\n   <td>Index finger region of primary somatosensory cortex\n   <\/td>\n   <td>During test\n   <\/td>\n   <td>50 Hz bursts for 2 s every 10 s, for 3 min\n   <\/td>\n   <td>Magstim Rapid &amp; 8-coil\n   <\/td>\n   <td>Improved tactile acuity\n   <\/td>\n   <td>23\n   <\/td>\n  <\/tr>\n<\/table>\n\n<p><strong>Spatial Estimation<\/strong><\/p>\n\n<table>\n  <tr>\n   <td><strong>Reference<\/strong>\n   <\/td>\n   <td><strong>Brain Location<\/strong>\n   <\/td>\n   <td><strong>Treatment Duration<\/strong>\n   <\/td>\n   <td><strong>Frequency<\/strong>\n   <\/td>\n   <td><strong>Machine<\/strong>\n   <\/td>\n   <td><strong>Result<\/strong>\n   <\/td>\n   <td><strong>N<\/strong>\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[52]\n   <\/td>\n   <td>Right temporoparietal junction\n   <\/td>\n   <td>20 sec\n   <\/td>\n   <td>Trains of 3 pulses at 50 Hz, delivered at 5 Hz, for 20 seconds\n   <\/td>\n   <td>Magstim model 200 Monopulse\n   <\/td>\n   <td>Inhibitory rTPJ stimulation, but not sham or control, increased the error rate for judging the angle of a rod off the vertical.\n   <\/td>\n   <td>22\n   <\/td>\n  <\/tr>\n<\/table>\n\n<p><strong>Task Switching<\/strong><\/p>\n\n<table>\n  <tr>\n   <td><strong>Reference<\/strong>\n   <\/td>\n   <td><strong>Brain Location<\/strong>\n   <\/td>\n   <td><strong>Treatment Duration<\/strong>\n   <\/td>\n   <td><strong>Frequency<\/strong>\n   <\/td>\n   <td><strong>Machine<\/strong>\n   <\/td>\n   <td><strong>Result<\/strong>\n   <\/td>\n   <td><strong>N<\/strong>\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[31]\n   <\/td>\n   <td>Right DLPFC\n   <\/td>\n   <td>20 min\n   <\/td>\n   <td>10 Hz\n   <\/td>\n   <td>Magstim Rapid Stimulator &amp; 8-coil\n   <\/td>\n   <td>Reduced reaction time (20% faster) on a task switching task\n   <\/td>\n   <td>22\n   <\/td>\n  <\/tr>\n<\/table>\n\n<p><strong>Time Discounting<\/strong><\/p>\n\n<table>\n  <tr>\n   <td><strong>Reference<\/strong>\n   <\/td>\n   <td><strong>Brain Location<\/strong>\n   <\/td>\n   <td><strong>Treatment Duration<\/strong>\n   <\/td>\n   <td><strong>Frequency<\/strong>\n   <\/td>\n   <td><strong>Machine<\/strong>\n   <\/td>\n   <td><strong>Result<\/strong>\n   <\/td>\n   <td><strong>N<\/strong>\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[40]\n   <\/td>\n   <td>Medial prefrontal cortex\n   <\/td>\n   <td>During testing\n   <\/td>\n   <td>10 Hz\n   <\/td>\n   <td>Magstim Rapid 2 with double cone coil\n   <\/td>\n   <td>Significantly increased preference for larger delayed rewards and decreased preference for small immediate rewards.\n   <\/td>\n   <td>24\n   <\/td>\n  <\/tr>\n<\/table>\n\n<p><strong>Time Estimation<\/strong><\/p>\n\n<table>\n  <tr>\n   <td><strong>Reference<\/strong>\n   <\/td>\n   <td><strong>Brain Location<\/strong>\n   <\/td>\n   <td><strong>Treatment Duration<\/strong>\n   <\/td>\n   <td><strong>Frequency<\/strong>\n   <\/td>\n   <td><strong>Machine<\/strong>\n   <\/td>\n   <td><strong>Result<\/strong>\n   <\/td>\n   <td><strong>N<\/strong>\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[67]\n   <\/td>\n   <td>Superior parietal cortex (Pz)\n   <\/td>\n   <td>15 min\n   <\/td>\n   <td>1 Hz\n   <\/td>\n   <td>Neuro-Ms Stimulator\n   <\/td>\n   <td>Significantly reduced error in estimating 9-second time intervals (but not shorter)\n   <\/td>\n   <td>23\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[111]\n   <\/td>\n   <td>Superior parietal cortex\n   <\/td>\n   <td>\n   <\/td>\n   <td>1 Hz\n   <\/td>\n   <td>Neuro-Ms stimulator\n   <\/td>\n   <td>Increased error in 4 and 9 second time intervals, \n   <\/td>\n   <td>20\n   <\/td>\n  <\/tr>\n<\/table>\n\n<p><strong>Threat Perception<\/strong><\/p>\n\n<table>\n  <tr>\n   <td><strong>Reference<\/strong>\n   <\/td>\n   <td><strong>Brain Location<\/strong>\n   <\/td>\n   <td><strong>Treatment Duration<\/strong>\n   <\/td>\n   <td><strong>Frequency<\/strong>\n   <\/td>\n   <td><strong>Machine<\/strong>\n   <\/td>\n   <td><strong>Result<\/strong>\n   <\/td>\n   <td><strong>N<\/strong>\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[68]\n   <\/td>\n   <td>Right posterior parietal cortex (P4)\n   <\/td>\n   <td>20 min\n   <\/td>\n   <td>1 Hz\n   <\/td>\n   <td>Mag-Pro X100 with butterfly coil\n   <\/td>\n   <td>Compared to sham or left PPC controls, right PPC inhibition increases reaction time on a visual search task in response to a scary (loud sound) distractor but not a neutral distractor.\n   <\/td>\n   <td>26\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[85]\n   <\/td>\n   <td>Right DLPFC\n   <\/td>\n   <td>20 min\n   <\/td>\n   <td>10 Hz\n   <\/td>\n   <td>Magstim with figure-8 coil &amp; MRI guidance\n   <\/td>\n   <td>No effect on mood or anxiety; treated subjects showed more reaction-time impairment when distracted by an angry face in a cueing task, but not a neutral face.  The higher anxiety was at baseline, the more rTMS increased attentional bias to threat.\n   <\/td>\n   <td>28\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[109]\n   <\/td>\n   <td>Intraparietal sulcus\n   <\/td>\n   <td>During testing\n   <\/td>\n   <td>1 Hz\n   <\/td>\n   <td>MagPro 100 &amp; Cool-B65 A\/P coil\n   <\/td>\n   <td>Compared to sham stimulation or no stimulation, rTMS reduced the startle response to electric shocks\n   <\/td>\n   <td>19\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[110]\n   <\/td>\n   <td>Right DLPFC\n   <\/td>\n   <td>During testing\n   <\/td>\n   <td>10 Hz\n   <\/td>\n   <td>MagPro 100 &amp; Cool-B65 A\/P coil\n   <\/td>\n   <td>Compared to sham stimulation, increased startle response to electric shocks\n   <\/td>\n   <td>24\n   <\/td>\n  <\/tr>\n<\/table>\n\n<p><strong>Visual Search\/Perception<\/strong><\/p>\n\n<table>\n  <tr>\n   <td><strong>Reference<\/strong>\n   <\/td>\n   <td><strong>Brain Location<\/strong>\n   <\/td>\n   <td><strong>Treatment Duration<\/strong>\n   <\/td>\n   <td><strong>Frequency<\/strong>\n   <\/td>\n   <td><strong>Machine<\/strong>\n   <\/td>\n   <td><strong>Result<\/strong>\n   <\/td>\n   <td><strong>N<\/strong>\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[81]\n   <\/td>\n   <td>P3 and P4 sites (posterior parietal cortex)\n   <\/td>\n   <td>During test\n   <\/td>\n   <td>1 Hz\n   <\/td>\n   <td>Magstim Rapid, Figure-8 Coil\n   <\/td>\n   <td>Right, but not left or sham, parietal rTMS improved reaction times when a distractor is present on a visual search task.\n   <\/td>\n   <td>8\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[107]\n   <\/td>\n   <td>Left posterior parietal cortex\n   <\/td>\n   <td>10 min\n   <\/td>\n   <td>1 Hz\n   <\/td>\n   <td>Magstim Rapid 2, Figure-8 coil\n   <\/td>\n   <td>Left, but not right, posterior parietal cortex rTMS reduced reaction times in a visual search task for picking out a mirror image letter from a field of letters\n   <\/td>\n   <td>88\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[108]\n   <\/td>\n   <td>Right posterior parietal cortex\n   <\/td>\n   <td>\n   <\/td>\n   <td>1 Hz\n   <\/td>\n   <td>Magstim Super Rapid, Figure 8 coil\n   <\/td>\n   <td>Compared to control stimulation at the vertex, right PPC stimulation reduced reaction times in a visual detection task with low-frequency Gabor filters\n   <\/td>\n   <td>36\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>[113]\n   <\/td>\n   <td>Right intraparietal sulcus\n   <\/td>\n   <td>8 min\n   <\/td>\n   <td>1 Hz\n   <\/td>\n   <td>NeoTonus with Brainsight and MRI guidance\n   <\/td>\n   <td>Compared to sham stimulation and left IPS stimulation, right IPS stimulation significantly reduced errors in identifying the color and shape of figures briefly flashed in peripheral vision.\n   <\/td>\n   <td>24\n   <\/td>\n  <\/tr>\n<\/table>\n\n<p><strong>References<\/strong><\/p>\n\n<p>[1]Mantovani, Antonio, et al. \u201cRepetitive transcranial magnetic stimulation (rTMS) in the treatment of obsessive\u2013compulsive disorder (OCD) and Tourette\u2019s syndrome (TS).\u201d <em>International Journal of Neuropsychopharmacology<\/em> 9.1 (2006): 95-100.<\/p>\n\n<p>[2]Fierro, Brigida, et al. \u201cContralateral neglect induced by right posterior parietal rTMS in healthy subjects.\u201d <em>Neuroreport<\/em> 11.7 (2000): 1519-1521.<\/p>\n\n<p>[3]Tegenthoff, Martin, et al. \u201cImprovement of tactile discrimination performance and enlargement of cortical somatosensory maps after 5 Hz rTMS.\u201d <em>PLoS Biol<\/em> 3.11 (2005): e362.<\/p>\n\n<p>[4]Oliveri, M., et al. \u201crTMS of the unaffected hemisphere transiently reduces contralesional visuospatial hemineglect.\u201d <em>Neurology<\/em> 57.7 (2001): 1338-1340.<\/p>\n\n<p>[5]Uddin, Lucina Q., et al. \u201crTMS to the right inferior parietal lobule disrupts self\u2013other discrimination.\u201d <em>Social cognitive and affective neuroscience<\/em> 1.1 (2006): 65-71.<\/p>\n\n<p>[6]Boroojerdi, Babak, et al. \u201cEnhancing analogic reasoning with rTMS over the left prefrontal cortex.\u201d <em>Neurology<\/em> 56.4 (2001): 526-528.<\/p>\n\n<p>[7]Pra\u0161ko, J\u00e1n, et al. \u201cThe effect of repetitive transcranial magnetic stimulation (rTMS) on symptoms in obsessive compulsive disorder.\u201d <em>Neuroendocrinology Letters<\/em> 27.3 (2006).<\/p>\n\n<p>[8]Schutter, Dennis JLG, et al. \u201cEffects of slow rTMS at the right dorsolateral prefrontal cortex on EEG asymmetry and mood.\u201d <em>Neuroreport<\/em> 12.3 (2001): 445-447.<\/p>\n\n<p>[9]Barwood, Caroline HS, et al. \u201cThe effects of low frequency Repetitive Transcranial Magnetic Stimulation (rTMS) and sham condition rTMS on behavioural language in chronic non-fluent aphasia: Short term outcomes.\u201d <em>NeuroRehabilitation<\/em> 28.2 (2011): 113-128.<\/p>\n\n<p>[10]Enticott, Peter G., et al. \u201cA double-blind, randomized trial of deep repetitive transcranial magnetic stimulation (rTMS) for autism spectrum disorder.\u201d <em>Brain Stimulation<\/em> 7.2 (2014): 206-211.<\/p>\n\n<p>[11]Luber, B., et al. \u201cFacilitation of performance in a working memory task with rTMS stimulation of the precuneus: frequency-and time-dependent effects.\u201d <em>Brain research<\/em> 1128 (2007): 120-129.<\/p>\n\n<p>[12]Turriziani, Patrizia. \u201cEnhancing memory performance with rTMS in healthy subjects and individuals with Mild Cognitive Impairment: the role of the right dorsolateral prefrontal cortex.\u201d <em>Frontiers in Human Neuroscience<\/em> 6 (2012): 62.<\/p>\n\n<p>[13]Dienes, Zoltan, and Sam Hutton. \u201cUnderstanding hypnosis metacognitively: rTMS applied to left DLPFC increases hypnotic suggestibility.\u201d <em>Cortex<\/em> 49.2 (2013): 386-392.<\/p>\n\n<p>[14]Zwanzger, Peter, et al. \u201cOccurrence of delusions during repetitive transcranial magnetic stimulation (rTMS) in major depression.\u201d <em>Biological Psychiatry<\/em> 51.7 (2002): 602-603.<\/p>\n\n<p>[15]Krause, Laura, et al. \u201cThe role of medial prefrontal cortex in theory of mind: a deep rTMS study.\u201d <em>Behavioural brain research<\/em> 228.1 (2012): 87-90.<\/p>\n\n<p>[16]Montagne-Larmurier, A., et al. \u201cTwo-day treatment of auditory hallucinations by high frequency rTMS guided by cerebral imaging: a 6 month follow-up pilot study.\u201d <em>Schizophrenia research<\/em> 113.1 (2009): 77-83.<\/p>\n\n<p>[17]Finocchiaro, Chiara, et al. \u201cA case study of primary progressive aphasia: improvement on verbs after rTMS treatment.\u201d <em>Neurocase<\/em> 12.6 (2006): 317-321.<\/p>\n\n<p>[18]W\u00f6lwer, Wolfgang, et al. \u201cRepetitive transcranial magnetic stimulation (rTMS) improves facial affect recognition in schizophrenia.\u201d <em>Brain Stimulation<\/em> 7.4 (2014): 559-563.<\/p>\n\n<p>[19]Pettorruso, Mauro, et al. \u201crTMS reduces psychopathological burden and cocaine consumption in treatment-seeking subjects with cocaine use disorder: an open label, feasibility study.\u201d <em>Frontiers in psychiatry<\/em> 10 (2019): 621.<\/p>\n\n<p>[20]Loo, Colleen K., et al. \u201cA sham-controlled trial of left and right temporal rTMS for the treatment of auditory hallucinations.\u201d <em>Psychological medicine<\/em> 40.4 (2010): 541.<\/p>\n\n<p>[21]Ragert, Patrick, et al. \u201cImprovement of tactile perception and enhancement of cortical excitability through intermittent theta burst rTMS over human primary somatosensory cortex.\u201d <em>Experimental Brain Research<\/em> 184.1 (2008): 1-11.<\/p>\n\n<p>[22]Casanova, Manuel Fernando, et al. \u201cEffects of weekly low-frequency rTMS on autonomic measures in children with autism spectrum disorder.\u201d <em>Frontiers in human neuroscience<\/em> 8 (2014): 851.<\/p>\n\n<p>[23]Barwood, Caroline HS, et al. \u201cLong term language recovery subsequent to low frequency rTMS in chronic non-fluent aphasia.\u201d <em>NeuroRehabilitation<\/em> 32.4 (2013): 915-928.<\/p>\n\n<p>[24]Udd\u00e9n, Julia, et al. \u201cThe inferior frontal cortex in artificial syntax processing: An rTMS study.\u201d <em>Brain research<\/em> 1224 (2008): 69-78.<\/p>\n\n<p>[25]Balconi, Michela, and Ylenia Canavesio. \u201cHigh-frequency rTMS on DLPFC increases prosocial attitude in case of decision to support people.\u201d <em>Social neuroscience<\/em> 9.1 (2014): 82-93.<\/p>\n\n<p>[26]Coltheart, Max, et al. \u201cBelief, delusion, hypnosis, and the right dorsolateral prefrontal cortex: A transcranial magnetic stimulation study.\u201d <em>Cortex<\/em> 101 (2018): 234-248.<\/p>\n\n<p>[27]Cardullo, Stefano, et al. \u201cClinical improvements in comorbid gambling\/cocaine use disorder (GD\/CUD) patients undergoing repetitive transcranial magnetic stimulation (rTMS).\u201d <em>Journal of clinical medicine<\/em> 8.6 (2019): 768.<\/p>\n\n<p>[28]Cailhol, Lionel, et al. \u201cBorderline personality disorder and rTMS: a pilot trial.\u201d <em>Psychiatry research<\/em> 216.1 (2014): 155-157.<\/p>\n\n<p>[29]Tulviste, Jaan, and Talis Bachmann. \u201cDiminished risk-aversion after right DLPFC stimulation: effects of rTMS on a risky ball throwing task.\u201d <em>Journal of the International Neuropsychological Society: JINS<\/em> 25.1 (2019): 72-78.<\/p>\n\n<p>[30]Steppel, Jeanne, et al. \u201cChanges in mood and hormone levels after rapid-rate transcranial magnetic stimulation (rTMS) of the prefrontal cortex.\u201d <em>Neurosciences<\/em> 8.2 (1996): 172-180.<\/p>\n\n<p>[31]Vanderhasselt, Marie-Anne, et al. \u201cThe influence of rTMS over the right dorsolateral prefrontal cortex on intentional set switching.\u201d <em>Experimental brain research<\/em> 172.4 (2006): 561-565.<\/p>\n\n<p>[32]Enticott, Peter G., et al. \u201cDeep repetitive transcranial magnetic stimulation associated with improved social functioning in a young woman with an autism spectrum disorder.\u201d <em>The journal of ECT<\/em> 27.1 (2011): 41-43.<\/p>\n\n<p>[33]Schutter, Dennis JLG, et al. \u201cA case of illusory own-body perceptions after transcranial magnetic stimulation of the cerebellum.\u201d <em>The Cerebellum<\/em> 5.3 (2006): 238-240.<\/p>\n\n<p>[34]Fossataro, Carlotta, et al. \u201cLosing my hand. Body ownership attenuation after virtual lesion of the primary motor cortex.\u201d <em>European Journal of Neuroscience<\/em> 48.6 (2018): 2272-2287.<\/p>\n\n<p>[35]Giardina, Angela, Carlo Caltagirone, and Massimiliano Oliveri. \u201cTemporo-parietal junction is involved in attribution of hostile intentionality in social interactions: an rTMS study.\u201d <em>Neuroscience letters<\/em> 495.2 (2011): 150-154.<\/p>\n\n<p>[36]Young, Liane, et al. \u201cDisruption of the right temporoparietal junction with transcranial magnetic stimulation reduces the role of beliefs in moral judgments.\u201d <em>Proceedings of the National Academy of Sciences<\/em> 107.15 (2010): 6753-6758.<\/p>\n\n<p>[37]Baumgartner, Thomas, et al. \u201cDiminishing parochialism in intergroup conflict by disrupting the right temporo-parietal junction.\u201d <em>Social cognitive and affective neuroscience<\/em> 9.5 (2014): 653-660.<\/p>\n\n<p>[38]Buckholtz, Joshua W., et al. \u201cFrom blame to punishment: disrupting prefrontal cortex activity reveals norm enforcement mechanisms.\u201d <em>Neuron<\/em> 87.6 (2015): 1369-1380.<\/p>\n\n<p>[39]Buckholtz, Joshua W., et al. \u201cFrom blame to punishment: disrupting prefrontal cortex activity reveals norm enforcement mechanisms.\u201d <em>Neuron<\/em> 87.6 (2015): 1369-1380.<\/p>\n\n<p>[40]Cho, Sang Soo, et al. \u201cInvesting in the future: stimulation of the medial prefrontal cortex reduces discounting of delayed rewards.\u201d <em>Neuropsychopharmacology<\/em> 40.3 (2015): 546-553.<\/p>\n\n<p>[41]Balconi, Michela, and Adriana Bortolotti. \u201cEmotional face recognition, empathic trait (BEES), and cortical contribution in response to positive and negative cues. The effect of rTMS on dorsal medial prefrontal cortex.\u201d <em>Cognitive neurodynamics<\/em> 7.1 (2013): 13-21.<\/p>\n\n<p>[42]Modirrousta, Mandana, et al. \u201cThe efficacy of deep repetitive transcranial magnetic stimulation over the medial prefrontal cortex in obsessive compulsive disorder: results from an open\u2010label study.\u201d <em>Depression and anxiety<\/em> 32.6 (2015): 445-450.<\/p>\n\n<p>[43]Herrmann, Martin J., et al. \u201cMedial prefrontal cortex stimulation accelerates therapy response of exposure therapy in acrophobia.\u201d <em>Brain stimulation<\/em> 10.2 (2017): 291-297.<\/p>\n\n<p>[44]Martinez, Diana, et al. \u201cTranscranial magnetic stimulation of medial prefrontal and cingulate cortices reduces cocaine self-administration: a pilot study.\u201d <em>Frontiers in psychiatry<\/em> 9 (2018): 80.<\/p>\n\n<p>[45]Guhn, Anne, et al. \u201cMedial prefrontal cortex stimulation modulates the processing of conditioned fear.\u201d <em>Frontiers in behavioral neuroscience<\/em> 8 (2014): 44.<\/p>\n\n<p>[46]Calder\u00f3n-Moctezuma, Angel R., et al. \u201cImprovement in borderline personality disorder symptomatology after repetitive transcranial magnetic stimulation of the dorsomedial prefrontal cortex: preliminary results.\u201d <em>Brazilian Journal of Psychiatry<\/em> 43.1 (2021): 65-69.<\/p>\n\n<p>[47]Ferrari, Chiara, et al. \u201cInterfering with activity in the dorsomedial prefrontal cortex via TMS affects social impressions updating.\u201d <em>Cognitive, Affective, &amp; Behavioral Neuroscience<\/em> 16.4 (2016): 626-634.<\/p>\n\n<p>[48]Ferrari, Chiara, et al. \u201cThe dorsomedial prefrontal cortex mediates the interaction between moral and aesthetic valuation: a TMS study on the beauty-is-good stereotype.\u201d <em>Social cognitive and affective neuroscience<\/em> 12.5 (2017): 707-717.<\/p>\n\n<p>[49]Baeken, Chris, et al. \u201cOne left dorsolateral prefrontal cortical HF-rTMS session attenuates HPA-system sensitivity to critical feedback in healthy females.\u201d <em>Neuropsychologia<\/em> 57 (2014): 112-121.<\/p>\n\n<p>[50]Tassy, S\u00e9bastien, et al. \u201cDisrupting the right prefrontal cortex alters moral judgement.\u201d <em>Social cognitive and affective neuroscience<\/em> 7.3 (2012): 282-288.<\/p>\n\n<p>[51]Fujino, Junya, et al. \u201cRole of the right temporoparietal junction in intergroup bias in trust decisions.\u201d <em>Human brain mapping<\/em> 41.6 (2020): 1677-1688.<\/p>\n\n<p>[52]Mantovani, Antonio, et al. \u201cTemporo-parietal junction stimulation in the treatment of depersonalization disorder.\u201d <em>Psychiatry Research<\/em> 186.1 (2011): 138-140.<\/p>\n\n<p>[53]Christopeit, Marie, et al. \u201cEffects of repetitive transcranial magnetic stimulation (rTMS) on specific symptom clusters in depersonalization disorder (DPD).\u201d <em>Brain Stimulation: Basic, Translational, and Clinical Research in Neuromodulation<\/em> 7.1 (2014): 141-143.<\/p>\n\n<p>[54]Zito, Giuseppe A., et al. \u201cTranscranial magnetic stimulation over the right temporoparietal junction influences the sense of agency in healthy humans.\u201d <em>Journal of psychiatry &amp; neuroscience: JPN<\/em> 45.4 (2020): 271.<\/p>\n\n<p>[55]Peterson, Krystyna T., et al. \u201cRight Temporoparietal Junction Transcranial Magnetic Stimulation in the Treatment of Psychogenic Non-epileptic Seizures: A Case Series.\u201d <em>Psychosomatics<\/em> 59.6 (2018): 601.<\/p>\n\n<p>[56]De Vidovich, Giulia Zelda, et al. \u201cRepetitive TMS on left cerebellum affects impulsivity in borderline personality disorder: A pilot study.\u201d <em>Frontiers in human neuroscience<\/em> 10 (2016): 582.<\/p>\n\n<p>[57]Knoch, Daria, et al. \u201cDiminishing reciprocal fairness by disrupting the right prefrontal cortex.\u201d <em>science<\/em> 314.5800 (2006): 829-832.<\/p>\n\n<p>[58]Knoch, Daria, et al. \u201cDisrupting the prefrontal cortex diminishes the human ability to build a good reputation.\u201d <em>Proceedings of the National Academy of Sciences<\/em> 106.49 (2009): 20895-20899.<\/p>\n\n<p>[59]Tsujii, Takeo, et al. \u201cThe role of inferior frontal cortex in belief-bias reasoning: an rTMS study.\u201d <em>Neuropsychologia<\/em> 48.7 (2010): 2005-2008.<\/p>\n\n<p>[60]Remue, Jonathan, et al. \u201cThe effect of a single HF-rTMS session over the left DLPFC on the physiological stress response as measured by heart rate variability.\u201d <em>Neuropsychology<\/em> 30.6 (2016): 756.<\/p>\n\n<p>[61]Oliveri, Massimiliano, et al. \u201cFacilitation of bottom-up feature detection following rTMS-interference of the right parietal cortex.\u201d <em>Neuropsychologia<\/em> 48.4 (2010): 1003-1010.<\/p>\n\n<p>[62]Costanzo, Floriana, et al. \u201cHigh frequency rTMS over the left parietal lobule increases non-word reading accuracy.\u201d <em>Neuropsychologia<\/em> 50.11 (2012): 2645-2651.<\/p>\n\n<p>[63]Costanzo, Floriana, et al. \u201cHow to improve reading skills in dyslexics: the effect of high frequency rTMS.\u201d <em>Neuropsychologia<\/em> 51.14 (2013): 2953-2959.<\/p>\n\n<p>[64]Peatfield, Nicholas, and Lorella Battelli. \u201crTMS to right inferior parietal lobule dilates the subjective experience of time.\u201d <em>Journal of Vision<\/em> 13.9 (2013): 316-316.<\/p>\n\n<p>[65]Gaudeau-Bosma, Christian, et al. \u201cEffect of two weeks of rTMS on brain activity in healthy subjects during an n-back task: a randomized double blind study.\u201d <em>Brain stimulation<\/em> 6.4 (2013): 569-575.<\/p>\n\n<p>[66]Luber, Bruce, et al. \u201cExtended remediation of sleep deprived-induced working memory deficits using fMRI-guided transcranial magnetic stimulation.\u201d <em>Sleep<\/em> 36.6 (2013): 857-871.<\/p>\n\n<p>[67]Rocha, Kaline, et al. \u201cLow-frequency rTMS stimulation over superior parietal cortex medially improves time reproduction and increases the right dorsolateral prefrontal cortex predominance.\u201d <em>International Journal of Neuroscience<\/em> 129.6 (2019): 523-533.<\/p>\n\n<p>[68]van Honk, Jack, et al. \u201cReductions in phenomenological, physiological and attentional indices of depressive mood after 2 Hz rTMS over the right parietal cortex in healthy human subjects.\u201d <em>Psychiatry Research<\/em> 120.1 (2003): 95-101.<\/p>\n\n<p>[69]Porciello, Giuseppina, et al. \u201crTMS-induced virtual lesion of the posterior parietal cortex (PPC) alters the control of reflexive shifts of social attention triggered by pointing hands.\u201d <em>Neuropsychologia<\/em> 59 (2014): 148-156.<\/p>\n\n<p>[70]Ritterband-Rosenbaum, Anina, et al. \u201c10 Hz rTMS over right parietal cortex alters sense of agency during self-controlled movements.\u201d <em>Frontiers in human neuroscience<\/em> 8 (2014): 471.<\/p>\n\n<p>[71]Balderston, Nicholas L., et al. \u201cLow-frequency parietal repetitive transcranial magnetic stimulation reduces fear and anxiety.\u201d <em>Translational psychiatry<\/em> 10.1 (2020): 1-10.<\/p>\n\n<p>[72]Vanderhasselt, Marie-Anne, et al. \u201cThe influence of rTMS over the left dorsolateral prefrontal cortex on Stroop task performance.\u201d <em>Experimental brain research<\/em> 169.2 (2006): 279-282.<\/p>\n\n<p>[73]Nahmias, Fr\u00e9d\u00e9ric, et al. \u201cDiffuse analgesic effects of unilateral repetitive transcranial magnetic stimulation (rTMS) in healthy volunteers.\u201d <em>PAIN\u00ae<\/em> 147.1-3 (2009): 224-232.<\/p>\n\n<p>[74]Short, E. Baron, et al. \u201cTen sessions of adjunctive left prefrontal rTMS significantly reduces fibromyalgia pain: a randomized, controlled pilot study.\u201d <em>Pain<\/em> 152.11 (2011): 2477-2484.<\/p>\n\n<p>[75]Vanderhasselt, Marie-Anne, et al. \u201cThe influence of rTMS over the right dorsolateral prefrontal cortex on top-down attentional processes.\u201d <em>Brain research<\/em> 1137 (2007): 111-116.<\/p>\n\n<p>[76]Ayache, S. S., et al. \u201cAnalgesic effects of navigated motor cortex rTMS in patients with chronic neuropathic pain.\u201d <em>European Journal of Pain<\/em> 20.9 (2016): 1413-1422.<\/p>\n\n<p>[77]Borckardt, Jeffrey J., et al. \u201cA pilot study investigating the effects of fast left prefrontal rTMS on chronic neuropathic pain.\u201d <em>Pain Medicine<\/em> 10.5 (2009): 840-849.<\/p>\n\n<p>[78]Kim, Sang Hee, et al. \u201cEffects of five daily high-frequency rTMS on Stroop task performance in aging individuals.\u201d <em>Neuroscience research<\/em> 74.3-4 (2012): 256-260.<\/p>\n\n<p>[79]Hwang, Ji Hee, et al. \u201cAcute high-frequency rTMS of the left dorsolateral prefrontal cortex and attentional control in healthy young men.\u201d <em>Brain research<\/em> 1329 (2010): 152-158.<\/p>\n\n<p>[80]Li, Yanmin, et al. \u201cThe effects of high-frequency rTMS over the left DLPFC on cognitive control in young healthy participants.\u201d <em>PloS one<\/em> 12.6 (2017): e0179430.<\/p>\n\n<p>[81]Hodsoll, John, Carmel Mevorach, and Glyn W. Humphreys. \u201cDriven to less distraction: rTMS of the right parietal cortex reduces attentional capture in visual search.\u201d <em>Cerebral Cortex<\/em> 19.1 (2009): 106-114.<\/p>\n\n<p>[82]Preston, Gilbert, et al. \u201cEffects of 10 Hz rTMS on the neural efficiency of working memory.\u201d <em>Journal of cognitive neuroscience<\/em> 22.3 (2010): 447-456.<\/p>\n\n<p>[83]Rizzo, Silvia, Marco Sandrini, and Costanza Papagno. \u201cThe dorsolateral prefrontal cortex in idiom interpretation: An rTMS study.\u201d <em>Brain research bulletin<\/em> 71.5 (2007): 523-528.<\/p>\n\n<p>[84]Cosentino, G., et al. \u201cA case of post-traumatic complex auditory hallucinosis treated with rTMS.\u201d <em>Neurocase<\/em> 16.3 (2010): 267-272.<\/p>\n\n<p>[85]Vanderhasselt, Marie-Anne, et al. \u201cThe effects of high frequency rTMS on negative attentional bias are influenced by baseline state anxiety.\u201d <em>Neuropsychologia<\/em> 49.7 (2011): 1824-1830.<\/p>\n\n<p>[86]Balconi, Michela, and Ylenia Canavesio. \u201cHigh-frequency rTMS improves facial mimicry and detection responses in an empathic emotional task.\u201d <em>Neuroscience<\/em> 236 (2013): 12-20.<\/p>\n\n<p>[87]M\u00fcller-Lein\u00df, Jan-Martin, et al. \u201cRetaliation or selfishness? An rTMS investigation of the role of the dorsolateral prefrontal cortex in prosocial motives.\u201d <em>Social neuroscience<\/em> 13.6 (2018): 701-709.<\/p>\n\n<p>[88]Takarada, Yudai, et al. \u201cInhibition of the primary motor cortex can alter one\u2019s \u201csense of effort\u201d: effects of low-frequency rTMS.\u201d <em>Neuroscience research<\/em> 89 (2014): 54-60.<\/p>\n\n<p>[89]Cotelli, Maria, et al. \u201cAction and object naming in physiological aging: an rTMS study.\u201d <em>Frontiers in aging neuroscience<\/em> 2 (2010): 151.<\/p>\n\n<p>[90]Schluter, Ren\u00e9e S., Ruth J. van Holst, and Anna E. Goudriaan. \u201cEffects of ten sessions of high frequency repetitive Transcranial magnetic stimulation (HF-rTMS) add-on treatment on impulsivity in alcohol use disorder.\u201d <em>Frontiers in neuroscience<\/em> 13 (2019): 1257.<\/p>\n\n<p>[91]Guillaume, Sebastien, et al. \u201cImproving decision\u2010making and cognitive impulse control in bulimia nervosa by rTMS: An ancillary randomized controlled study.\u201d <em>International Journal of Eating Disorders<\/em> 51.9 (2018): 1103-1106.<\/p>\n\n<p>[92]Baeken, Chris, et al. \u201cImpact of one HF-rTMS session on fine motor function in right-handed healthy female subjects: a comparison of stimulation over the left versus the right dorsolateral prefrontal cortex.\u201d <em>Neuropsychobiology<\/em> 65.2 (2012): 96-102.<\/p>\n\n<p>[93]Snyder, Allan, et al. \u201cSavant-like numerosity skills revealed in normal people by magnetic pulses.\u201d <em>Perception<\/em> 35.6 (2006): 837-845.<\/p>\n\n<p>[94]Gallate, Jason, et al. \u201cReducing false memories by magnetic pulse stimulation.\u201d <em>Neuroscience letters<\/em> 449.3 (2009): 151-154.<\/p>\n\n<p>[95]K\u00f6hler, Stefan, et al. \u201cEffects of left inferior prefrontal stimulation on episodic memory formation: a two-stage fMRI\u2014rTMS study.\u201d <em>Journal of cognitive neuroscience<\/em> 16.2 (2004): 178-188.<\/p>\n\n<p>[96]Demeter, Elise, et al. \u201cShort theta burst stimulation to left frontal cortex prior to encoding enhances subsequent recognition memory.\u201d <em>Cognitive, Affective, &amp; Behavioral Neuroscience<\/em> 16.4 (2016): 724-735.<\/p>\n\n<p>[97]Van\u2019t Wout, Mascha, et al. \u201cRepetitive transcranial magnetic stimulation over the right dorsolateral prefrontal cortex affects strategic decision-making.\u201d <em>Neuroreport<\/em> 16.16 (2005): 1849-1852.<\/p>\n\n<p>[98]Knoch, Daria, et al. \u201cDisruption of right prefrontal cortex by low-frequency repetitive transcranial magnetic stimulation induces risk-taking behavior.\u201d <em>Journal of Neuroscience<\/em> 26.24 (2006): 6469-6472.<\/p>\n\n<p>[99]Balconi, Michela, and Ylenia Canavesio. \u201cHigh-frequency rTMS on DLPFC increases prosocial attitude in case of decision to support people.\u201d <em>Social neuroscience<\/em> 9.1 (2014): 82-93.<\/p>\n\n<p>[100]Christov-Moore, Leonardo, et al. \u201cIncreasing generosity by disrupting prefrontal cortex.\u201d <em>Social Neuroscience<\/em> 12.2 (2017): 174-181.<\/p>\n\n<p>[101]Fujino, Junya, et al. \u201cRole of the right temporoparietal junction in intergroup bias in trust decisions.\u201d Human brain mapping 41.6 (2020): 1677-1688.<\/p>\n\n<p>[102]Essex, Brian G., et al. \u201cThe impact of the posterior parietal and dorsolateral prefrontal cortices on the optimization of long-term versus immediate value.\u201d <em>Journal of Neuroscience<\/em> 32.44 (2012): 15403-15413.<\/p>\n\n<p>[103]Cappelletti, Marinella, et al. \u201crTMS over the intraparietal sulcus disrupts numerosity processing.\u201d <em>Experimental Brain Research<\/em> 179.4 (2007): 631-642.<\/p>\n\n<p>[104]Kalbe, Elke, et al. \u201cDissociating cognitive from affective theory of mind: a TMS study.\u201d <em>cortex<\/em> 46.6 (2010): 769-780.<\/p>\n\n<p>[105]Pulopulos, Matias M., et al. \u201cThe effect of HF-rTMS over the left DLPFC on stress regulation as measured by cortisol and heart rate variability.\u201d <em>Hormones and Behavior<\/em> 124 (2020): 104803.<\/p>\n\n<p>[106]Klichowski, Michal, and Gregory Kroliczak. \u201cMental shopping calculations: a transcranial magnetic stimulation study.\u201d <em>Frontiers in Psychology<\/em> 11 (2020).<\/p>\n\n<p>[107]Mangano, Giuseppa Renata, et al. \u201cRepetitive transcranial magnetic stimulation over the left parietal cortex facilitates visual search for a letter among its mirror images.\u201d <em>Neuropsychologia<\/em> 70 (2015): 196-205.<\/p>\n\n<p>[108]Elkin-Frankston, Seth, Richard J. Rushmore, and Antoni Valero-Cabr\u00e9. \u201cLow frequency transcranial magnetic stimulation of right posterior parietal cortex reduces reaction time to perithreshold low spatial frequency visual stimuli.\u201d <em>Scientific reports<\/em> 10.1 (2020): 1-9.<\/p>\n\n<p>[109]Balderston, Nicholas L., et al. \u201cLow-frequency parietal repetitive transcranial magnetic stimulation reduces fear and anxiety.\u201d <em>Translational psychiatry<\/em> 10.1 (2020): 1-10.<\/p>\n\n<p>[110]Balderston, Nicholas L., et al. \u201cMechanistic link between right prefrontal cortical activity and anxious arousal revealed using transcranial magnetic stimulation in healthy subjects.\u201d <em>Neuropsychopharmacology<\/em> 45.4 (2020): 694-702.<\/p>\n\n<p>[111]Manaia, Fernanda, et al. \u201cThe role of low-frequency rTMS in the superior parietal cortex during time estimation.\u201d <em>Neurological Sciences<\/em> 40.6 (2019): 1183-1189.<\/p>\n\n<p>[112]Wu, Xingqi, et al. \u201cImproved cognitive promotion through accelerated magnetic stimulation.\u201d <em>Eneuro<\/em> 8.1 (2021).<\/p>\n\n<p>[113]\u200b\u200bEsterman, Michael, Timothy Verstynen, and Lynn C. Robertson. \u201cAttenuating illusory binding with TMS of the right parietal cortex.\u201d <em>Neuroimage<\/em> 35.3 (2007): 1247-1255.<\/p>","author":{"name":{}},"category":{"@attributes":{"term":"lit-review"}},"summary":"Introduction"},{"title":"How To Be An Educated Layman","link":{"@attributes":{"href":"https:\/\/srconstantin.github.io\/2021\/06\/09\/Educated-Layman.html","rel":"alternate","type":"text\/html","title":"How To Be An Educated Layman"}},"published":"2021-06-09T00:00:00+00:00","updated":"2021-06-09T00:00:00+00:00","id":"https:\/\/srconstantin.github.io\/2021\/06\/09\/Educated-Layman","content":"<p>Doing business development for new initiatives at Nanotronics is kind of like being an \u201ceducated layman\u201d for a living. My blog is also a pretty good example of an \u201ceducated layman\u201d\u2019s thinking about a variety of issues.  So I plausibly know what I\u2019m talking about here, and may have useful advice for other people looking to succeed at being \u201ceducated laymen.\u201d<\/p>\n\n<p>What does being an \u201ceducated layman\u201d mean, to me?<\/p>\n\n<p>Basically, an \u201cexpert\u201d or \u201cspecialist\u201d is someone who has spent their whole life studying or working on a specific narrow topic. If it\u2019s an academic topic, they\u2019ll typically have a PhD in that topic.<\/p>\n\n<p>An \u201ceducated layman\u201d is someone who is not an expert, but who, in a discussion with experts about their field of specialization, can contribute useful ideas.<\/p>\n\n<p>An \u201ceducated layman\u201d will typically <em>know less stuff<\/em> than any expert does about their field of expertise, but can still contribute good ideas that no expert has thought of.<\/p>\n\n<p>How is that possible?  Usually, because the \u201ceducated layman\u201d brings a different perspective, or a toolkit from another field, or has an unusual set of priorities that the expert community hasn\u2019t been optimizing for.<\/p>\n\n<p>There are a couple standard examples I\u2019ve encountered where it\u2019s useful to be an \u201ceducated layman.\u201d<\/p>\n\n<ol>\n  <li>\n    <p>Making decisions about whether\/how to apply a new technology.  If I\u2019m investigating how XYZ tech might fit in with my own company\u2019s work, or a customer\u2019s work, then I don\u2019t need to know nearly as much as the specialists who spend their lives <em>creating<\/em> XYZ tech. I just need to know inputs and outputs \u2013 how much does it cost, what does it require, what results does it produce \u2013 and just enough about how the tech works to be able to make some generalizations about that beyond the specific reported examples in the published literature.<\/p>\n  <\/li>\n  <li>\n    <p>Making medical decisions as a patient.  In order to decide what treatment you should get, you don\u2019t need to know all the things a doctor needs to know. You don\u2019t need to be able to actually <em>perform<\/em> the treatment. You don\u2019t need to know about all the different diseases a doctor might encounter.  You need to know about <em>your<\/em> disease, and how safe\/effective different treatments are for that disease.  You may actually have more time to read the literature on your specific disease than your doctor does, especially if it\u2019s a rare disease.  And, you may have different incentives than your doctor.  The treatment that\u2019s actually best for you may not be popular among clinicians, for reasons that don\u2019t apply to you (like high risk of side effects in a patient population you\u2019re not part of.)  So it\u2019s possible for an \u201ceducated layman\u201d patient to have a good idea that an \u201cexpert\u201d doesn\u2019t have.<\/p>\n  <\/li>\n  <li>\n    <p>Managing experts. You don\u2019t need to know how to do their jobs in order to propose useful ideas that they haven\u2019t thought of. You have a high-level view of what everyone is working on and what goal it\u2019s for, and they have a tendency to get hyperfocused on the specific task at hand.  You can ask a \u201cdumb\u201d question like \u201chow does this task impact our overall goal?\u201d and very quickly find out \u201cwhoops, it doesn\u2019t help at all, maybe it\u2019s time to quit working on this sub-project.\u201d  You can be a fresh set of eyes, and a \u201cNorth Star\u201d to keep everyone oriented towards the overall mission.<\/p>\n  <\/li>\n  <li>\n    <p>Importing a highly general \u201ctoolkit\u201d or technology to a field where it hasn\u2019t penetrated yet. I see this very often with statistics or computer automation.  A stats\/ML\/computers person can often very easily create a ton of value just by importing the techniques they\u2019re familiar with to a field where nobody has heard of them. You need domain knowledge to do this effectively, but not as <em>much<\/em> domain knowledge as the experts have.  Just enough to check whether the technology you introduce is actually making the field\u2019s problems better rather than worse.<\/p>\n  <\/li>\n<\/ol>\n\n<p>Being an \u201ceducated layman\u201d in the sense I\u2019m talking about presupposes that you believe there\u2019s actual value in a field and its experts to begin with.  If you think the whole business is bunk, like, say, astrology, then you\u2019d have no reason to teach yourself enough of the technical details of astrology to converse intelligently with astrologers.<\/p>\n\n<p>You can think a \u201cfield\u201d or community of expertise is flawed, biased, or just missing some context that you have, and still consider it valuable enough to dialogue with and learn from.  <em>This<\/em> is the context in which it can be worth \u201ctooling up\u201d in a field enough to function as an \u201ceducated layman.\u201d  You\u2019ll be hoping to make a contribution as a non-expert \u2013 so, definitionally, you believe that the field is \u201cmissing\u201d something that you can provide \u2013 but you\u2019ll also be learning from and collaborating with experts very heavily.<\/p>\n\n<p>Being an \u201ceducated layman\u201d is in this way very different from the kind of anti-expert view you see in, say, Nassim Taleb\u2019s opinions about social science. He doesn\u2019t think there\u2019s <em>any<\/em> real knowledge in contemporary social science, so he doesn\u2019t bother to learn their specialized lingo. He dismisses them, and they dismiss him.<\/p>\n\n<p>That\u2019s fine, if you\u2019re confident there\u2019s nothing there. This post is for situations when you <em>do<\/em> think there\u2019s something there \u2013 even if you\u2019re skeptical about some parts.<\/p>\n\n<p>I\u2019m most confident in my ability to do the \u201ceducated layman\u201d thing in biology and medicine, since I\u2019ve been doing it the longest there.<\/p>\n\n<p>Really, there\u2019s no such thing as reaching \u201ceducated layman\u201d status in something as broad as \u201cbiology\u201d as a whole.  What you can do is tool up to the point of being able to have discussions with experts <em>in a super-specific question<\/em>.  And I\u2019ve done it in enough specific biological or medical topics to be pretty confident in my ability to do it again on a new topic, assuming there\u2019s the right kind and distribution of available literature.<\/p>\n\n<p>What do I mean by that?<\/p>\n\n<p>The ideal scientific literature on a topic, for the purposes of self-study, is:<\/p>\n\n<ul>\n  <li>Not so huge that you can\u2019t read literally all the published studies that attempt to answer the question, after you\u2019ve restricted attention to certain kinds of sufficiently good study designs<\/li>\n  <li>Not so tiny or low-quality that you come out of the self-study process knowing no more than you\u2019d get from a couple of anecdotes or opinion pieces<\/li>\n  <li>\u201cSimple\u201d enough, or close enough to what you already understand, that you\u2019re confident you can summarize, for each paper you read, what the experimenters or paper authors did, why they expected their methods to answer the question, what results they got, and what features of the study design and results make you more or less confident in the conclusion.<\/li>\n<\/ul>\n\n<p>It\u2019s harder to self-teach enough to know what\u2019s going on, in subjects that have heavily nested prerequisites you didn\u2019t study in school (for me, that\u2019s chemistry and physics).  I can almost always read a biology or social-science paper, if I have my trusty Google handy and a place to take notes.  I can <em>sometimes<\/em> read engineering or experimental-physics papers, but not always, and I can\u2019t read chemistry or theoretical physics papers at all.  There\u2019s also an intermediate stage of \u201cI bet I could learn the prerequisites, but it would take a while and I haven\u2019t gotten around to it yet\u201d, which is roughly where I am with a lot of computational genetics.<\/p>\n\n<p>It\u2019s also hard to self-teach in subjects where 3D awareness of where things are is important, so learning from text or diagrams is difficult.  For instance, if you\u2019re researching \u201cwhich of these surgical techniques works best for this condition?\u201d you may run into problems noticing when two different anatomy phrases are actually referring to the same thing, if you\u2019re just black-boxing the anatomy and don\u2019t have a spatial model of where anything is.  (Though YouTube videos demonstrating medical, laboratory, and industrial procedures are a huge help for understanding things that are hard to visualize from text.)<\/p>\n\n<p>In my experience, more time reading stuff does matter.  Both at the micro and macro scales.<\/p>\n\n<p>On the micro scale \u2013 I am way more able to contribute in a meeting with an expert if I\u2019ve done at least an hour of prep first than if I haven\u2019t. The difference is striking.<\/p>\n\n<p>On the macro scale \u2013 I get way worse feedback from knowledgable people when I propose ideas about topics I\u2019ve spent less total time self-teaching (like economics) than topics I\u2019ve spent more total time self-teaching (like biology.)  I\u2019m more likely to be reinventing the wheel, looking at only part of the story, or just plain stuck in economics; I\u2019m more likely to be able to come up with something actionable and novel, or at least something that\u2019s not obviously terrible, in biology.  This despite the fact that I\u2019ve taken almost an undergrad major\u2019s worth of economics classes, and no biology classes since high school.  I think avid reading is a bigger factor than formal classes, at least in my case \u2013 possibly simply because, over an adult lifetime, \u201cself-study\u201d reading can add up to more hours of focused attention than formal education.<\/p>\n\n<p>Basically, I think, in order to be a good \u201ceducated layman\u201d, you have to put in the time, and focus on what\u2019s easier to do as a non-expert.<\/p>\n\n<p>What you\u2019re missing, as an \u201ceducated layman\u201d, is apprenticeship with a \u201cmaster.\u201d  You will not know how to actually <em>do<\/em> lab procedures, so you will not know how they tend to fail in ways that aren\u2019t captured in the published papers.   You will not necessarily be able to replicate the results in papers if the \u201csecret sauce\u201d is unwritten and passed from lab tech to lab tech.  You will not know the field\u2019s gossip about who is worth listening to and who isn\u2019t.<\/p>\n\n<p>Your strength, as an \u201ceducated layman\u201d, is the ability to drill down and learn <em>everything<\/em> about the one question within the field that you care about, which will often be different from what most experts in the field care about.  Your lack of embeddedness in the community can actually be helpful, because by aggregating <em>everything<\/em> in the one slice of data you care about, you can generate ideas that aren\u2019t correlated with the field\u2019s biases.<\/p>\n\n<p>Some of these ideas will be bunk because you\u2019re missing part of the picture; listen to those criticisms; but some will survive skeptical examination, and that\u2019s where you add value.<\/p>","author":{"name":{}},"category":{"@attributes":{"term":"science-and-epistemics"}},"summary":"Doing business development for new initiatives at Nanotronics is kind of like being an \u201ceducated layman\u201d for a living. My blog is also a pretty good example of an \u201ceducated layman\u201d\u2019s thinking about a variety of issues. So I plausibly know what I\u2019m talking about here, and may have useful advice for other people looking to succeed at being \u201ceducated laymen.\u201d"},{"title":"Do High-Performing Investment Firms Drive Out Low Performers?","link":{"@attributes":{"href":"https:\/\/srconstantin.github.io\/2021\/06\/09\/Investment-Turnover.html","rel":"alternate","type":"text\/html","title":"Do High-Performing Investment Firms Drive Out Low Performers?"}},"published":"2021-06-09T00:00:00+00:00","updated":"2021-06-09T00:00:00+00:00","id":"https:\/\/srconstantin.github.io\/2021\/06\/09\/Investment-Turnover","content":"<p>In the last post, I found evidence for the claim that a minority of investment firms seek out <em>more information<\/em> than others, and that firms in this \u201cinfovore\u201d minority see above-average returns on investments.<\/p>\n\n<p>In other words, the median financial investment firm is doing <em>less research<\/em> than is optimal, in terms of economic self-interest.<\/p>\n\n<p>Is this a social problem that we should care about even if we don\u2019t work at investment firms?<\/p>\n\n<p>Does it indicate that there\u2019s pervasive <em>malinvestment<\/em> into bad projects, and <em>underinvestment<\/em> into good projects?<\/p>\n\n<p>Well, not exactly.<\/p>\n\n<p>First of all, there\u2019s the issue that \u201cgood\u201d from my perspective as a person who lives on Planet Earth, does not necessarily line up exactly with \u201cprofitable for its investors.\u201d<\/p>\n\n<p>But I\u2019m not too worried about that issue. If an investor is failing to do enough research to maximize his own profits, it\u2019s very unlikely that he\u2019s doing enough research to invest in companies with the most \u201cpositive externalities\u201d or \u201cpublic benefit.\u201d Benefits and harms to third parties are harder to find good information about than financial returns, and investors have less incentive to seek out that information.  So \u201cinvestors don\u2019t do enough research to maximize profits\u201d probably means they <em>also<\/em> don\u2019t do enough research to maximally make the world a better place.<\/p>\n\n<p>The more critical issue is about turnover and competition.<\/p>\n\n<p>Maybe the majority of investment firms are Terrible At Investing (to dramatize the situation a bit), but they are also small and go out of business quickly, while the few firms that are Good At Investing stick around year after year and grow large.  In such a situation, most investment capital is <em>not<\/em> tied up in unprofitable projects; the bad investors may be more numerous but the good investors control more of the resources.  (Or, the good investors are <em>trending towards<\/em> controlling most of the resources in the long run.)<\/p>\n\n<p>This is a testable hypothesis.  It makes certain predictions.<\/p>\n\n<ul>\n  <li>High-performing investment firms survive longer than low-performing investment firms.<\/li>\n  <li>High-performing investment firms have more money under management than low-performing investment firms.<\/li>\n  <li>High-performing investment firms get more inflows (new investment dollars from clients) than low-performing investment firms.<\/li>\n<\/ul>\n\n<p><strong>Survival<\/strong><\/p>\n\n<p>The available data confirms the hypothesis that high-performing investment firms usually survive longer than low-performing ones.<\/p>\n\n<p>Most hedge funds don\u2019t live long.  The median hedge fund only lasts a few years. And survival probabilities consistently correlate with performance, as measured by market returns.  Bad hedge funds, it seems, do tend to go out of business faster than good ones, and in relatively short time frames.<\/p>\n\n<p>Commodity trading advisors (CTAs) also have short lifespans, with median survival of 4.42 years, and they too survive longer when their returns are higher.<\/p>\n\n<p>Mutual funds live longer, with a median lifespan of about 12-17 years.  In most, but not all, studies, they too have higher survival probabilities when they perform better. But malinvestment can persist longer in poorly-performing mutual funds.  (In fact, mutual funds as a class usually underperform index funds without dying out, which indicates persistent malinvestment.)<\/p>\n\n<p><em>Commodity Trading Funds<\/em><\/p>\n\n<p>In a sample of 1504 commodity trading funds (CTAs) between 1990 and 2003, median survival was 4.42 years. Mean monthly return correlated positively with survival, p&lt;0.0001.  Above-median return firms survived an median of 6.16 years, while below-median return firms survived an average of 3.25 years.[1]<\/p>\n\n<p>The hazard ratio associated with median return was 0.88, i.e. for each 1% additional percentage point of monthly return, there\u2019s a reduction of 11.20% of the risk of failure.[1]<\/p>\n\n<p>In a sample of 1053 CTAs, each 1% additional percentage point of annual alpha, or risk-adjusted return in the CAPM model, corresponds to a 9.6% reduced risk of firm failure.[4]<\/p>\n\n<p><em>Hedge Funds<\/em><\/p>\n\n<p>In a dataset of 3491 hedge funds located in the Asia Pacific region, a probit model for the probability of failure of a firm found a negative relationship with mean firm performance, (-0.39, p&lt;0.01), indicating that better-performing firms survive longer.  The hazard ratio for mean return is 0.52, indicating that each 1% increase in annual returns corresponds to a halving of the annual risk of firm failure.[2]<\/p>\n\n<p>Assets under management also have a slight negative correlation (-0.01, p&lt;0.01) with probability of failure, indicating that larger firms survive longer.[2]<\/p>\n\n<p>In a sample of 5827 hedge funds, firm returns correlate negatively (p&lt;0.01) with the probability of firm liquidation. Each 1% increase in average return corresponds to a 7% reduction in the rate of failure.[3]<\/p>\n\n<p>In a dataset of 1091 hedge funds and commodity trading advisor funds, 1971-1998, in a probit multivariate model predicting probability of firm failure, there was a significant negative association between a firm\u2019s CAPM alpha (or market risk-adjusted performance) and its probability of failure.  A 1% increase in a hedge fund\u2019s annual alpha corresponds to a 18.7% lower risk of failure, in a Cox proportional hazards model. [4]<\/p>\n\n<p>In a database of 2776 hedge funds, 1990-2001, the median survival time was 5.5 years. In a chi-squared test, there was a significant (p&lt;0.001) positive association between survival time and both amount under management and average monthly return. The hazard ratio associated with mean monthly return was 0.899; that is, a 1% increase in monthly return corresponds to a 10% lower risk of liquidation.[5]<\/p>\n\n<p>In a dataset of 1222 hedge funds, 1985-2005, mean survival was around 4-6 years, and failure probability was negatively correlated (p&lt;0.01) with return in the past year or in the previous year.  Mean return was associated with a hazard ratio of 0.726, or each 1% increase in mean return corresponds to a 27.4% lower risk of firm failure.[6]<\/p>\n\n<p>In a dataset of 6943 hedge funds over the period 1963-2005, 64% of the hedge funds survived for less than 5 years, 25% survived 10-30 years, and 11% survived more than 30 years. Median survival was 5 years.  The probability of failure in a year was negatively correlated (coefficient -0.034, p&lt;0.001) with performance.  Every 1% increase in monthly performance corresponds to a 3.6% decrease in the hazard rate of firm failure.[7]<\/p>\n\n<p>Larger hedge funds\u2019 failure risk is more sensitive to performance; in firms with &gt;$100M under management, each 1% increase in monthly performance corresponds to a 6% decrease in hazard rate.  That is, small firms have a high failure rate whether they\u2019re good or bad, but large firms are much more likely to survive if they\u2019re good than if they\u2019re bad.[7]<\/p>\n\n<p><em>Mutual Funds<\/em><\/p>\n\n<p>In a dataset of 2375 UK mutual funds, over the period 1972-1995, median survival was 16.7 years, and hazard rate correlated negatively (t = -3.180) with market return.[8]<\/p>\n\n<p>In a dataset of 1057 Spanish mutual funds, over the period 2006-2016,  median survival is 17 years.  Survival does <em>not<\/em> correlate with returns in the past year or three years.[9]<\/p>\n\n<p>In a dataset of mutual funds, 1980-2000, median survival was 12 years.  Survival was significantly associated with fund performance; a 1% increase in Sharpe ratio was associated with a 2% reduction of risk of fund liquidation.[10]<\/p>\n\n<p><strong>Size<\/strong><\/p>\n\n<p>It appears that better-performing funds cannot generally grow their amount under management to \u201ctake over\u201d the market.  The most inclusive datasets show that as funds grow, their returns worsen.<\/p>\n\n<p>In a sample of 924 hedge funds listed in a commercial dataset between 1994 and 1996, average returns were positively correlated (coeff = 0.090) with the amount of assets under management.[11]<\/p>\n\n<p>In a sample of 4327 hedge funds in a commercial dataset from 1994-2003, there is a weak positive correlation between asset sizes and returns.  In a linear regression, the correlation coefficient of log assets on mean annualized returns was 0.0036 (p = 0.0048). There is a much stronger negative correlation between firm size and variance in returns, and correspondingly a positive correlation between firm size and Sharpe ratio (which is mean excess return divided by standard deviation of return).[12]<\/p>\n\n<p>The largest hedge funds are not listed at all in the commercially available hedge fund databases. When unlisted hedge funds are included, firm size correlates <em>negatively<\/em> with firm returns (coefficient = -0.03, t-value = -2.17)[13]<\/p>\n\n<p>In a sample of 7417 hedge funds from commercial datasets, 1994-2008, the two smallest size quintiles have significantly higher average abnormal returns than the two largest size quintiles, and there is a negative correlation (-0.25) between average risk-adjusted returns and amount under management.[14]<\/p>\n\n<p><strong>Inflows<\/strong><\/p>\n\n<p>New inflows of investment (in institutional or individual investors) do correlate positively with fund performance, indicating that investors reward good performance and punish bad performance. However, this incentive tends to be focused on the low end of performance (investors punish the lowest performing funds, but don\u2019t reward the highest performing funds) and focused on short-term results.<\/p>\n\n<p>Hedge fund performance and inflows correlate positively.  The top quintile of hedge funds by performance, measured by excess returns, gets 0.2% more investment a year by wealthy individuals, and 0.15% more investment a year by institutional investors; by contrast, the bottom-performing quintile of hedge funds <em>loses<\/em> 0.05% per year from institutional investors and loses 0.17% per year from wealthy individuals.[15]<\/p>\n\n<p>Growth in amount under management correlates positively (0.32) with firm returns, out of a sample of 5827 hedge funds.[3]<\/p>\n\n<p>In a dataset of 1392 hedge funds, 1979-2000, cash inflows correlate well with returns in the previous quarter.  A 1% increase in returns in the most recent quarter corresponds to an 0.25% expected increase in cash inflows.[12]<\/p>\n\n<p>Hedge funds are required to file Form D with the SEC, disclosing their number of new investors and size of offering.  Using this dataset, there were 22,800 hedge funds that filed Form D between 2009 and 2014, only 17% of which were listed in the commercial databases used in other studies of hedge funds. Net flows greatly differ based on prior quarter performance: the bottom quintile performers in the previous quarter had net cashflow of -10.2%, while the top quintile performers had net cashflow of 27.2%.  Inflows correlate strongly (p&lt;0.01) positively with high returns and anticorrelate with the standard deviation of returns. Outflows are positively correlated (p &lt;0.05) with low returns.  Fund death is significantly (p&lt;0.01) negatively correlated with fund returns.[16]<\/p>\n\n<p>If you look at the above-median cashflow funds as an \u201cinvestment portfolio\u201d (the funds that investors increased their holdings in) and the below-median cashflow funds as the \u201cdivestment portfolio\u201d (the funds that investors decreased their holdings in, the difference between these portfolios (either equal-weighted or cash-flow weighted) actually <em>underperforms<\/em> the market,by at least 1% per quarter in subsequent quarters.  In other words, investors reward short-term good performance and punish short-term bad performance, but this isn\u2019t generally predictive of long-term results.  Good short-run performance is <em>not<\/em> predictive of good long-run performance, so the cash-flow weighted \u201cinvestment portfolio\u201d underperforms an equal-weighted strategy.  By contrast, bad short-run performance <em>is<\/em> predictive of bad long-run performance, so the cash-flow weighted \u201cdivestment portfolio\u201d outperforms an equal-weighted strategy.[17]<\/p>\n\n<p>86% of all negative cash flows are from investors divesting from the bottom-decile performing hedge funds, which also have very high (&gt;22%) rates of liquidation within two years. Investors are good at driving out the very worst hedge funds, but not at picking persistent winners.  Investors tend to invest the most in the largest funds, which have medium returns, and neglect the smaller funds that comprise the top and bottom performers. There is persistence in winners, but investors aren\u2019t exploiting it; a portfolio that just invested in last quarter\u2019s above-median hedge funds would have outperformed the actual cash flow allocations of investors.[17]<\/p>\n\n<p>Similarly, in corporate bond mutual funds, their outflows are more sensitive to bad performance than their inflows are to good performance.[18]<\/p>\n\n<p><strong>Conclusions<\/strong><\/p>\n\n<p>It seems that of our three hypotheses, one is true, one is false, and one is mixed.<\/p>\n\n<ul>\n  <li>Do high-performing investment firms survive longer than low-performing investment firms?\n    <ul>\n      <li>Yes, they do.<\/li>\n    <\/ul>\n  <\/li>\n  <li>Do high-performing investment firms have more money under management than low-performing investment firms?\n    <ul>\n      <li>No; the correlation between size and performance may even be negative.<\/li>\n    <\/ul>\n  <\/li>\n  <li>Do high-performing investment firms get more inflows (new investment dollars from clients) than low-performing investment firms?\n    <ul>\n      <li>Yes, but this is generally an asymmetric relationship; investors \u201cpunish\u201d especially low-performing firms but don\u2019t \u201creward\u201d especially high-performing firms.<\/li>\n    <\/ul>\n  <\/li>\n<\/ul>\n\n<p>In a world where a minority of exceptionally good investors and investment firms perform <em>much<\/em> better than the mediocre majority, do we see the exceptionally good investors \u201cdriving out\u201d the mediocre ones?<\/p>\n\n<p>The picture is mixed, but it seems that no, on the whole, we do not. The below-average firms do die sooner than average, but the best firms don\u2019t necessarily grow to \u201ctake over.\u201d  And new firms, mostly mediocre, will enter the market to fill the gap when the worst of the last batch have gone out of business.  \u201cBad investors\u201d, in the long term, remain a substantial percent of the market, even if they have higher turnover than \u201cgood investors.\u201d<\/p>\n\n<p>So yes, we can conclude that a substantial fraction of investment dollars are being allocated by \u201cbad investors.\u201d<\/p>\n\n<p>One model of why \u201cgood investors\u201d don\u2019t drive out \u201cbad investors\u201d is that there are diminishing returns to scale.<\/p>\n\n<p>A small firm may show great investment returns because it knows about a handful of good investment opportunities; if you give that firm more money to manage, it doesn\u2019t necessarily know more good things to do with the money, so its returns will drop.  To the extent institutional investors know this, they will be reluctant to reward especially-high-performing firms with more inflows. This would explain the picture we see.<\/p>\n\n<p>On this model, \u201callocate more resources to the smartest existing investors\u201d isn\u2019t going to reduce the amount of malinvestment in the system as a whole, nor will it even necessarily be profitable.<\/p>\n\n<p>That\u2019s the bad news. The good news is that the model predicts that there\u2019s \u201croom\u201d for many more small, smart investors to enter the market, and that they\u2019ll be more likely than average to stick around, even if they have trouble growing very big.<\/p>\n\n<p>This <em>would<\/em> decrease the total amount of malinvestment, albeit slowly, because new, small, smart investors would compete with the exceptionally bad investors (who tend to fail early).<\/p>\n\n<p><strong>References<\/strong><\/p>\n\n<p>[1]Gregoriou, Greg N., et al. \u201cSurvival of commodity trading advisors: 1990\u20132003.\u201d <em>Journal of Futures Markets: Futures, Options, and Other Derivative Products<\/em> 25.8 (2005): 795-816.<\/p>\n\n<p>[2]Chen, Jianguo, Martin Young, and Mui Kuen Yuen. \u201cHEDGE FUND FACTORS AND SURVIVAL ANALYSIS: EVIDENCE FROM ASIA PACIFIC.\u201d<\/p>\n\n<p>[3]Gupta, Jairaj, Adrien Becam, and Andros Gregoriou. \u201cDoes Size Matter in Predicting Hedge Funds\u2019 Liquidation?.\u201d <em>European Financial Management (Forthcoming)<\/em> (2017).<\/p>\n\n<p>[4]Goetzmann, William N., Stephen J. Brown, and James M. Park. \u201cConditions for survival: Changing risk and the performance of hedge fund managers and CTAs.\u201d <em>Yale School of Management Working Paper No. F-59<\/em> (1997).<\/p>\n\n<p>[5]Gregoriou, Greg N. \u201cHedge fund survival lifetimes.\u201d <em>Journal of Asset Management<\/em> 3.3 (2002): 237-252.<\/p>\n\n<p>[6]Baba, Naohiko, and Hiromichi Goko. \u201cSurvival analysis of hedge funds.\u201d <em>Institute for Monetary and Economic Studies and Financial Markets Department<\/em> 6 (2006).<\/p>\n\n<p>[7]Nhogue Wabo, Blanche Nadege. <em>Hedge funds and Survival analysis<\/em>. Diss. Universit\u00e9 d\u2019Ottawa\/University of Ottawa, 2013.<\/p>\n\n<p>[8]Lunde, Asger, Allan Timmermann, and David Blake. \u201cThe hazards of mutual fund underperformance: A Cox regression analysis.\u201d <em>Journal of Empirical Finance<\/em> 6.2 (1999): 121-152.<\/p>\n\n<p>[9]Barber\u00e0-Marin\u00e9, M. Gl\u00f2ria, Laura Fabregat-Aibar, and Antonio Terce\u00f1o. \u201cInvestment objectives and factors that influence the disappearance of Spanish mutual funds.\u201d <em>Journal of Business Economics and Management<\/em> 21.1 (2020): 255-276<\/p>\n\n<p>[10]Keenan, Alexander J. <em>The CAPM and the duration of poorly performing mutual funds<\/em>. No. 2001-04. Working Paper, 2001..<\/p>\n\n<p>[11]Liang, Bing. \u201cOn the performance of hedge funds.\u201d <em>Financial Analysts Journal<\/em> 55.4 (1999): 72-85.<\/p>\n\n<p>[12]Ammann, Manuel, and Patrick Moerth. \u201cImpact of fund size on hedge fund performance.\u201d <em>Journal of Asset Management<\/em> 6.3 (2005): 219-238.<\/p>\n\n<p>[13]Barth, Daniel, et al. \u201cThe hedge fund industry is bigger (and has performed better) than you think.\u201d <em>OFR WP<\/em> (2020): 20-01.<\/p>\n\n<p>[14]Teo, Melvyn. \u201cDoes size matter in the hedge fund industry?.\u201d <em>Available at SSRN 1331754<\/em> (2009).<\/p>\n\n<p>[15]Sinclair, Andrew, and Chuyi Zhang. \u201cDo Wealthy Investors Benefit from Access to Hedge Funds?.\u201d <em>Available at SSRN 3779042<\/em> (2021).<\/p>\n\n<p>[16]Jorion, Philippe, and Christopher Schwarz. <em>Who are the smartest investors in the room? Evidence from US hedge funds solicitation<\/em>. Working paper, University of California at Irvine, 2015.<\/p>\n\n<p>[17]Baquero, Guillermo, and Marno Verbeek. \u201cA portrait of hedge fund investors: Flows, performance and smart money.\u201d ERIM Report Series Reference No. ERS-2005-068-F&amp;A (2005).<\/p>\n\n<p>[18]Goldstein, Itay, Hao Jiang, and David T. Ng. \u201cInvestor flows and fragility in corporate bond funds.\u201d <em>Journal of Financial Economics<\/em> 126.3 (2017): 592-613.<\/p>","author":{"name":{}},"category":{"@attributes":{"term":"lit-review"}},"summary":"In the last post, I found evidence for the claim that a minority of investment firms seek out more information than others, and that firms in this \u201cinfovore\u201d minority see above-average returns on investments."},{"title":"Does It Pay To Do More Research?","link":{"@attributes":{"href":"https:\/\/srconstantin.github.io\/2021\/03\/08\/does-it-pay-to-do-more-research.html","rel":"alternate","type":"text\/html","title":"Does It Pay To Do More Research?"}},"published":"2021-03-08T00:00:00+00:00","updated":"2021-03-08T00:00:00+00:00","id":"https:\/\/srconstantin.github.io\/2021\/03\/08\/does-it-pay-to-do-more-research","content":"<p><strong>The Hypothesis<\/strong><\/p>\n\n<p>Do investors profit from spending more time and effort researching and analyzing their decisions?  Does it pay to be an \u201cinfovore\u201d who seeks out an unusual amount of information?<\/p>\n\n<p>It\u2019s pretty obvious, and well-confirmed by the literature, that the <em>least<\/em> info-seeking investors do poorly.  In stock markets, for instance, individual investors (e.g. day traders) get worse returns than institutional investors. Institutional investors have full-time professionals on staff and access to expensive information sources; individual investors typically know far less.<\/p>\n\n<p>The interesting question is whether being unusually info-seeking correlates with having <em>higher<\/em> than median returns, not whether being unusually ignorant correlates with having lower than median returns.  Do the most information-seeking investors earn the highest returns?<\/p>\n\n<p><strong>Motivation<\/strong><\/p>\n\n<p>This Venkat Rao <a href=\"https:\/\/twitter.com\/vgr\/status\/1277262959828283392\">thread <\/a>claims that a major problem with society is that too many \u201crich people\u201d are \u201clazy\u201d when they make resource allocation decisions.<\/p>\n\n<blockquote>\n  <p>The word \u201cinvest\u201d has 2 distinct meanings in relation to capital:\n  Invest (1): Spend money to build a capability. Example: a bridge, a factory, a mansion.<\/p>\n\n  <p>Invest (2): Spend money to acquire a formal stake in an existing capability. Example: stock, bond, lien.<\/p>\n\n  <p>2 now dominates 1.<\/p>\n\n  <p>The two are coupled. For example, you invest (2) in my company so I can invest (1) in a new factory. Instead of shareholder value or a dividend, you might claim a share of the output at a good price for example (offtakes, kinda like futures).<\/p>\n\n  <p>\u2026<\/p>\n\n  <p>It\u2019s a moral hazard to purely invest (2) in money-in-money-out (MIMO) ways. You have no interest in how black box works. All knowledge risk lies with investee. If your MIMO deal is not honored you can\u2019t tell fraud apart from real problems. You can\u2019t judge whether to grant relief.<\/p>\n\n  <p>This is the definition of dumb money. Of course most real investment (2) does informally include some appreciation of the underlying investment (1), but not in any way that is operationally specific. Few investors who play for even controlling stakes actually desire control.<\/p>\n\n  <p>Control in finance has come to mean \u201ccontrol of the board and ability to hire\/fire top executives\u201d, which is increasingly just too shallow to address the complexity of modern principal-agent relations. Money _wants _to be stupid because the rich don\u2019t want to do invest (1) work.<\/p>\n\n  <p>Financialization, \u201cshareholder value\u201d as a disease, etc, all have their tools in a single psychological problem: the rich are really lazy. They don\u2019t want to put in the work to make their money smart. They want to either swarm opportunities via imitation, or rely on \u201canalysts.\u201d<\/p>\n\n  <p>There is a lot of bullshit conservative sermonizing about how the poor deserve their fates because they don\u2019t work hard and that\u2019s why the economy suffers etc. This is not only not the problem, it\u2019s not even true. Most economic problems arise from the rich not working hard enough.<\/p>\n\n  <p>If you have 10s of millions of dollars, it <em>matters<\/em> how hard you, PERSONALLY, think about where to put it.  Even a single degree of delegation causes huge principal-agent distortions. To the extent that some wealth creation opportunities need concentrated capital, the rich must think.<\/p>\n\n  <p>Some rich do think and work hard but they think wide and shallow for \u201chighest ROIC\u201d (where the I is investment (2), not investment (1)) opportunities. They rarely think deep about how a particular investment (2) will drive the invest (1). They don\u2019t care about the meaning of the money.<\/p>\n\n  <p>There is something deeply nihilistic, stupid, fearful, and acting-dead about this. If the only difference between 2 investments for you is return rates, and you are not curious about the futures implied by investing in either, you\u2019re kinda dumb and boring.<\/p>\n\n  <p>\u2026<\/p>\n\n  <p>This whole point is why I\u2019m not a socialist. I don\u2019t think it matters much who \u201cowns\u201d the capital. Whether it is a workers\u2019 co-op or a fat-cat single rich person, the question is how hard they think.<\/p>\n\n<\/blockquote>\n\n<p>There\u2019s a lot in this thread, a lot of it resonates with me, and I think it\u2019s worth taking seriously enough to actually unpack the claims and investigate whether they\u2019re literally <em>true.<\/em><\/p>\n\n<p>As I see it, Venkat is making two separate claims.<\/p>\n\n<p>One is about the relationship between \u201cinvestment (1)\u201d and \u201cinvestment (2)\u201d, between constructing physical objects that produce value, and the abstracted process of spending money to turn it into more money.<\/p>\n\n<p>He seems to believe, and I share the same intuition, that the world would be a better place if more people who had the means to invest in big projects did so because they wanted those projects to exist, not just because they wanted the revenue stream.<\/p>\n\n<p>Elon Musk <em>wants to go to Mars<\/em>; he\u2019s also trying to structure his companies to be profitable, but I\u2019m pretty sure he would count it a failure if he made a bunch of money but humanity never became a multiplanetary species.  That\u2019s the kind of thing Venkat is talking about.<\/p>\n\n<p>It\u2019s natural, for kids at least, or for people imagining what they\u2019d do with wealth vastly greater than their own, to think \u201cIf I ever have money, I\u2019ll use it to do something <em>awesome<\/em>.\u201d You could make the world a better place, make your mark on history, or even just have a spectacularly good time.<\/p>\n\n<p>Venkat seems to be claiming that a.) the people who actually <em>have<\/em> that much money rarely want to spend it on things they personally find awesome, and b.) it would be better for the world if they did.<\/p>\n\n<p>I share this intuition, but I don\u2019t really know how I\u2019d go about testing it.  Since there\u2019s almost no public data about the psychology of rich investors, we have to rely on anecdote; and while a consultant like Venkat has met many rich investors, he\u2019s seen a very selective picture of how they think and spend their time.  My own experience with rich investors is even more limited.<\/p>\n\n<p>As for how the world would be different if investors put money into projects that they valued for reasons other than revenue, I\u2019m not sure how to seriously answer the question without an incredibly broad theory of economics and ethics.<\/p>\n\n<p>But Venkat is also making a narrower, more tractable claim: \u201cthe rich are really lazy.\u201d  That is, investors do not \u201cthink hard\u201d about where to put their money. In more neutral terms, investors underinvest in information-gathering and analysis.<\/p>\n\n<p>This is a testable hypothesis, at least if you only think about the financial self-interest of investors.  If the investors who are <em>most<\/em> inclined to investigate\/research\/seek information are also earning the highest returns, then most investors are irrationally <em>neglecting<\/em> research by comparison.<\/p>\n\n<p>If investors tend to \u201cunderthink\u201d relative to what would be economically rational, then they are <em>certainly<\/em> underthinking relative to Venkat\u2019s socially beneficial ideal, which includes not only considering the effect of an investment on your bank account, but also its effect on the rest of the world.<\/p>\n\n<p><strong>Conclusions From The Literature<\/strong><\/p>\n\n<p>Most of the evidence I could find comes from investments on public markets, since of course there\u2019s far more data on the stock performance of publicly traded companies. I am less confident about what this means about private equity or venture capital investment.<\/p>\n\n<p>Overall, engaging in more research into company fundamentals, and being in some sense \u201cbetter at formal analysis\u201d, <em>does<\/em> correlate reliably with higher returns.<\/p>\n\n<ul>\n  <li>Hedge funds that make more in-person site visits to portfolio companies have higher returns. Site-visitors have annual returns 6.1 percentage points higher than non-visitors.<\/li>\n  <li>Investment firms that download more SEC filings have higher returns.  Downloaders (of any files) have annual returns 1.5 percentage points higher than non-downloaders.<\/li>\n  <li>Financial analysts who download SEC filings make more accurate forecasts than non-downloaders, and the longer they spend reading SEC filings, the more accurate their forecasts.<\/li>\n  <li>\u201cBuy-side analysis\u201d refers to the research and forecasting performed in-house by employees of investment firms. Mutual funds whose investment decisions more closely track the recommendations of their analysts have higher returns.<\/li>\n  <li>Mutual fund managers who score higher on the Cognitive Reflection Test (a measure of how good people are at avoiding intuitive-but-wrong answers; strongly correlated with IQ) have funds with higher Sharpe ratios (the same returns, but less risk) than their low-scoring peers.  That is, roughly, being less prone to \u201cjump to conclusions\u201d is associated with better investment performance.<\/li>\n  <li>Angel investors who do more due diligence have a significantly higher proportion of their investments become \u201chome runs\u201d, defined as investments where the investor receives returns of at least 100% upon exit of the company.<\/li>\n<\/ul>\n\n<p>Strikingly, the biggest downloader of public financial documents is Renaissance Technologies, whose <a href=\"https:\/\/papers.ssrn.com\/sol3\/papers.cfm?abstract_id=3504766\">66% annual returns over the past 30 years<\/a> dwarf anything else in the financial markets.<\/p>\n\n<p>It seems to be the case that spending more time and effort on fact-finding that relates to fundamentals (reading financial documents, visiting factory sites, engaging in due diligence) and listening more closely to the employees who specialize in such research, is profitable \u2013 and thus that most firms underinvest in it.<\/p>\n\n<p>By contrast, \u201cimitative information-seeking\u201d, all things equal, seems to anticorrelate with investment returns and forecasting accuracy.<\/p>\n\n<ul>\n  <li>Investment analysts who change their forecasts the most in response to changes in other analysts\u2019 published forecasts have worse performance.<\/li>\n  <li>Investment firms tend to perform worse if their portfolios closely track changes in published financial analyst recommendations.<\/li>\n  <li>Investment firms that tend to buy stocks that have been in the news recently, have worse performance than investment firms that are less correlated with the news cycle.<\/li>\n<\/ul>\n\n<p>Basically, the evidence available to me suggests that Venkat is right. Institutional investors <em>do<\/em> perform better when they do more investigation into company fundamentals, and worse when they focus more on how other people perceive a company.  The median institutional investor would make more money if they were more investigative and less imitative.<\/p>\n\n<p><strong>Information Seeking by Investment Analysts<\/strong><\/p>\n\n<p>Investment analysts who download more publicly available data about firms tend to make more accurate price forecasts. Financial analysts whose recommendations correlate closely with the average of other financial analysts\u2019 recommendations tend to perform worse than the contrarians.  This suggests that analysts who are good at research and do more of it make better predictions.<\/p>\n\n<p>Strangely, financial analysis firm <em>rankings<\/em> were found to anticorrelate with the use of internal library resources at the firm (in a study published in 1997, when written information resources were mostly in hard copy.)<\/p>\n\n<p>Financial analysts who download more publicly available data about firms from EDGAR, the SEC database, perform better. Only 24% of analysts made an EDGAR download within a day before issuing a new recommendation update.  Those that did, had a 3.7% reduction in forecast error.  Spending more time reading reports also corresponds to better accuracy \u2013 each 1% increase in time spent reading files corresponded to an 0.8% increase in forecast accuracy.[1]<\/p>\n\n<p>However, analysts that base their recommendations more on public consensus tend to perform worse.  A measure of Reliance on Public Information (RPI) can be calculated for financial analysts based on the sensitivity of their recommendations to public variables like price momentum, earnings surprise, average turnover, change in consensus recommendation, and change in consensus earnings forecast.  A portfolio that follows stock recommendations of analysts in quintile 1 of RPI (the least reliant on public information) produces an average monthly return of 1.83%, or 22% a year.  Data was collected on 3480 analysts over the period 1993-2006; returns were calculated over the 31 days following a new recommendation.  Low-RPI analysts tend to recommend buying larger firms (factor loading -0.19, p&lt;0.05), while high-RPI analysts tend to recommend shorting larger firms (factor loading (-0.21, p&lt;0.05), and more high-priced firms (-0.29, p&lt;0.05).[2]<\/p>\n\n<p>A 1997 survey of 100 securities analysts from the largest UK and US investment firms found that firm ranking <em>negatively<\/em> correlated (p&lt;0.001) with the frequency that respondents answered that their staff checks the internal library.[3]<\/p>\n\n<p><strong>Information Seeking by Investment Funds and Fund Performance<\/strong><\/p>\n\n<p><em>Use of Public Information<\/em><\/p>\n\n<p>Firms that download more publicly available files about their investments generally perform better than firms that do not.  Also, \u201cshort sellers\u201d who make leveraged bets against firms earn more profit when they trade immediately after public news about a firm, suggesting that they are profiting from making better use of publicly available information than most investors.<\/p>\n\n<p>On the other hand, firms whose investment choices are more closely correlated with the public advice of analysts generally perform worse.<\/p>\n\n<p>Hedge funds that access more SEC filings online perform better. The most frequent downloader of all is Renaissance Technologies. Firms that download files have on average 1.5% higher annualized returns than firms that don\u2019t.[4]<\/p>\n\n<p>Users who download files from EDGAR, the official website where SEC filings are stored, can be traced to IP addresses corresponding either to institutional investors (e.g. Goldman Sachs, Morgan Stanley) or to individual \u201cretail\u201d investors.  There is no correlation between a firm\u2019s future stock performance and how much its filings were downloaded by \u201cretail\u201d investors, but there is a positive correlation (p&lt;0.01) between a firm\u2019s future performance and how much its files were downloaded by institutional investors, and also a positive correlation (p&lt;0.01) between a firm\u2019s institutional-investor downloads and its subsequent change in holdings among those investors, particularly when the 10K filings have a positive overall \u201ctone\u201d, suggesting that institutional investors do in fact invest more in firms when the firms\u2019 publicly available data is favorable.[4]<\/p>\n\n<p>Short selling does not increase immediately before news about a stock is published, but does increase after, suggesting that short sellers are making their decisions on the basis of public news rather than anticipating that news.  Moreover, the returns on short sales are more than twice as high on days when there is news about a stock, which also suggests that short sellers are making better use of public information than other investors.[5]<\/p>\n\n<p>Short-selling in the COVID-19 pandemic was more profitable for investors who had previously held a short position in any healthcare stock before, suggesting that investors with more familiarity with healthcare were more able to understand what was going on with COVID-19 and how it would affect stock prices.[6]<\/p>\n\n<p>Reliance on Public Information (RPI) is a measure of how sensitive an investor\u2019s holdings are to changes in public information, in this case changes in analysts\u2019 recommendations.  RPI is negatively correlated (r = -0.17) with Carhart 4-factor alpha, in a sample of 1696 mutual funds.[7]  Better funds use more private as opposed to public information.<\/p>\n\n<p>Also, if you construct a measure \u201cRPI_\u03c3\u201d to represent the coefficients from regressing the change in a mutual fund\u2019s % holdings on the change in the standard deviation of analysts\u2019 recommendations, and compare the  RPI_\u03c3 of 1220 mutual funds to their fund performance, the correlation is significantly negative (p&lt;0.05).  [8]<\/p>\n\n<p>A measure (PTMC, Propensity to Trade with Media Coverage) of a mutual fund\u2019s tendency to trade stocks more when they\u2019re in the news, negatively correlates with fund performance. Over the period 1993-2002, stocks purchased by top-quintile PTMC funds lost 0.17% monthly in CAPM-adjusted alpha, while stocks purchased by bottom-quintile PTMC funds gained 0.46% monthly. The difference is still significant for Fama-French three-factor adjusted alpha and Carhart 4-factor adjusted alpha.[9]<\/p>\n\n<p><em>Use of Private Information<\/em><\/p>\n\n<p>Private research by an investment firm \u2013 site visits to portfolio companies, interviews with portfolio CEOs, and in-house analysts estimating stock values \u2013 _does _correspond to higher returns. Investment firms that engage in more in-house research activities, or weight in-house research more heavily in investment decisions, tend to perform better.<\/p>\n\n<p>About \u2159 of hedge funds make site visits to the companies they invest in.  Among 2469 Chinese hedge funds over the period 2012-2017, and CSMAR data on corporate site visits in China, 15.43% of hedge fund managers visited at least one company site.  Funds that made site visits had significantly (p&lt;0.01) higher returns, CAPM alpha, Sharpe ratio, and volatility than funds that didn\u2019t. Mean annual returns were 21.4% for funds that did site visits, vs. 15.3% for funds that did not.[10]<\/p>\n\n<p>Female fund managers and managers with a graduate degree are more likely to make site visits.  11% of male managers made site visits, while 33% of female managers did.  12% of managers with graduate degrees made site visits, vs. 9% of managers without graduate degrees.[10]<\/p>\n\n<p>Chinese mutual funds between 2006-2016  were more likely to make trades on stocks if they had recently made a site visit, indicating that site visits did indeed provide them with decision-relevant information.  A portfolio of stocks that were bought by a mutual fund after a site visit had above-market returns after adjusting for Fama-French factors, indicating that mutual funds are successfully using site visits to identify good investments.[11]<\/p>\n\n<p>Fund managers who report (in a questionnaire) rating conversations with company executives as \u201cvery important\u201d to their investment decisions perform significantly better (p &lt;0.05) than fund managers who rate conversations with executives as \u201cnot important.\u201d[12]<\/p>\n\n<p>The added value of buy-side research \u2013 that is, the work of investment analysts doing proprietary research for investment firms \u2013 can be evaluated by measuring the \u201cbuy-side alpha\u201d logged in a private database for an investment firm.   All investment analysts at this firm use the same baseline algorithm for valuing stocks; then, their individual research prices some stocks higher or lower than the algorithm would predict. This difference is called the \u201cbuy-side alpha.\u201d  In the month following portfolio formation, it turns out, the \u201cbuy-side alpha\u201d does correlate with actual stock performance.<\/p>\n\n<p>Stocks with top-quintile buy-side alphas are rated significantly <em>lower<\/em> by sell-side analysts than stocks with bottom-quintile buy-side alphas (p&lt;0.01), and have higher book-to-market ratios (p &lt;0.01).  A portfolio based on buying stocks each month that had seen upgrades in buy-side alpha would earn 1.19% monthly, or an expected 15% per year, while a portfolio based on buying stocks whose buy-side alphas had been downgraded would earn 0.61% monthly, or an expected 7.6% yearly.  This is a significant difference, and continues to be significant after adjusting for risk, while the advantage of buying stocks recommended by sell-side analysts is no longer significant after risk adjustment.[13]<\/p>\n\n<p>Moreover, the mutual funds included in this database did buy stocks more when their buy-side analysts rated them higher, and sell stocks more when their buy-side analysts rated them lower.  The regression coefficient of firm investment on buy-side analyst ratings is significantly positive, p&lt;0.01, even when controlling for sell-side analysts\u2019 ratings.[13]<\/p>\n\n<p>Finally, the risk-adjusted quarterly returns of mutual funds correlate positively (p&lt;0.01) with the sensitivity of their investment decisions to buy-side analyst recommendations, but returns do _not _correlate with the sensitivity to sell-side analyst recommendations.  In other words, it pays to rely on (private) buy-side research, but not to rely on (public) sell-side analysis.[13]<\/p>\n\n<p><strong>Fund Manager Cognitive Characteristics and Fund Performance<\/strong><\/p>\n\n<p>84 fund managers from 267 mutual funds were given a battery of online cognitive tests, and their test results were compared to their publicly available fund performance.  The abnormal returns of funds (over their benchmark) did <em>not<\/em> correlate with fund managers\u2019 performance on the Cognitive Reflection Test,  their score on a Theory of Mind test, or their self-reported competitiveness.  Ambiguity tolerance was positively (p&lt;0.005) associated with abnormal returns.[14]<\/p>\n\n<p>Unsurprisingly, higher risk tolerance among fund managers in an experimental setting correlated positively with higher volatility in their funds (p&lt;0.005), while a perfect score of 5 on the Cognitive Reflection Test (which 30% of the fund managers got) was negatively correlated with volatility (p&lt;0.05).[14]<\/p>\n\n<p>Together, these two facts imply that risk-adjusted performance (i.e. Sharpe ratio) is higher for fund managers who get perfect scores on the CRT.<\/p>\n\n<p>Performance on the CRT by fund managers also has a strong positive correlation (0.51, p&lt;0.005) with performance on the Advanced Progressive Matrices test, a measure of fluid intelligence. [14]<\/p>\n\n<p><strong>Information Seeking by Venture Capital and Investment Performance<\/strong><\/p>\n\n<p>In a survey of 128 angel investors investing in 1038 new ventures, firms that exited were classified as losing money (Failures), producing an internal rate of return of 0-99%, and exiting at 100% gains or greater (Home Runs).  \u2154 of investments were failures, and 20% were home runs. The number of home run exits of an investor correlated positively (0.24, p&lt;0.05) with the investor\u2019s propensity to engage in due diligence.[15]<\/p>\n\n<p><strong>Limitations and Conclusions<\/strong><\/p>\n\n<p>The data we have about the benefits of site visits comes entirely from the Chinese markets, which may not be representative of other investment markets.  For instance, checking on a factory to make sure its production is as good as it reports may be more important in a lower-trust environment.<\/p>\n\n<p>We also are short of data on investment performance in private equity in general, and particularly in the individual characteristics and decision processes of private equity investors that are predictive of fund performance.<\/p>\n\n<p>Despite these limitations, we do seem to see consistent results pointing towards positive correlations between higher information-seeking activities by investors and higher investment returns, across investment categories.<\/p>\n\n<p><strong>References<\/strong><\/p>\n\n<p>[1]Gibbons, Brian, Peter Iliev, and Jonathan Kalodimos. \u201cAnalyst information acquisition via EDGAR.\u201d <em>Management Science<\/em> (2020).<\/p>\n\n<p>[2]Ali, Usman, et al. <em>Analysts\u2019 use of public information and the profitability of their recommendation revisions<\/em>. Working Paper, Yale University, 2008.<\/p>\n\n<p>[3]Baldwin, Nancy Sadler, and Ronald E. Rice. \u201cInformation\u2010seeking behavior of securities analysts: Individual and institutional influences, information sources and channels, and outcomes.\u201d <em>Journal of the American Society for Information Science<\/em> 48.8 (1997): 674-693.<\/p>\n\n<p>[4]Crane, Alan, Kevin Crotty, and Tarik Umar. \u201cDo hedge funds profit from public information.\u201d <em>Rice University<\/em> (2018).<\/p>\n\n<p>[5]Engelberg, Joseph E., Adam V. Reed, and Matthew C. Ringgenberg. \u201cHow are shorts informed?: Short sellers, news, and information processing.\u201d <em>Journal of Financial Economics<\/em> 105.2 (2012): 260-278.<\/p>\n\n<p>[6]Schattmann, Levy, Jan-Oliver Strych, and P. Joakim Westerholm. \u201cInformation Processing Skills of Short Sellers: Empirical Evidence from the COVID-19 Pandemic.\u201d <em>Available at SSRN 3763198<\/em> (2021).<\/p>\n\n<p>[7]Kacperczyk, Marcin, and Amit Seru. \u201cFund manager use of public information: New evidence on managerial skills.\u201d <em>The Journal of Finance<\/em> 62.2 (2007): 485-528.<\/p>\n\n<p>[8]Abdesaken, Gerald. \u201cOn the precision of public information and mutual fund performance.\u201d <em>Journal of Asset Management<\/em> 16.2 (2015): 85-100.<\/p>\n\n<p>[9]Fang, Lily H., Joel Peress, and Lu Zheng. \u201cDoes your fund manager trade on the news? media coverage, mutual fund trading and performance.\u201d Media Coverage, Mutual Fund Trading and Performance (March 18, 2009)<\/p>\n\n<p>[10]Drake, Michael S., et al. \u201cIs there information content in information acquisition?.\u201d <em>The Accounting Review<\/em> 95.2 (2020): 113-139.<\/p>\n\n<p>[11]Chen, Honghui, et al. \u201cThe Geography of Information Acquisition.\u201d <em>Available at SSRN 3371978<\/em> (2019).<\/p>\n\n<p>[12]Drachter, Kerstin, Alexander Kempf, and Michael Wagner. \u201cDecision processes in German mutual fund companies: evidence from a telephone survey.\u201d <em>International Journal of Managerial Finance<\/em> (2007).<\/p>\n\n<p>[13]Rebello, Michael, and Kelsey Wei. \u201cA glimpse behind a closed door: The investment value of buy-side research and its effect on fund trades and performance.\u201d (2011).<\/p>\n\n<p>[14] Farago, Adam, et al. <em>Cognitive skills and economic preferences in the fund industry<\/em>. No. 2019-16. Working Papers in Economics and Statistics, 2019.<\/p>\n\n<p>[15] Wiltbank, Robert. \u201cInvestment practices and outcomes of informal venture investors.\u201d <em>Venture Capital<\/em> 7.4 (2005): 343-357.<\/p>","author":{"name":{}},"category":{"@attributes":{"term":"lit-review"}},"summary":"The Hypothesis"},{"title":"Mammalian Aggression","link":{"@attributes":{"href":"https:\/\/srconstantin.github.io\/2021\/01\/17\/Mammalian-Aggression.html","rel":"alternate","type":"text\/html","title":"Mammalian Aggression"}},"published":"2021-01-17T00:00:00+00:00","updated":"2021-01-17T00:00:00+00:00","id":"https:\/\/srconstantin.github.io\/2021\/01\/17\/Mammalian-Aggression","content":"<p><strong>Introduction<\/strong><\/p>\n\n<p>In trying to understand how aggression works, as well as aggressive emotions like anger, I decided to go to the animal literature.  Human psychology research is all too prone to being determined by researchers\u2019 preconceptions, and we all have a lot of firsthand experience and personal agendas when it comes to theorizing about human behavior. It\u2019s easier to get some distance when thinking about animals; we have less stake in any particular theory of how animal emotions work.  It\u2019s also easier to set up experimental conditions with animals that would be hard to do ethically with humans, like keeping them in confinement and exposing them to stressors.<\/p>\n\n<p>What the mammal literature says about aggression is that it splits neatly into discrete types.  Researchers disagree on exactly how many clusters there are, since there are inevitable judgment calls in defining taxonomies. And the pattern is somewhat different depending on species.  But one very consistent finding is that there <em>are<\/em> qualitatively different types of aggression.  They are governed by different hormones, activated in different situations, and seem to involve different subjective experiences.<\/p>\n\n<table>\n  <tr>\n   <td>\n   <\/td>\n   <td><strong>Defensive<\/strong>\n   <\/td>\n   <td><strong>Social<\/strong>\n   <\/td>\n   <td><strong>Maternal<\/strong>\n   <\/td>\n   <td><strong>Predatory<\/strong>\n   <\/td>\n  <\/tr>\n  <tr>\n   <td><strong>Target<\/strong>\n   <\/td>\n   <td>Conspecifics, other species, inanimate objects\n   <\/td>\n   <td>Conspecifics only\n   <\/td>\n   <td>Conspecifics and other species\n   <\/td>\n   <td>Other species only\n   <\/td>\n  <\/tr>\n  <tr>\n   <td><strong>Situation<\/strong>\n   <\/td>\n   <td>Acute pain, imminent danger without possibility of escape\n   <\/td>\n   <td>Competition (over e.g. food, territory, mates)\n   <\/td>\n   <td>Threats to nursing young\n   <\/td>\n   <td>Hunting edible prey\n   <\/td>\n  <\/tr>\n  <tr>\n   <td><strong>Attack lethality<\/strong>\n   <\/td>\n   <td>Low\n   <\/td>\n   <td>Varies\n   <\/td>\n   <td>High\n   <\/td>\n   <td>High\n   <\/td>\n  <\/tr>\n  <tr>\n   <td><strong>Arousal<\/strong>\n   <\/td>\n   <td>High\n   <\/td>\n   <td>High\n   <\/td>\n   <td>Low\n   <\/td>\n   <td>Low\n   <\/td>\n  <\/tr>\n  <tr>\n   <td><strong>Affect<\/strong>\n   <\/td>\n   <td>Distressed, angry, fearful\n   <\/td>\n   <td>alert\n   <\/td>\n   <td>fearless\n   <\/td>\n   <td>Calm, alert, happy, curious, fearless\n   <\/td>\n  <\/tr>\n  <tr>\n   <td><strong>Piloerection<\/strong>\n   <\/td>\n   <td>Depends on species\n   <\/td>\n   <td>Yes\n   <\/td>\n   <td>Yes\n   <\/td>\n   <td>No\n   <\/td>\n  <\/tr>\n  <tr>\n   <td><strong>Vocalizing and threats<\/strong>\n   <\/td>\n   <td>Yes\n   <\/td>\n   <td>Yes\n   <\/td>\n   <td>No\n   <\/td>\n   <td>No\n   <\/td>\n  <\/tr>\n  <tr>\n   <td><strong>Association with sex hormones<\/strong>\n   <\/td>\n   <td>?\n   <\/td>\n   <td>Yes (increased by testosterone; blocked by ovarian hormones)\n   <\/td>\n   <td>Yes (increased by progesterone, testosterone)\n   <\/td>\n   <td>Depends on species\n   <\/td>\n  <\/tr>\n  <tr>\n   <td><strong>Cortisol levels during attack<\/strong>\n   <\/td>\n   <td>High\n   <\/td>\n   <td>High\n   <\/td>\n   <td>Low\n   <\/td>\n   <td>Low\n   <\/td>\n  <\/tr>\n  <tr>\n   <td><strong>Other positively associated hormones<\/strong>\n   <\/td>\n   <td>cholecystokinin, dopamine, histamine, substance P \n   <\/td>\n   <td>ACTH, CRH, histamine, norepinephrine, substance P, vasopressin\n   <\/td>\n   <td>NO, vasopressin, oxytocin\n   <\/td>\n   <td>acetylcholine\n   <\/td>\n  <\/tr>\n  <tr>\n   <td><strong>Other negatively associated hormones<\/strong>\n   <\/td>\n   <td>norepinephrine\n   <\/td>\n   <td>serotonin\n   <\/td>\n   <td>CRH, neuropeptide Y, neurotensin\n   <\/td>\n   <td>serotonin\n   <\/td>\n  <\/tr>\n  <tr>\n   <td><strong>Brain region promoting the behavior <\/strong>\n   <\/td>\n   <td>amygdala, hippocampus, PAG\n   <\/td>\n   <td>Amygdala, lateral hypothalamus, lateral septum, olfactory bulb\n   <\/td>\n   <td>dorsal raphe, lateral septum\n   <\/td>\n   <td>amygdala, lateral hypothalamus, olfactory bulb\n   <\/td>\n  <\/tr>\n  <tr>\n   <td><strong>Brain region inhibiting the behavior<\/strong>\n   <\/td>\n   <td>lateral septum, medial hypothalamus\n   <\/td>\n   <td>?\n   <\/td>\n   <td>PAG\n   <\/td>\n   <td>PAG\n   <\/td>\n  <\/tr>\n  <tr>\n   <td><strong>Drugs that increase the behavior<\/strong>\n   <\/td>\n   <td>amitriptyline, delta-9-THC, desmethylimipramine, ethanol, imipramine, iproniazid, naloxone, nialamide, pargyline\n   <\/td>\n   <td>amphetamine, anabolic steroids, chlordiazepoxide, cyproheptadine, ethanol, fenfluramine, PCPA\n   <\/td>\n   <td>alprazolam, chlordiazepoxide, diazepam, fluoxetine, oxazepam \n   <\/td>\n   <td>arecoline\n   <\/td>\n  <\/tr>\n  <tr>\n   <td><strong>Drugs that decrease the behavior<\/strong>\n   <\/td>\n   <td>lithium, opioids, PCP\n   <\/td>\n   <td>5-HT, cannabis, citalopram, fluoxetine, fluprazine, naloxone, quipazine, tryptophan\n   <\/td>\n   <td>5-HT, amitriptyline, amfonelic acid, desipramine, fluprazine, GnRH antagonists, imipramine, morphine, NOS inhibitors, PCPA\n   <\/td>\n   <td>5-HT, amphetamine, atropine,  delta-9-cannabidiol, ethanol, scopolamine\n   <\/td>\n  <\/tr>\n  <tr>\n   <td><strong>Effect of domestication<\/strong>\n   <\/td>\n   <td>reduces\n   <\/td>\n   <td>no change\n   <\/td>\n   <td>no change\n   <\/td>\n   <td>no change\n   <\/td>\n  <\/tr>\n<\/table>\n\n<p><strong>\u201cDefensive Aggression\u201d\/\u201dDefensive Rage\u201d \u2013 Cortisol, Substance P<\/strong><\/p>\n\n<p>A certain cluster of behaviors in mammals can be called \u201cdefensive aggression\u201d, \u201caffective defense,\u201d or \u201cdefensive rage\u201d. These behaviors are reactions to pain or immediate threat, whether that threat comes from a member of the same species, a member of a different species, or an inanimate object.<\/p>\n\n<p>Defensive aggression is associated with negative emotions like fear and anger. It is aversive; a rat will learn not to push a lever that stimulates its brain in the same region that stimulates defensive aggression.  It is also associated with cortisol (the \u201cstress hormone\u201d), substance P (involved in pain perception), cholecystokinin (associated with panic), all suggesting that it is a reaction to frightening and painful situations.<\/p>\n\n<p>Defensive aggression in some species seems to involve qualitatively different and \u201cmilder\u201d types of attack (less likely to cause injury) than other types of aggression.  It is also prompted by the same types of situations and same regions of brain stimulation associated with fleeing, hiding, and submission signals (like baring the belly to get an opponent to stop attacking.)  And animals engage in defensive aggression reflexively when hurt even when there is no visible attacker; they\u2019ll \u201cattack\u201d inanimate objects or the air, as though \u201cletting off steam\u201d.  Speculatively, these details suggest that defensive aggression is something of a reflexive \u201clashing out\u201d when an animal is hurt or scared, not very well optimized to injure or intimidate an opponent, and have more in common with other self-preservation behaviors (like fleeing, hiding, or submitting) than with other types of aggression.<\/p>\n\n<p><em>\u201cAffective Defense\u201d\/\u201cDefensive Rage\u201d in Cats<\/em><\/p>\n\n<p>\u201cAffective defense\u201d in mammals typically involves flattening of the ears, lowering of the body, drawing in the head, pupillary dilation, piloerection, hissing, and stiffening of the tail. It is triggered by either a conspecific or a member of another species who is perceived to be a threat.[18]<\/p>\n\n<p>In cats, \u201cdefensive rage\u201d behavior includes ear retraction, piloerection, back arching, pupillary dilatation, vocalization, unsheathing of the claws, and paw strike.  It occurs when a cat is threatened by either a member of the same or different species. Stimulating the midbrain periaqueductal gray (PAG), which is generally a pain center, elicits defensive rage behaviors in cats.[21]<\/p>\n\n<p>Various compounds associated with pain and stress, as well as acute ethanol intoxication, can affect the \u201cdefensive rage\u201d response.<\/p>\n\n<p>Blocking substance P, a substance involved in pain response, in cats reduces the defensive rage response to stimulation in the medial amygdala and medial hypothalamus.[22]<\/p>\n\n<p>Ethanol enhances defensive rage responses in cats, while it reduces predatory attacks.[23]<\/p>\n\n<p>Cholecystokinin, a neuropeptide and digestive hormone which causes nausea and induces panic when administered to humans, potentiates the defensive rage response in cats.[24]<\/p>\n\n<p>Naloxone reduces the threshold for inducing defensive rage in the cat by brain stimulation; opioid receptor agonists block defensive rage.[57]<\/p>\n\n<p>Defensive rage in cats appears to be inhibited by the medial hypothalamus.  Medial hypothalamus lesions make cats extremely defensive \u2013 they spit and claw in the presence of humans, they\u2019ll run from a dog and fight if attacked.[48]  However, olfactory bulbectomy doesn\u2019t affect defensive aggression in cats.[48]<\/p>\n\n<p><em>Defensive Aggression in Dogs<\/em><\/p>\n\n<p>The septal region in the brain is involved in inhibiting defensive aggression in dogs.  Septal lesions make dogs more \u201coverexcitable, baring their teeth, and attempting to bite when handled.\u201d[48]<\/p>\n\n<p><em>Cortisol-Related Aggression in Hamsters<\/em><\/p>\n\n<p>Syrian and Siberian hamsters are more aggressive in the winter (short-day condition) than the summer, despite their testes being smaller in the winter.  The increased aggression appears to be mediated by elevated cortisol, downstream of melatonin signaling.  In primates as well, seasonal rises in testosterone don\u2019t always correlate to increased aggression, and exogenous T doesn\u2019t always increase aggression. Just as in male humans, there is no correlation between testosterone levels and aggressive behavior.[33]<\/p>\n\n<p>However, amygdala lesions suppress shock-induced fighting in hamsters.[48]<\/p>\n\n<p><em>Defensive Aggression in Marmosets<\/em><\/p>\n\n<p>As with cats and opossums, stimulating the marmoset ventromedial hypothalamus elicits aggressive responses, chiefly short attacks and vocal threats, as well as flight responses.[27]<\/p>\n\n<p>Female marmosets attack intruders; the magnitude of the aggressive response correlates positively with testosterone level immediately after the attack.[92]<\/p>\n\n<p><em>Defensive Aggression in Mice<\/em><\/p>\n\n<p>Defensive aggression in mice seems to be inhibited by the septal region of the brain and enhanced by the olfactory bulb, unlike hamsters and gerbils who do not have an olfactory bulb-dependent aggression response.[48]<\/p>\n\n<p>Mice who have had their olfactory bulb removed do not fight back when attacked or exhibit fighting behavior after electric shocks. Peripheral anosmia does not cause this response, indicating that its effect on aggression is not due exclusively to the fact that it is necessary for smell.[48]<\/p>\n\n<p>Septal lesions in mice enhance defensiveness; struggling, biting, and escaping.[48]<\/p>\n\n<p><em>Defensive Aggression in Rabbits<\/em><\/p>\n\n<p>Septal lesions increase defensive responses (like foot thumping) to human experimenters in rabbits.[48]<\/p>\n\n<p><em>Defensive Aggression in Rats<\/em><\/p>\n\n<p>Defensive biting in rats is different from attack biting; it is usually targeted at the snout, while attacking rats bite their opponent\u2019s back; and defensive biting is seen <em>more<\/em> often against human hands or tools than against rats.  Defensive biting only occurs during or immediately after the defending animal has been hurt, and only when escape is impossible. Defensive biting also does not involve piloerection, while offensive biting always does.[4]<\/p>\n\n<p>Defensive aggression is specifically selected against when rats are domesticated.<\/p>\n\n<p>233 wild-caught rats were selected for \u201ctameness\u201d, that is, lower rates of aggressive behaviors towards human handlers, or \u201caggression\u201d, that is, higher rates of aggressive behaviors towards human handlers, over 8-10 generations.  [1]<\/p>\n\n<p>There was no difference in testosterone levels between tame and wild rats of both sexes; however, aggressive rats had significantly higher serum cortisone levels than wild rats, in both sexes.  Aggressive rats had significantly larger startle responses to stimuli than tame rats, in both sexes.[1]<\/p>\n\n<p>Tame rats show fewer displays of defensive aggression towards other rats than aggressive rats, but no fewer displays of offensive aggression.[1]<\/p>\n\n<p>As with other animals, the septal and medial hypothalamus regions of the brain appear to inhibit defensive aggression in rats, while the amygdala and hippocampus stimulate it.<\/p>\n\n<p>Septal lesions in rats enhance defensiveness \u2013 heightened fighting in response to foot shock and handling.  Medial hypothalamus lesions also dramatically increase defensiveness.  Amygdala and hippocampus lesions, by contrast, decrease defensiveness.[48][79]<\/p>\n\n<p>Certain drugs affect defensive aggression in rats.<\/p>\n\n<p>\u201cIrritable aggression\u201d in both male and female rats \u2013 an increased tendency to fight each other when deprived of food or sleep or administered electric shocks \u2013 is increased by administering cannabis or delta-9-THC.[78]<\/p>\n\n<p>Lithium reduces aggression in rats in response to pain from hot plates or electric shocks.[80]<\/p>\n\n<p>The tricyclic antidepressant drugs imipramine, amitryptiline, and desmethylimipramine, and the MAOIs nialamide, iproniazid, and pargyline, all increased shock-induced aggression in rats.[81]<\/p>\n\n<p>Acute administration of dopamine intravenously increases shock-induced aggression in rats, while acute intravenous norepinephrine reduces it.[82]<\/p>\n\n<p>Phencyclidine (PCP) dose-dependently reduces defensive aggression in rats both against other rats after foot shock, and against an inanimate target after immobilization and tail shock.[83]<\/p>\n\n<p>Histamine increases rat aggression in response to foot shocks; this effect is further potentiated by an H1-receptor-blocking antihistamine and suppressed by an H2-receptor-blocking antihistamine, suggesting that H2 histamine receptors are involved in defensive aggression.[84]<\/p>\n\n<p>Cholecystokinin type 2 receptors in the PAG are necessary for two defensive behaviors in rats, freezing and escape.[116]<\/p>\n\n<p><em>Pain-Induced Aggression in Spider Monkeys<\/em><\/p>\n\n<p>Spider monkeys will bite other monkeys, rats, mice, dolls, and balls immediately after being administered painful electric shocks.  If two monkeys are both shocked, initially both will attack; after repeated shocks, a pattern emerges where one always attacks and one always flees.[29]<\/p>\n\n<p><em>Aggressive Vocalization and Pain-Induced Aggression in Squirrel Monkeys<\/em><\/p>\n\n<p>The \u201ckecker\u201d call, associated with aggression, can be stimulated in squirrel monkeys by electrodes in the amygdala, hypothalamus, and periventricular gray.[36]<\/p>\n\n<p>Phencyclidine at high doses blocks pain-induced aggression in squirrel monkeys.[94]<\/p>\n\n<p><strong>Social Aggression (\u201cOffensive Aggression\u201d, \u201cIntermale Aggression\u201d) \u2013 Testosterone, Vasopressin, Low Serotonin<\/strong><\/p>\n\n<p>Social aggression, unlike defensive aggression, is directed only at members of one\u2019s own species.  It is sometimes called \u201cintermale aggression\u201d or \u201chormone-dependent aggression\u201d even though it is not exclusive to males, because it is generally more common in males and correlates well to testosterone levels.  It also inversely correlates to serotonin levels.<\/p>\n\n<p>Social aggression revolves around competition for scarce resources \u2013 mates, territory, or in some species food and water. It generally involves threat displays intended to make an opponent back down without a fight.<\/p>\n\n<p>Social aggression is the least well-categorized of the types of aggression I describe here; in some species (such as marmosets) there doesn\u2019t seem to be a clear distinction between social and defensive aggression.  In rats, social aggression is always accompanied by piloerection (hair standing on end) while defensive aggression never is.  But not all species seem to have this sharp distinction.<\/p>\n\n<p>There are major differences between the ways \u201csocial aggression\u201d is studied in rodents vs. primates which make the situation more confusing.<\/p>\n\n<p>In rodents, \u201coffensive aggression\u201d is defined as the propensity for an individual to attack an unknown intruder into his space.  Since the \u201cresident\u201d invariably defeats the \u201cintruder\u201d, dominance and \u201coffensive aggression\u201d are identical.  Dominant rodents are higher in testosterone than average and have more access to mates.  In rodents, the relationship between social aggression and the hormones serotonin and testosterone is straightforward: testosterone raises social aggression and serotonin lowers it.   Stress and anxiety anticorrelate with offensive aggression.<\/p>\n\n<p>In primates and social carnivores such as wolves and mongooses, however, studies are typically done within a group of individuals who live together (in the wild or the lab).  Conflicts are primarily with community members, and only occasionally with strangers.  And intragroup conflicts often resolve with little or no physical violence, just threat behaviors and mild scuffling.  So \u201cdominance\u201d is a more complex phenomenon; a dominant individual in a group is the one who wins most conflicts and receives the most submission behavior, and has the most access to resources (like mates, food, and water), but the dominant individual is <em>not<\/em> necessarily the most aggressive individual.<\/p>\n\n<p>The relationship between dominance, aggression, and the hormones testosterone, serotonin, and cortisol, is likewise complicated in primates and in social carnivores. Dominance rank does not necessarily correlate positively with aggression.  Completely nonviolent individuals are, by definition, at the bottom of the dominance hierarchy (they lose all fights they\u2019re in), but otherwise, in primates and carnivores, \u201cfighting more\u201d is not necessarily \u201cwinning more.\u201d  The most dominant individuals in a stable hierarchy are rarely threatened, and can easily cause others to back down with a harmless threat display.<\/p>\n\n<p>Aggression does not always correlate with cortisol in primates and social carnivores. Dominance usually correlates positively with baseline cortisol levels.  On the other hand, losing fights causes an <em>acute<\/em> spike in cortisol in the loser. Because of the negative feedback in cortisol levels, these two observations are consistent; frequent experiences of losing fights can be expected to <em>depress<\/em> long-term baseline cortisol levels, even as each losing battle causes a spike in cortisol in the short term.<\/p>\n\n<p>Serotonin in primates correlates <em>positively<\/em> with dominance rank and with <em>non-severe<\/em> aggression (initiating threat displays or harmless physical scuffles) but <em>negatively<\/em> with severe aggression (wounding another primate).  As in rodents, low serotonin correlates with serious violence in primates, but primates also have a more complex repertoire of dominant\/threatening social behavior which are associated with <em>high<\/em> serotonin.<\/p>\n\n<p>Testosterone, though, in primates and carnivores just as in rodents, has a straightforward positive correlation with both dominance and aggression.<\/p>\n\n<p><em>Social Aggression in Baboons<\/em><\/p>\n\n<p>Among female baboons, testosterone correlates with dominance rank and within-individual aggression but not across-individual aggression \u2013 i.e. higher-T baboons are not more aggressive overall, but particular baboons are more aggressive at times when their T is higher.[90]<\/p>\n\n<p>Dominant baboons have more copulatory success, are more likely to dominate in conflicts (receive submissive gestures or avoidance from other baboons), and are more likely to win conflicts over food. But they do not engage in more aggressive encounters.  High dominance rank among baboons is associated with low baseline cortisol and high cortisol response to stress.[98]<\/p>\n\n<p><em>Social Aggression in Chimpanzees<\/em><\/p>\n\n<p>Behavioral style in chimpanzees was broken down into 6 principal components:<\/p>\n\n<ul>\n  <li>\u201cSmart\u201d (uses coalitions when initiating aggression; is usually the groom-ee in grooming interactions; has most play offers accepted)<\/li>\n  <li>\u201cAffiliative\u201d (participates in a lot of grooming; frequent hugging and touching)<\/li>\n  <li>\u201cPlayful\u201d (plays often and with many other chimps)<\/li>\n  <li>\u201cAggressive\u201d (most social interactions are aggressive; has many coalition partners in aggression)<\/li>\n  <li>\u201cFriendly\u201d (has many friends; spreads affiliative behavior around many individuals)<\/li>\n  <li>\u201cMellow\u201d (frequently does not react to aggression or social approach)<\/li>\n<\/ul>\n\n<p>\u201cFriendly\u201d and \u201cAffiliative\u201d personality was not associated with dominance rank.<\/p>\n\n<p>\u201cPlayful\u201d and \u201cSmart\u201d personalities were more likely to be subordinate.<\/p>\n\n<p>\u201cAggressive\u201d and \u201cMellow\u201d personalities were more likely to be dominant.<\/p>\n\n<p>Cortisol did not correlate with rank, aggression given, or aggression received.  There was a nonsignificant positive association between cortisol and the \u201cSmart\u201d and \u201cAggressive\u201d styles.[61]<\/p>\n\n<p>In adolescent male chimpanzees, testosterone (after correcting for age) was positively associated with dominance and aggression given, negatively associated with aggression received, and positively associated with the \u201cmellow\u201d behavioral style.  Testosterone was not associated with the \u201cAggressiveness\u201d behavioral style.  Note that \u201cAggressiveness\u201d indicates that a high percent of one\u2019s total social interactions are aggressive, so an individual who is both aggressive and friendly might have a <em>low<\/em> \u201cAggressiveness\u201d score.[100]<\/p>\n\n<p>Dominance rank, aggression, and testosterone are correlated in adult male chimpanzees.[98]<\/p>\n\n<p>Citalopram, an SSRI, reduced aggressive behavior in a zoo chimpanzee.[102]<\/p>\n\n<p><em>Aggression and Social Dominance in Cynomolgus Monkeys<\/em><\/p>\n\n<p>Dominant cynomolgus monkeys (those who win most conflicts) tend to also engage in more aggression overall.  Serotonin tends to inhibit aggression.<\/p>\n\n<p>Other hormones have relationships with aggression and dominance as well: testosterone is positively correlated with dominance rank; cortisol is positively correlated with rank in males but not females; and ovariectomy increases both aggression and submission in females, suggesting that some ovarian hormone is responsible for blocking aggression and submission.<\/p>\n\n<p>In female cynomolgus monkeys, the lower the social rank of a monkey, the more aggression she received and the more submissive behaviors she practiced.  But aggressive behaviors follow an inverted U-shaped relationship with rank; the most dominant individuals actually engage in less aggression than the middle ranks, though the most subordinate individuals do the least aggression of all.  If monkeys are split into two groups, \u201cdominant\u201d and \u201csubordinate\u201d, the difference in aggression is not significant, but it\u2019s clear how with this pattern, different choices of split point would result in different conclusions.[107]<\/p>\n\n<p>Dominant monkeys were larger and had higher levels of LH, cortisol response, oxytocin, and dopamine metabolites than subordinates.[107]<\/p>\n\n<p>There was no association between cortisol levels and social rank in female cynomolgus monkeys.  Higher-ranked monkeys engaged in more aggression while lower-ranked monkeys engaged in more submission.[59]<\/p>\n\n<p>When given sertraline, an SSRI, adult female cynomolgus monkeys showed changes in social behavior. Before treatment, dominant monkeys were more aggressive than subordinates; with sertraline, dominant monkeys engaged in less aggression until they matched the low subordinate level.  Before treatment, subordinate monkeys engaged in more submission than dominants; with sertraline, the subordinates\u2019 submissive behavior dropped to match the low dominant level.[103]<\/p>\n\n<p>Homovanillic acid levels (a metabolite of dopamine) were higher in both male and female dominant cynomolgus monkeys than in subordinates.  No association with norepinephrine metabolites. In males but not females, lower HIAA (a metabolite of serotonin) was associated with dominance.[105]<\/p>\n\n<p>Dominant male monkeys have higher basal cortisol and testosterone levels; subordinate monkeys have stronger cortisol response to ACTH challenge.[58]<\/p>\n\n<p>Ovariectomy causes a 2-3x increase in aggression and submission in female cynomolgus monkeys.[106]<\/p>\n\n<p>As with other animals, ethanol can stimulate aggression in cynomolgus monkeys.<\/p>\n\n<p>Acute and chronic alcohol drinking both increase rates of contact aggression in cynomolgus monkeys.[104]<\/p>\n\n<p><em>Social Aggression in Dogs<\/em><\/p>\n\n<p>Domestic dogs who engaged in \u201cleash aggression\u201d (attempting to attack other dogs while on leash) were matched to a dog of the same age, sex, and breed who did not engage in \u201cleash aggression.\u201d  Aggressive dogs were more likely to bark, lunge, and growl at model dogs than non-aggressive dogs.  Aggressive dogs had higher levels of free vasopressin than nonaggressive dogs, but no difference in oxytocin.[89]<\/p>\n\n<p>Among assistance dogs bred for affectionate dispositions and low aggressiveness, oxytocin was higher than in pet dogs.[89]<\/p>\n\n<p><em>Social Aggression in Gerbils<\/em><\/p>\n\n<p>Like mice and rats, male gerbils who cohabit with a female will attack unfamiliar intruders in their home territory.[109]  Castration abolishes territorial aggression; castration + supplemental testosterone restores it.[110]<\/p>\n\n<p>Olfactory bulbectomy reduces social aggression in gerbils; high dose testosterone propionate reverses this effect. [48]<\/p>\n\n<p>Gerbils will typically attack unfamiliar gerbils and also rats and mice that venture into their territory.  Gerbils dosed with delta-9-THC will still sniff, approach, and chase a mouse, but will not bite it.[111]<\/p>\n\n<p><em>Social Aggression in Hamsters<\/em><\/p>\n\n<p>As with other animals, testosterone and other androgens increase aggression in hamsters; so do the hormones vasopressin and corticotropin releasing hormone (CRH), a stimulator of the HPA-axis.<\/p>\n\n<p>In hamsters, vasopressin administration increases rates of flank marking (a dominance behavior), and vasopressin antagonists reduce flank marking by dominant hamsters, which in turn increases flank marking by submissive hamsters.[33]<\/p>\n\n<p>Blocking vasopressin dose-dependently reduces male hamsters\u2019 rate of attacking intruders.[91]<\/p>\n\n<p>A CRF1 antagonist blocks attacks against intruding male hamsters \u2013 higher latency to bite, lower chase duration, lower attack frequency.[63]<\/p>\n\n<p>Anabolic steroids (testosterone cypionate, nandrolone deconate, and boldenone undecylinate) increase offensive aggression in male hamsters.[74]<\/p>\n\n<p><em>Social Aggression in Marmosets<\/em><\/p>\n\n<p>Common marmosets exhibit \u201cvocal threats\u201d along with limited piloerection in the tail and relatively harmless \u201cshort attacks\u201d, when competing over food.  Short attacks are generally made against lower-ranking or younger monkeys, are terminated by flight or submissive squeals, and are never followed by chasing.<\/p>\n\n<p>Genital display and flicking of the ear-tufts are behaviors that alpha marmosets usually make towards subordinate marmosets, or any marmosets towards strange marmosets and humans.  If the strangers counter-threaten, serious biting attacks ensue.  Violent attacks and fighting are accompanied by substantial piloerection.[26]<\/p>\n\n<p>In the common marmoset and black tufted-ear marmoset, as well as in lemurs and tamarins, dominant individuals have higher cortisol than subordinates.[88]<\/p>\n\n<p><em>Social Aggression in Mice<\/em><\/p>\n\n<p>Olfactory bulbectomy reduces social aggression in mice; peripherally induced anosmia does not.[48]<\/p>\n\n<p>Naloxone suppresses intermale aggression in isolated mice.[75]<\/p>\n\n<p>Cannabis reduces the tendency of mice to fight an intruder, even at doses too low to suppress locomotor activity.[78]<\/p>\n\n<p>In a subpopulation of rats and mice, roughly a quarter of subjects, ethanol administration increases aggression against intruders. In particular, ethanol lengthens the duration of bursts of aggressive activity, but does not affect the latency to attack.[96]<\/p>\n\n<p>Mice lacking the HNMT gene have higher levels of brain histamine, and are more aggressive against intruders.  They also have an altered sleep\/wake cycle (they are more active during the light period when mice usually sleep, and less active during the dark period when mice are usually awake.)[117]<\/p>\n\n<p>Mice lacking substance P receptors are far less likely to attack an intruder.[118]<\/p>\n\n<p><em>Social Aggression in Rabbits<\/em><\/p>\n\n<p>The male rabbit who is most likely to follow, attack, and chase is considered the dominant rabbit in a group; he has higher peripheral testosterone levels than the others.[93]<\/p>\n\n<p><em>\u201cOffensive\u201d or \u201cHormone-dependent\u201d Aggression in Rats<\/em><\/p>\n\n<p>Offensive aggression in rats is clearly delineated from defensive aggression.<\/p>\n\n<p>In a colony of rats, if an intruder enters, one male rat will typically attack the intruder; this male is also the dominant rat in \u201cagonistic encounters\u201d within the colony.  These attacks are preceded by approach, sniffing, and (if the rat is not a colony member) piloerection, followed by biting, boxing, and climbing on top of the other rat.  The intruder rat rarely bites back after being attacked.[4]<\/p>\n\n<p>Only hormone-dependent aggression in rats is accompanied by piloerection; defensive and predatory aggression are not. Hormone-dependent aggression is not territorial \u2013 a male rat will attack an unfamiliar male rat even if he is in an unfamiliar area.[6]<\/p>\n\n<p>When a cat smell is added to a rat cage, offensive attacks disappear; defensive biting is unchanged or increased, however.[3]<\/p>\n\n<p>Offensive aggression in rats is associated with testosterone, copulation, and winning fights; it is reduced when a rat experiences \u201cdisappointment\u201d, failing to get an expected reward.<\/p>\n\n<p>Castration reduces social aggression in male rats, and testosterone supplementation increases it.  The amount of aggression in intact male rats correlates with the baseline level of serum testosterone. Rat testosterone spikes after exposure to a receptive female and after successful aggression.[6]<\/p>\n\n<p>Male rats will exhibit much more social aggression if they cohabit with females.  Both male and female rats will exhibit more hormone-dependent aggression if they are competing for scarce food.[6]<\/p>\n\n<p>Offensive aggression in male rats increases after copulation with females.[7]<\/p>\n\n<p>Male intruder rats display offensive aggression against female residents, but never males.  Female intruder rats rarely are attacked, and when they are it is usually only after they rebuff multiple attempts to mate.[8]<\/p>\n\n<p>When access to food or water is restricted, the \u201calpha\u201d male or female rats in a colony (those who attack intruders the most) are <em>not<\/em> the same rats who get the most access to the food or water.  But alpha male rats <em>are<\/em> the ones who have the most access to copulating with females.[8]<\/p>\n\n<p>Rats surprised by a lack of reward in a situation that normally provides rewards show a reduction in social aggression and a greater propensity to be attacked.[9]<\/p>\n\n<p>Social aggression in rats also anti-correlates with serotonin and is increased by serotonin-depleting drugs and decreased by serotonergic drugs.<\/p>\n\n<p>Male Wistar rats treated with PCPA, a drug which depletes cerebral serotonin, or a saline control, before being placed in another weight-matched rat\u2019s cage.  The PCPA-treated intruder rats frequently attacked the residents; the control rats never did. PCPA-treated rats were also more likely to socially approach the resident rats.  Defensive and submissive behaviors were unchanged.[2]<\/p>\n\n<p>When it was the resident rats who were treated with PCPA or control, treated rats attacked more; there was no change in defensive or submissive behaviors.[2]<\/p>\n\n<p>Hypothalamic stimulation prompts rats to attack other rats (male and female), anaesthetized or dead rats, and mice, but not toy rats.  Castration increases latency of hypothalamic aggression; testosterone reverses the effect.  Serotonin-receptor-binding drugs such as fluprazine, quipazine, and TFMPP, increase the threshold for hypothalamic aggression.[5]<\/p>\n\n<p>Perhaps surprisingly, though, social aggression in rats anticorrelates with anxiety.  Rats bred for low rates of anxious behavior were more aggressive than rats bred for high rates of anxious behavior or rats without selective breeding.[76]<\/p>\n\n<p><em>Social Aggression in Mongooses<\/em><\/p>\n\n<p>In the dwarf mongoose, dominant females have higher cortisol levels than subordinate females.[88]<\/p>\n\n<p>Unusually among social mammals, mongooses don\u2019t show elevated testosterone in situations of conflict. Testosterone levels in male mongooses don\u2019t correlate with rates of aggression, dominance rank, or mating rates. [112]<\/p>\n\n<p>Mongooses are unusual in that they are cooperative breeders; only a few individuals in a group reproduce, and the rest are \u201chelpers\u201d who look after the children.  However the \u201chelper\u201d males have just as much testosterone as the dominant males.  Mongooses also continue to play even as adults, which many species don\u2019t.[112]<\/p>\n\n<p><em>Social Aggression in Oryx<\/em><\/p>\n\n<p>Oryx engage in postural threats (erect posture, threatening with horns) and head-butting conflicts with the horns of other males. They submit by bowing their heads or leaving after challenged.  Melengestrol acetate, a progestin, reduces aggression when given in the feed of a herd of male oryx.  Melengestrol reduces testosterone levels, as well as levels of posturing, contact, chasing, and submission.[108]<\/p>\n\n<p><em>Social Aggression in Rhesus Monkeys<\/em><\/p>\n\n<p>In rhesus monkeys, serotonin is negatively associated with intra-species aggression in rhesus monkeys, but positively associated with dominance.  When aggression is split into the two categories of competitive aggression (threatening, chasing, and displacing, without causing serious injury) vs. severe aggression (causing wounds), we find that serotonin, and dominance rank, are <em>positively<\/em> associated with competitive aggression and <em>negatively<\/em> associated with severe aggression.<\/p>\n\n<p>Testosterone is positively associated with aggression.  Cortisol is negatively associated with threat displays.<\/p>\n\n<p>In free-living young male rhesus monkeys, ACTH and norepinephrine levels were positively associated with aggressiveness ratings, while 5-HIAA (a serotonin metabolite) levels were negatively associated.[27]<\/p>\n\n<p>28 young male monkeys taken from 3500 free-living macaques on an island in South Carolina were rated for \u201caggressiveness\u201d by researchers based on direct observation, examination of scars and wounds, and photographs.  ACTH was significantly positively associated with aggressiveness, as was norepinephrine; serotonin was negatively associated.[37]<\/p>\n\n<p>Dominance among females in a free-living macaque colony is associated with the frequency of threatening, displacing, and chasing behavior, but not with severe aggression or spontaneous wounding.  High dominance rank correlated positively with 5-HIAA (a serotonin metabolite.)  Severe aggression or wounding correlated negatively with 5-HIAA.[41]<\/p>\n\n<p>The C77G polymorphism in the mu-opioid receptor gene in macaques is associated with an abnormally low cortisol response to stress and pain.  Threat displays, such as teeth-baring, staring, and ear-flapping, correlated <em>negatively<\/em> with cortisol levels.  The mutant macaques had significantly higher rates of threat display, but not more cage-shaking or attacks on self or inanimate objects.[35]<\/p>\n\n<p>Testosterone in male rhesus monkeys correlates positively with rates of aggression, dominance rank, rate of receiving submission, and \u201ctension\u201d (yawning, teeth grinding, and banging objects; also symptomatic of inhibited aggressive behavior due to the presence of dominant animals.)  High testosterone correlates negatively with submissive behaviors. On the other hand, the reverse correlation does not apply; the monkeys most likely to submit do not have the lowest testosterone.[40]<\/p>\n\n<p>Dominance in rhesus monkeys seems to involve activity in the amygdala and lateral hypothalamus.<\/p>\n\n<p>If you remove the amygdala from a dominant rhesus monkey, he becomes submissive, never aggresses or retaliates, and moves to the bottom of the dominance hierarchy. He also becomes more aggressive\/fearless in individual-cage settings.[41]<\/p>\n\n<p>Stimulation of male rhesus monkeys in the lateral hypothalamus prompts them to aggressively attack the dominant monkey.  The stimulated monkeys did not attack females or inanimate objects.  The stimulated subordinate monkey usually lost fights with the dominant; the dominant monkey mounted the female more and actively threatened the stimulated subordinate male.  Eventually the formerly subordinate monkeys became dominant; their hair stood on end, they strutted, they <em>looked<\/em> dominant, while the formerly dominant monkeys crouched and had matted hair.[39]<\/p>\n\n<p>When amphetamine is administered to stumptail macacques, affiliative behavior decreases and aggressive behavior increases.[97]<\/p>\n\n<p><em>Social Aggression in Squirrel Monkeys<\/em><\/p>\n\n<p>Squirrel monkeys make threat displays and aggressive vocalizations when faced with a strange intruder; the rate of these aggressive responses increases when they are given ethanol or the benzodiazepine chlordiazepoxide.[95]<\/p>\n\n<p><em>Dominance in Vervet Monkeys<\/em><\/p>\n\n<p>Dominance is measured by how often a male monkey succeeds in agonistic encounters (i.e. the other monkey submits or avoids).  36 adult male vervet monkeys were separated into 12 groups of 4. In each, a dominant male (winning over 85% of encounters) emerged.  Tryptophan and fluoxetine (both serotonergic) significantly increased the frequency of approaching, proximity, and grooming but decreased the rate of aggressive behaviors.  By contrast, fenfluramine and cyproheptadine (which deplete serotonin), decreased approaching, proximity, and grooming and increased aggression.[38]<\/p>\n\n<p>The animals treated with serotonergic drugs became dominant and remained so; the animals treated with anti-serotonin drugs became subordinate and remained so.  This suggests that low serotonin may be a signal of <em>low<\/em> or <em>threatened<\/em> dominance, which prompts aggression.[38]<\/p>\n\n<p>Cortisol levels do not correlate with social dominance in stable groups of vervet monkeys. Cortisol levels rise during competition for dominance among familiar males, particularly among the winners of such competitions.[60]<\/p>\n\n<p><em>Social Aggression in Wolves<\/em><\/p>\n\n<p>Cortisol is higher in dominant wolves than subordinate wolves, consistent across 3 packs and 2 years.  There is no overall correlation between cortisol and levels of agonistic and aggressive behavior.  However, cortisol is higher during the mating period, and so is aggressive behavior.  Dominant wolves do not fight more than subordinate wolves; they just win a higher percentage of their fights.[85]<\/p>\n\n<p>Male wolves are more likely than female wolves to fight against other packs; male wolves also have higher cortisol than female wolves.[86]<\/p>\n\n<p>Dominant male wolves have higher testosterone and cortisol than subordinate wolves.[87]<\/p>\n\n<p><strong>Maternal Aggression: Oxytocin, Vasopressin<\/strong><\/p>\n\n<p>Maternal aggression is the propensity of mammalian mothers to become more aggressive in defense of their offspring during pregnancy and while nursing.<\/p>\n\n<p><em>Maternal Aggression in Mice<\/em><\/p>\n\n<p>Mouse maternal aggression is promoted by nursing and caring for infant offspring, not necessarily pregnancy or even female sex.  The male sex hormone testosterone, in addition to pregnancy-related female hormones, increases maternal aggression.<\/p>\n\n<p>In a species of mice where fathers as well as mothers have significant parental investment into raising children, there is a \u201cpaternal aggression\u201d phenomenon in which male parents are more aggressive towards intruders than male virgins are.[66]<\/p>\n\n<p>Prenatal testosterone exposure increases maternal aggression in mice.[67]<\/p>\n\n<p>Mouse maternal aggression is blocked by stress, as well as stress and anxiety-related hormones, such as CRH, neuropeptide Y, and neurotensin.<\/p>\n\n<p>Corticotropin-releasing hormone, as well as the presence of stressors, inhibits maternal aggression in mice.  Nursing mice also show reduced fear and anxiety.[50]<\/p>\n\n<p>Mice selected for high maternal aggression have reduced neuropeptide Y expression, which also correlates with decreased fear and anxiety.  They also have increased CRF binding protein expression (which reduces the effect of CRF), and increased NO synthase. [51]<\/p>\n\n<p>Neurotensin injected into a lactating mouse\u2019s brain significantly and dose-dependently reduces maternal aggression.  Neurotensin antagonists significantly increase maternal aggression.  Neurotensin has many functions, including stimulating ACTH production.[53]<\/p>\n\n<p>Serotonin-related drugs also affect maternal aggression in mice, though the pattern of effect is not obvious.<\/p>\n\n<p>PCPA, a serotonin depletion agent, as well as 5-HTP, a serotonin precursor, inhibit maternal aggression in postpartum mice.  Antagonists of serotonin receptors such as mianserin, methiothepin, and methysergide, also reduce maternal aggression.[70]  5-HTP and PCPA have opposite effects on serotonin but they both increase dopamine levels, and also increase levels of 5HIAA, the metabolite of serotonin.[70]<\/p>\n\n<p>Imipramine, a tricyclic antidepressant with strong effects on many neurotransmitter receptors, reduces maternal aggression in mice.[69]<\/p>\n\n<p>Morphine reduces maternal care for pups and maternal aggression in mice.[68]<\/p>\n\n<p><em>Maternal Aggression in Rats<\/em><\/p>\n\n<p>Maternal aggression in rodents, like predatory aggression and unlike social aggression, is <em>not<\/em> accompanied by a cortisol response, elevated arousal, or social signaling (threats).  Maternal aggression tends to attack more vulnerable body parts (the belly) as opposed to social aggression (which attacks the back) or defensive aggression (which attacks the face).[33]<\/p>\n\n<p>Female rats become more aggressive against unfamiliar rats during pregnancy, after birth, and during lactation. To a lesser extent, cohabiting with even a sterile male induces increased aggression in female rats.[6]<\/p>\n\n<p>Female social aggression in rats is confined to the living area, unlike social aggression in male rats; a female rat outside her home will not attack a stranger.[6]<\/p>\n\n<p>Female rats need to be stimulated by suckling pups in order to have maternal aggression. Removing nipples doesn\u2019t remove the aggression, but anaesthesia to the ventral skin does, suggesting that the trigger is sensory rather than lactation-related.[10]<\/p>\n\n<p>Lactating female rats, but not alpha male rats, will bury an intruder after attacking it.  Like social aggression and unlike defensive aggression, piloerection is present in both maternal and alpha male attacks on intruders.[55]<\/p>\n\n<p>Maternal aggression in rats is enhanced by oxytocin and vasopressin, as well as GnRH (which increases the release of sex hormones).<\/p>\n\n<p>Blocking oxytocin chemically reduces maternal aggression in high-aggression lactating rats, and adding IV oxytocin increases maternal aggression in low-aggression lactating rats.  Likewise, blocking vasopressin in high-aggression lactating rats reduces maternal aggression, while IV vasopressin in low-aggression lactating rats increases maternal aggression.[11]<\/p>\n\n<p>GnRH antagonists reduce maternal aggression in rats, but not maternal care.[71]<\/p>\n\n<p>Serotonin has a complicated relationship with maternal aggression in rats.<\/p>\n\n<p>Lesions to the serotonin-producing cells in the dorsal raphe reduce both maternal aggression and maternal care in rats, indicating that serotonin is necessary for maternal aggression.[54]<\/p>\n\n<p>Also, fluoxetine (an SSRI) increases maternal aggression in rats relative to controls.[64]<\/p>\n\n<p>On the other hand, serotonergic drugs often decrease maternal aggression, such as  fluprazine [64], amitriptyline[73], and desipramine.[73]<\/p>\n\n<p>In keeping with the finding that stress anticorrelates with maternal aggression, all benzodiazepines (which have anxiolytic effects) increase maternal aggression in rats.[67]<\/p>\n\n<p>The lateral septum is necessary for maternal aggression in rats, and the periaqueductal gray (PAG) inhibits it, as one would expect for a behavior that is negatively associated with anxiety.<\/p>\n\n<p>Lesions to the lateral septum in rats abolish maternal aggression, as well as maternal behavior such as retrieving, licking, and nursing pups.[52]<\/p>\n\n<p>Rats lesioned in the periaqueductal gray (PAG) attack intruders 2x as often as controls.[56]<\/p>\n\n<p>Domestication does not inhibit maternal aggression; wild and domesticated Norway rat strains show no difference in maternal aggression.[77]<\/p>\n\n<p><em>Maternal Aggression in Voles<\/em><\/p>\n\n<p>A nitric oxide synthesis inhibitor reduces maternal aggression in prairie voles.[72]<\/p>\n\n<p>Prairie voles are monogamous, and after pair-bonding, <em>male<\/em> prairie voles become much more aggressive against intruders.  Vasopressin receptor antagonists prevent this increase in aggression, while supplemental vasopressin increases it.[113]<\/p>\n\n<p>It\u2019s possible that male aggression in voles actually is a closer hormonal match to maternal aggression given the pair-bonding aspect.  Consistent with this hypothesis, supplemental testosterone does not increase aggression in male voles[114] and castration does not inhibit aggression.[115]<\/p>\n\n<p><strong>Predatory Aggression<\/strong><\/p>\n\n<p>Predatory aggression is violence against edible prey. It is almost always directed against members of a different species, though some mutations make animals attack conspecifics in ways that resemble predatory aggression.<\/p>\n\n<p>Predation is distinct from social and defensive aggression in that it is <em>stealthy<\/em> (there is no vocalization or threat display, to avoid scaring off the prey) and it is <em>pleasurable rather than stressful<\/em> to the predator.  Predatory behavior is not associated with cortisol response, and it is stimulated by the centers of the brain associated with reward and alertness, rather than the ones associated with fear and pain.<\/p>\n\n<p><em>Predatory Aggression in Baboons<\/em><\/p>\n\n<p>Olive baboons hunt occasionally, mostly hares, gazelles, birds, and other ungulates.  Male olive baboons do most of the killing and eating of prey.[101]<\/p>\n\n<p><em>Predatory Aggression in Cats<\/em><\/p>\n\n<p>Cats can attack other animals in two obviously distinct ways; \u201caffective attack\u201d, which involves hissing, growling, back arching, and piloerection; and \u201cpredatory attack\u201d, in which the cat quietly stalks its prey and does not make aggressive noises or arch its back, and its hair does not stand on end.[12]<\/p>\n\n<p>Cats who are quicker to attack rats are also quicker to approach novel stimuli and slower to avoid threatening stimuli; the reverse is true of cats who are slow to attack rats.  Predatory behavior in cats seems to be related to curiosity and fearlessness.[21]<\/p>\n\n<p>Predatory aggression in cats is stimulated by activity in the lateral hypothalamus and amygdala and inhibited by activity in the periaqueductal gray.<\/p>\n\n<p>Electrical stimulation of the lateral hypothalamus in the cat (the same area that promotes feeding and wakefulness behavior) elicits predatory aggression.[21]<\/p>\n\n<p>Cats lesioned in the amygdala stop killing mice.[48]<\/p>\n\n<p>Lesions in the periaqueductal gray (PAG) lowered the threshold to cats attacking rats when stimulated in the hypothalamus.[43]<\/p>\n\n<p>Gonadectomy in female cats makes them quicker to attack a rat; gonadectomy in male cats makes them slower to attack a rat.  This suggests a positive association between testosterone and predation in cats.[25]<\/p>\n\n<p>The muscarinic agonist arecoline can induce biting attack in the cat; muscarinic antagonists such as scopolamine and atropine block this effect.[62]  Arecoline is the psychoactive ingredient in betel nuts, and in humans causes an effect similar to nicotine \u2013 alertness, energy, euphoria, and relaxation.<\/p>\n\n<p><em>Predatory Aggression in Chimpanzees<\/em><\/p>\n\n<p>There is significant overlap between intraspecific aggression and predation in chimpanzees. They sometimes stalk each other before attacking, and they have been known to eat infant chimpanzees after a fight.[49]<\/p>\n\n<p><em>Predatory Aggression in Foxes<\/em><\/p>\n\n<p>Administration of 5-HT (serotonin) significantly reduced a fox\u2019s likelihood of attacking a rat placed in its cage.[42]<\/p>\n\n<p><em>Predatory Aggression in Mice<\/em><\/p>\n\n<p>Mice kill and eat crickets.  A strain of mice bred for large amounts of voluntary wheel-running had no significant difference from controls in their rates of intermale aggression or maternal aggression, but the wheel-running mice were quicker to attack crickets.  Since wheel-running is a pleasurable activity that mice seek out, this suggests that propensity to kill crickets is associated with reward from active behaviors.  The wheel-running mice were smaller and had more pups than the control mice; serum testosterone levels were the same.[17]<\/p>\n\n<p>The reproductive and hormone status of female mice does not correlate with their propensity to attack crickets, suggesting that predatory and maternal aggression have different physiological bases.  Ovariectomy reduces maternal aggression in mice but does not reduce cricket-killing.<\/p>\n\n<p>A mouse\u2019s sense of smell seems related to its ability to distinguish its own species from others. Abolishing it doesn\u2019t reduce predation, but does cause cannibalism (a mouse \u201cpreying\u201d on its own kind.)<\/p>\n\n<p>Experimentally induced anosmia reduces both maternal aggression and intermale aggression, but not cricket-killing.[19]<\/p>\n\n<p>Olfactory bulbectomy in mice causes cannibalism \u2013 one adult mouse will kill and eat the other, and mothers will eat their young.[48]<\/p>\n\n<p>Similarly, the hormone vasopressin in mice seems to be essential for aggression against other mice, but not for predation against other species.<\/p>\n\n<p>Mice with a disrupted vasopressin receptor, Avpr1b-\/-, have lower intermale aggression, maternal aggression, and defensive biting responses, but the same number of \u201cdefensive avoidance\u201d behaviors (fleeing, boxing).  Predatory aggression against crickets is intact in Avpr1b-\/- mice.  This gene seems to be required for all types of attack responses towards conspecifics, but not to other species.[20]<\/p>\n\n<p>Some neuroactive drugs block mouse predation, including drugs that increase serotonin.<\/p>\n\n<p>Amphetamine, imipramine, and tripelennamine (an antihistamine) block mice from killing frogs.[14]  Serotonergic drugs (imipramine, fluoxetine, 5-HT) inhibit locust-killing in CBA mice[42].<\/p>\n\n<p><em>Predatory Aggression in Minks<\/em><\/p>\n\n<p>If you put a rat in a mink\u2019s cage, it will attack 100% of the time. When given 5-HT (serotonin), only half the minks attacked the rat.[42]<\/p>\n\n<p><em>Predatory Aggression in Primates<\/em><\/p>\n\n<p>Many species of primates engage in some predation, against frogs, lizards, snakes, birds, or monkeys. Almost all use the craniocervical bite, a killing bite to the head or neck of the prey.  The exception is the baboon, which often starts to eat before its prey is dead, perhaps because the baboon\u2019s size and strength allow it to immobilize prey even without immediately killing it.[30]<\/p>\n\n<p><em>Predatory Aggression in Rats<\/em><\/p>\n\n<p>Rats often kill and eat frogs and turtles. Attacks on these animals are probably a better measure of rat predatory aggression than mouse-killing, even though rats do often eat mice as well; mouse-killing seems stimulated by some of the same mechanisms as social aggression and is a less \u201cpure\u201d instance of the class.<\/p>\n\n<p>Testosterone doesn\u2019t affect predatory aggression in rats.<\/p>\n\n<p>When male Wistar rats were tested for whether they would kill a frog (<em>Rana pipens<\/em>) placed in their cage, those who didn\u2019t kill the frog immediately never attacked a frog on subsequent trials. Testosterone injection didn\u2019t induce frog killing.  The rats who did kill frogs learned to kill them faster upon repeated trials, but again testosterone injection had no effect on latency.[13]<\/p>\n\n<p>Testosterone supplementation doesn\u2019t increase frog-killing in female rats either.[15]<\/p>\n\n<p>Some drugs also reduce predatory aggression in rats.<\/p>\n\n<p>Amphetamine blocks rats from killing mice, and not just because it reduces appetite; at low doses, rats are still willing to kill mice even though they don\u2019t want to eat them.  The same is true for frog-killing.[16]<\/p>\n\n<p>Delta-9-cannabinol (the main psychoactive ingredient in cannabis) reduces rats\u2019 frequency of attacking turtles.[45]<\/p>\n\n<p>Some rats attack other rats in ways more akin to predation than social aggression.<\/p>\n\n<p>In strains of rats with abnormally low glucocorticoid function, the lateral hypothalamus is activated during conflicts with other rats. These low-cortisol rats attack other rats on the head, throat, and belly, without any of the usual preliminaries of signaling aggression. In other words, their aggression against conspecifics looks more like predation.  Humans diagnosed with antisocial personality disorder also have lower cortisol levels than average.[33]<\/p>\n\n<p>Rats subjected to post-weaning social isolation also are abnormally aggressive and prone to attack vulnerable regions without intention signaling, again more like predatory or maternal aggression than typical social aggression.[47]<\/p>\n\n<p>As with social aggression and maternal aggression, domestication of rats does not reduce predatory aggression.  Norway rats bred for low aggression towards humans did not show any decline in predatory behavior.[42]<\/p>\n\n<p><em>Predatory Aggression in Voles<\/em><\/p>\n\n<p>After 13 generations of selecting bank voles for higher rates of predatory behavior, raising the rate of predatory behavior 5x relative to controls, the two highest SNPs found in the predatory lines were in the gene PDE4D, found expressed in the brain. PDE4D is responsible for degrading cAMP.  PDE4D inhibitors have antidepressant effects.[46]<\/p>\n\n<p><strong>Mobbing<\/strong><\/p>\n\n<p>Mobbing refers to behaviors by groups of prey animals to approach, intently observe, harass, and attack a predator or other large member of another species.  Mobbing is common in primates, particularly New World monkeys.<\/p>\n\n<p>Baboons, geladas, and chimpanzees launch aggressive counterattacks that can seriously wound predators; e.g. baboons often kill leopards.  Arboreal New World monkeys like tamarins and capuchins, by contrast, tend to lunge, jump, and make stereotyped threat behaviors when a predator (such as a snake) has captured one of them.  Where mobbing does not pose a lethal threat to the predator, it may be an attempt to get the predator to move on, as well as monitoring the threat. But capuchins also mob non-threatening, non-prey animals, and the reason why is unknown.[31]<\/p>\n\n<p><strong>Parallels to Human Aggression<\/strong><\/p>\n\n<p>The criminology literature tends to make a single distinction in types of aggression \u2013 \u201creactive\u201d aggression, a spontaneous, \u201chair-trigger\u201d loss of self-control in response to frustration or provocation, or \u201cpredatory\u201d aggression, a deliberate behavior engaged in to achieve a desired goal. Acts of \u201creactive\u201d aggression are done under stress; acts of \u201cpredatory\u201d aggression are done calmly and strategically, and may even be enjoyable.  The analogy between \u201cpredatory\u201d aggression in humans and literal predation in animals is loose, and based primarily on the fact that both involve low cortisol and are not associated with strong negative emotions.<\/p>\n\n<p>\u201cReactive\u201d aggression in this criminology paradigm would seem to correspond either with \u201cdefensive\u201d or \u201csocial\u201d aggression \u2013 they\u2019re not clearly delineated.<\/p>\n\n<p>Children with a history of aggressive behavior have been observed to cluster into two types. One type of child engages only in \u201cimpulsive\u201d or \u201creactive\u201d aggression. A second type of child engages both in this \u201cimpulsive\u201d aggression and in \u201cpremeditated\u201d\/ \u201cpro-active\u201d aggression.<\/p>\n\n<p>Children in the \u201cimpulsive\u201d group were more likely to have low IQs and schizophrenia diagnoses; children in the \u201cmixed\u201d group were more likely to have a history of drug abuse.  [12]<\/p>\n\n<p>In studies of juvenile offenders, \u201cpremeditated\u201d\/\u201dinstrumental\u201d aggression was reported to be a better predictor of future criminality than \u201creactive\u201d aggression.[12]<\/p>\n\n<p>In studies of men who battered their wives, some men\u2019s heart rate rises during marital conflict, and some men\u2019s heart rate lowers.  The low-heart-rate group was more likely to have a history of violence outside the marriage, more likely to have a drug dependence, and more likely to have antisocial and aggressive-sadistic characteristics.[12]<\/p>\n\n<p>Human hunter-gatherers rarely engage in spontaneous \u201creactive\u201d aggression, while chimpanzees and bonobos engage in conflict three orders of magnitude more often. An unusually high-violence group of Australian aborigines, plagued by poverty and alcoholism, was observed by ethnographers to engage in violence 0.005 times per 100 hours per individual, compared to 1-3 times per 100 hours per individual for chimpanzees and bonobos.  In other words, human hunter-gatherers spend at least 1000x less time than apes in violent squabbles with members of their community.[32]<\/p>\n\n<p>On the other hand, human hunter-gatherers engage in hostile raids and ambushes that are deadlier than anything other primates do.  Compared to our nearest primate neighbors, we have extremely low rates of reactive aggression and extremely high rates of proactive (premeditated) aggression.[32]<\/p>\n\n<p>When animals such as dogs are bred for tameness, it is chiefly defensive aggression that is selected against (since we are selecting primarily for lack of violence against humans, who are neither prey nor conspecifics).  Hominid facial morphology has changed in the same way as dog facial morphology, and we have developed a longer developmental period, prolonged play, and cooperative communication, similar to the \u201cdomestication syndrome\u201d in other animals.<\/p>\n\n<p>Some hypothesize that have \u201cbred ourselves\u201d for tameness starting about 200,000 years ago, perhaps through capital punishment of reactively-aggressive, antisocial individuals.  Capital punishment appears to be a human universal, and in hunter-gatherer societies it is typically antisocial males with a history of selfish violence who are executed.  Capital punishment itself, of course, is an example of <em>proactive<\/em> aggression \u2013 carefully planned and calmly premeditated.[32]<\/p>\n\n<p>Chimpanzees have a lower death rate from intergroup aggression than human subsistence farmers, but comparable to human subsistence hunter-gatherers, based on 33 human groups from around the world.[99]<\/p>\n\n<p><strong>Generalizations &amp; Speculations<\/strong><\/p>\n\n<p>Defensive aggression is pretty clearly a response to fear and pain, which belongs in the same category with other behaviors like fleeing, hiding, freezing, cowering (protecting vulnerable body parts), and fawning (submission signals.)  It is an <em>agitated, reactive, and non-strategic<\/em> form of aggression, as you can see from the fact that it is relatively ineffective at harming the opponent, and that often an animal in pain will \u201ctake its frustration out on\u201d any nearby animals or inanimate objects, regardless of whether they caused the pain. Human experiences like frustration, irritability, or \u201cdefensiveness\u201d are probably manifestations of defensive aggression.<\/p>\n\n<p>Translating social aggression into the human realm is more complicated. It seems clearly related to testosterone, competition, and status conflict, as well as protecting valuable resources (like territory, food, or mates), all of which of course humans do.  But it\u2019s unclear to me what the <em>subjective feeling<\/em> is that corresponds with social aggression.  Even valence is unclear \u2013 is engaging in social aggression pleasant or unpleasant for animals?<\/p>\n\n<p>The lateral hypothalamus is generally considered a pleasure center (or at least a \u201creward-seeking\u201d center), and stimulating it makes rhesus monkeys much more socially aggressive, suggesting that they are in a \u201cseeking\u201d, eager mood when they start fights; the amygdala is associated with fear, and amygdalectomized monkeys are passive and placid and never fight back.  So, at least, social aggression is associated with energetic, urgent feelings, but it seems to be a mix or an ambiguous relationship between fear and pleasure-seeking.<\/p>\n\n<p>Maternal aggression is very clearly associated with <em>fearlessness<\/em> and the <em>absence of stress<\/em>.  It is a calm, non-agitated, deadly type of aggression.  It\u2019s not otherwise clear to me what it \u201cfeels like from the inside\u201d, though, or what situations (if any) apart from defending young children it would arise in.<\/p>\n\n<p>Predatory aggression has a very consistent psychological profile \u2013 it\u2019s alert, calm, focused, and eager.  It is a strategic and goal-directed kind of aggression, very effective at killing.  In humans, it probably shows up during literal hunting (we are a predatory species after all), as well as in strategic types of conflict such as warfare.  It seems to have a lot in common with the \u201cflow state\u201d of enjoyable, focused, trance-like absorption in a stimulating activity, which humans also engage in through nonviolent activities such as games and skilled work.<\/p>\n\n<p>Animal domestication selectively breeds animals for reduced defensive aggression, while preserving other types of aggression (social, maternal, and predatory.)  Tame animals are less fearful and skittish around new objects and surprising encounters, less likely to either flee or fight out of fear or irritation.<\/p>\n\n<p>Human evolution, our own \u201cdomestication\u201d, probably did the same thing; we have drastically fewer impulsive, irritable violent reactions to our neighbors than other primates, but probably equal motivation for defending our children and competing for social status, and <em>greater<\/em> skill than any of our primate relatives in forms of organized violence such as hunting and warfare.<\/p>\n\n<p>Among contemporary humans, showing frustration is viewed as a sign of weakness, but being calmly dangerous can earn respect. We admire predatory (and social) aggression, but disdain defensive aggression.<\/p>\n\n<p>As far as hormones go, serotonin seems to clearly correlate with what might be termed \u201ccontentment\u201d or \u201csatiety.\u201d It reduces motivation to hunt and to engage in social aggression, reliably across animals.  High serotonin levels correlate with and even cause dominant social rank; the very most dominant individuals in a hierarchy are typically <em>less<\/em> violent, or less severely violent, than the mid-rank individuals, presumably because they\u2019re so high status they don\u2019t have to fight much.<\/p>\n\n<p>Testosterone seems to increase motivation to engage in <em>both<\/em> social aggression and social submission, while progesterone inhibits both aggression and submission.  This is contrary to the stereotype of submission as \u201cunmanly\u201d.<\/p>\n\n<p>Perhaps testosterone increases motivation to engage in <em>all<\/em> social-status-related activities, both fighting and submission, while serotonin has a somewhat independent effect, such that low serotonin increases aggression but not submission.<\/p>\n\n<p><strong>References<\/strong><\/p>\n\n<p>[1]Albert, Frank W., et al. \u201cPhenotypic differences in behavior, physiology and neurochemistry between rats selected for tameness and for defensive aggression towards humans.\u201d Hormones and behavior 53.3 (2008): 413-421.<\/p>\n\n<p>[2]Vergnes, Marguerite, Antoine Depaulis, and Any Boehrer. \u201cParachlorophenylalanine-induced serotonin depletion increases offensive but not defensive aggression in male rats.\u201d <em>Physiology &amp; behavior<\/em> 36.4 (1986): 653-658.<\/p>\n\n<p>[3]Blanchard, Robert J., et al. \u201cFear and aggression in the rat.\u201d <em>Aggressive Behavior<\/em> 10.4 (1984): 309-315.<\/p>\n\n<p>[4]Blanchard, Robert J., and D. Caroline Blanchard. \u201cAggressive behavior in the rat.\u201d <em>Behavioral biology<\/em> 21.2 (1977): 197-224.<\/p>\n\n<p>[5]Kruk, Menno R. \u201cEthology and pharmacology of hypothalamic aggression in the rat.\u201d <em>Neuroscience &amp; Biobehavioral Reviews<\/em> 15.4 (1991): 527-538.<\/p>\n\n<p>[6]Albert, D. J., R. H. Jonik, and M. L. Walsh. \u201cHormone-dependent aggression in male and female rats: experiential, hormonal, and neural foundations.\u201d <em>Neuroscience &amp; Biobehavioral Reviews<\/em> 16.2 (1992): 177-192.<\/p>\n\n<p>[7]Flannelly, Kevin J., et al. \u201cCopulation increases offensive attack in male rats.\u201d <em>Physiology &amp; behavior<\/em> 29.2 (1982): 381-385.<\/p>\n\n<p>[8]Blanchard, Robert J., Kevin J. Flannelly, and D. Caroline Blanchard. \u201cLife-span studies of dominance and aggression in established colonies of laboratory rats.\u201d <em>Physiology &amp; behavior<\/em> 43.1 (1988): 1-7.<\/p>\n\n<p>[9]Mustaca, Alba E., Cristina Mart\u00ednez, and Mauricio R. Papini. \u201cSurprising nonreward reduces aggressive behavior in rats.\u201d <em>International Journal of Comparative Psychology<\/em> 13.1 (2000).<\/p>\n\n<p>[10]Bosch, Oliver J., and Inga D. Neumann. \u201cBoth oxytocin and vasopressin are mediators of maternal care and aggression in rodents: from central release to sites of action.\u201d <em>Hormones and behavior<\/em> 61.3 (2012): 293-303.<\/p>\n\n<p>[11]Bosch, Oliver J. \u201cMaternal aggression in rodents: brain oxytocin and vasopressin mediate pup defence.\u201d <em>Philosophical Transactions of the Royal Society B: Biological Sciences<\/em> 368.1631 (2013): 20130085.<\/p>\n\n<p>[12]McEllistrem, Joseph E. \u201cAffective and predatory violence: A bimodal classification system of human aggression and violence.\u201d <em>Aggression and violent behavior<\/em> 10.1 (2004): 1-30.<\/p>\n\n<p>[13]Bernard, Bruce K. \u201cFrog killing (ranacide) in the male rat: lack of effect of hormonal manipulations.\u201d <em>Physiology &amp; behavior<\/em> 12.3 (1974): 405-408.<\/p>\n\n<p>[14]Barr, Gordon A., K. E. Moyer, and Judith L. Gibbons. \u201cEffects of imipramine, d-amphetamine, and tripelennamine on mouse and frog killing by the rat.\u201d <em>Physiology &amp; Behavior<\/em> 16.3 (1976): 267-269.<\/p>\n\n<p>[15]Bernard, Bruce K. \u201cTestosterone manipulations: effects on ranacide aggression and brain monoamines in the adult female rat.\u201d <em>Pharmacology Biochemistry and Behavior<\/em> 4.1 (1976): 59-65.<\/p>\n\n<p>[16]Gay, Patricia E., et al. \u201cThe effects of d-amphetamine on prey killing and prey eating in the rat and mouse.\u201d <em>Bulletin of the Psychonomic Society<\/em> 10.5 (1977): 385-388.<\/p>\n\n<p>[17]Gammie, Stephen C., et al. \u201cPredatory aggression, but not maternal or intermale aggression, is associated with high voluntary wheel-running behavior in mice.\u201d <em>Hormones and behavior<\/em> 44.3 (2003): 209-221.<\/p>\n\n<p>[18]Weinshenker, Naomi J., and Allan Siegel. \u201cBimodal classification of aggression: affective defense and predatory attack.\u201d <em>Aggression and Violent Behavior<\/em> 7.3 (2002): 237-250.<\/p>\n\n<p>[19]Al-Maliki, Sami, and Paul F. Brain. \u201cA comparison of effects of simple experimental manipulations on fighting generated by breeding activity and predatory aggression in\u2019TO\u2019strain mice.\u201d <em>Behaviour<\/em> 69.3-4 (1979): 183-199.<\/p>\n\n<p>[20]Wersinger, Scott R., et al. \u201cDisruption of the vasopressin 1b receptor gene impairs the attack component of aggressive behavior in mice.\u201d <em>Genes, Brain and Behavior<\/em> 6.7 (2007): 653-660.<\/p>\n\n<p>[21]Siegel, Allan, and Majid B. Shaikh. \u201cThe neural bases of aggression and rage in the cat.\u201d <em>Aggression and Violent Behavior<\/em> 2.3 (1997): 241-271.<\/p>\n\n<p>[22]Shaikh, Majid B., Anda Steinberg, and Allan Siegel. \u201cEvidence that substance P is utilized in medial amygdaloid facilitation of defensive rage behavior in the cat.\u201d <em>Brain research<\/em> 625.2 (1993): 283-294.<\/p>\n\n<p>[23]Schubert, Kristie, et al. \u201cDifferential effects of ethanol on feline rage and predatory attack behavior: an underlying neural mechanism.\u201d <em>Alcoholism: Clinical and Experimental Research<\/em> 20.5 (1996): 882-889.<\/p>\n\n<p>[24]Panksepp, Jaak, and Margaret R. Zellner. \u201cTowards a neurobiologically based unified theory of aggression.\u201d <em>REVUE INTERNATIONALE DE PSYCHOLOGIE SOCIALE.<\/em> 17 (2004): 37-62.<\/p>\n\n<p>[25]Inselman-Temkin, Barbara R., and John P. Flynn. \u201cSex-dependent effects of gonadal and gonadotropic hormones on centrally-elicited attack in cats.\u201d <em>Brain Research<\/em> 60.2 (1973): 393-410.<\/p>\n\n<p>[26]Lipp, Hanspeter P. \u201cAggression and flight behaviour of the marmoset monkey Callithrix jacchus: an ethogram for brain stimulation studies.\u201d <em>Brain, Behavior and Evolution<\/em> 15.4 (1978): 241-259.<\/p>\n\n<p>[27]Lipp, Hanspeter P., and R. W. Hunsperger. \u201cThreat, Attack and Flight Elicited by Electrical Stimulation of the Ventromedial Hypothalamus of the Marmoset Monkey Callithrix jacchus; pp. 276\u2013293.\u201d <em>Brain, behavior and evolution<\/em> 15.4 (1978): 276-293.<\/p>\n\n<p>[28]Higley, J. Dee, et al. \u201cCerebrospinal fluid monoamine and adrenal correlates of aggression in free-ranging rhesus monkeys.\u201d <em>Archives of General Psychiatry<\/em> 49.6 (1992): 436-441.<\/p>\n\n<p>[29]Azrin, Nathan H., R. Rv Hutchinson, and R. D. Sallery. \u201cPAIN\u2010AGGRESSION TOWARD INANIMATE OBJECTS 1.\u201d <em>Journal of the Experimental Analysis of Behavior<\/em> 7.3 (1964): 223-228.<\/p>\n\n<p>[30]Steklis, Horst D., and Glenn E. King. \u201cThe craniocervical killing bite: Toward an ethology of primate predatory behavior.\u201d <em>Journal of Human Evolution<\/em> 7.7 (1978): 567-581.<\/p>\n\n<p>[31]Crofoot, Margaret C. \u201cWhy mob? Reassessing the costs and benefits of primate predator harassment.\u201d <em>Folia primatologica<\/em> 83.3-6 (2012): 252-273.<\/p>\n\n<p>[32]Wrangham, Richard W. \u201cTwo types of aggression in human evolution.\u201d <em>Proceedings of the National Academy of Sciences<\/em> 115.2 (2018): 245-253.<\/p>\n\n<p>[33]Haller, J\u00f3zsef. \u201cThe role of the lateral hypothalamus in violent intraspecific aggression\u2014The glucocorticoid deficit hypothesis.\u201d <em>Frontiers in systems neuroscience<\/em> 12 (2018): 26.<\/p>\n\n<p>[34]Albers, GE Demas MA Cooper HE, and K. K. Soma. \u201c8 Novel Mechanisms Underlying Neuroendocrine Regulation of Aggression: A Synthesis of Rodent, Avian, and Primate Studies.\u201d (2007).<\/p>\n\n<p>[35]Miller, G. M., et al. \u201cA mu-opioid receptor single nucleotide polymorphism in rhesus monkey: association with stress response and aggression.\u201d Molecular psychiatry 9.1 (2004): 99-108.<\/p>\n\n<p>[36]J\u00fcrgens, Uwe, et al. \u201cVocalization in the squirrel monkey (Saimiri sciureus) elicited by brain stimulation.\u201d <em>Experimental brain research<\/em> 4.2 (1967): 114-117.<\/p>\n\n<p>[37]Higley, J. Dee, et al. \u201cCerebrospinal fluid monoamine and adrenal correlates of aggression in free-ranging rhesus monkeys.\u201d <em>Archives of General Psychiatry<\/em> 49.6 (1992): 436-441.<\/p>\n\n<p>[38]Raleigh, Michael J., et al. \u201cSerotonergic mechanisms promote dominance acquisition in adult male vervet monkeys.\u201d <em>Brain research<\/em> 559.2 (1991): 181-190.<\/p>\n\n<p>[39]Robinson, Bryan W., Margery Alexander, and Glenda Bowne. \u201cDominance reversal resulting from aggressive responses evoked by brain telestimulation.\u201d <em>Physiology &amp; Behavior<\/em> 4.5 (1969): 749-752.<\/p>\n\n<p>[40]Rose, Robert M., John W. Holaday, and Irwin S. Bernstein. \u201cPlasma testosterone, dominance rank and aggressive behaviour in male rhesus monkeys.\u201d <em>Nature<\/em> 231.5302 (1971): 366-368.<\/p>\n\n<p>[41]Rosvold, H. Enger, Allan F. Mirsky, and Karl H. Pribram. \u201cInfluence of amygdalectomy on social behavior in monkeys.\u201d <em>Journal of comparative and physiological psychology<\/em> 47.3 (1954): 173.<\/p>\n\n<p>[42]Nikulina, Ella M. \u201cNeural control of predatory aggression in wild and domesticated animals.\u201d <em>Neuroscience &amp; Biobehavioral Reviews<\/em> 15.4 (1991): 545-547.<\/p>\n\n<p>[43]Manchanda, S. K., et al. \u201cPredatory aggression induced by hypothalamic stimulation: modulation by midbrain periaqueductal gray (PAG).\u201d <em>Neurobiology (Budapest, Hungary)<\/em> 3.3-4 (1995): 405.<\/p>\n\n<p>[44]McDonough Jr, J. H., F. J. Manning, and To F. Elsmore. \u201cReduction of predatory aggression of rats following administration of delta-9-tetrahydrocannabinol.\u201d <em>Life Sciences<\/em> 11.3 (1972): 103-111.<\/p>\n\n<p>[45]McDonough Jr, J. H., F. J. Manning, and To F. Elsmore. \u201cReduction of predatory aggression of rats following administration of delta-9-tetrahydrocannabinol.\u201d <em>Life Sciences<\/em> 11.3 (1972): 103-111.<\/p>\n\n<p>[46]Konczal, Mateusz, et al. \u201cGenomic response to selection for predatory behavior in a mammalian model of adaptive radiation.\u201d <em>Molecular Biology and Evolution<\/em> 33.9 (2016): 2429-2440.<\/p>\n\n<p>[47]de Boer, Sietse F. \u201cAnimal models of excessive aggression: implications for human aggression and violence.\u201d <em>Current opinion in psychology<\/em> 19 (2018): 81-87.<\/p>\n\n<p>[48]Albert, D. J., and M. L. Walsh. \u201cNeural systems and the inhibitory modulation of agonistic behavior: a comparison of mammalian species.\u201d <em>Neuroscience &amp; Biobehavioral Reviews<\/em> 8.1 (1984): 5-24.<\/p>\n\n<p>[49]Bygott, J. David. \u201cCannibalism among wild chimpanzees.\u201d <em>Nature<\/em> 238.5364 (1972): 410-411.<\/p>\n\n<p>[50]Gammie, Stephen C., et al. \u201cCorticotropin-releasing factor inhibits maternal aggression in mice.\u201d <em>Behavioral neuroscience<\/em> 118.4 (2004): 805.<\/p>\n\n<p>[51]Gammie, Stephen C., et al. \u201cAltered gene expression in mice selected for high maternal aggression.\u201d <em>Genes, Brain and Behavior<\/em> 6.5 (2007): 432-443.<\/p>\n\n<p>[52]Flannelly, Kevin J., et al. \u201cEffects of septal-forebrain lesions on maternal aggression and maternal care.\u201d <em>Behavioral and neural biology<\/em> 45.1 (1986): 17-30.<\/p>\n\n<p>[53]Gammie, Stephen C., et al. \u201cNeurotensin inversely modulates maternal aggression.\u201d <em>Neuroscience<\/em> 158.4 (2009): 1215-1223.<\/p>\n\n<p>[54]Holschbach, M. Allie, Erika M. Vitale, and Joseph S. Lonstein. \u201cSerotonin-specific lesions of the dorsal raphe disrupt maternal aggression and caregiving in postpartum rats.\u201d <em>Behavioural brain research<\/em> 348 (2018): 53-64.<\/p>\n\n<p>[55]Albert, D. J., et al. \u201cMaternal aggression and intermale social aggression: A behavioral comparison.\u201d <em>Behavioural processes<\/em> 14.3 (1987): 267-276.<\/p>\n\n<p>[56]Lonstein, Joseph S., and Judith M. Stern. \u201cRole of the midbrain periaqueductal gray in maternal nurturance and aggression: c-fos and electrolytic lesion studies in lactating rats.\u201d <em>Journal of Neuroscience<\/em> 17.9 (1997): 3364-3378.<\/p>\n\n<p>[57]Siegel, Allan, and Kristie Schubert. \u201cNeurotransmitters regulating feline aggressive behavior.\u201d <em>Reviews in the Neurosciences<\/em> 6.1 (1995): 47-62.<\/p>\n\n<p>[58]Czoty, Paul W., Robert W. Gould, and Michael A. Nader. \u201cRelationship between social rank and cortisol and testosterone concentrations in male cynomolgus monkeys (Macaca fascicularis).\u201d <em>Journal of neuroendocrinology<\/em> 21.1 (2009): 68-76.<\/p>\n\n<p>[59]Stavisky, R. C., et al. \u201cDominance, cortisol, and behavior in small groups of female cynomolgus monkeys (Macaca fascicularis).\u201d <em>Hormones and Behavior<\/em> 39.3 (2001): 232-238.<\/p>\n\n<p>[60]McGuire, Michael T., Gary L. Brammer, and Michael J. Raleigh. \u201cResting cortisol levels and the emergence of dominant status among male vervet monkeys.\u201d <em>Hormones and behavior<\/em> 20.1 (1986): 106-117.<\/p>\n\n<p>[61]Anestis, Stephanie F. \u201cBehavioral style, dominance rank, and urinary cortisol in young chimpanzees (Pan troglodytes).\u201d <em>Behaviour<\/em> 142.9-10 (2005): 1245-1268.<\/p>\n\n<p>[62]Siegel, Allan, et al. \u201cNeuropharmacology of brain-stimulation-evoked aggression.\u201d <em>Neuroscience &amp; Biobehavioral Reviews<\/em> 23.3 (1999): 359-389.<\/p>\n\n<p>[63]Farrokhi, Catherine, et al. \u201cEffects of the CRF1 antagonist SSR125543A on aggressive behaviors in hamsters.\u201d <em>Pharmacology Biochemistry and Behavior<\/em> 77.3 (2004): 465-469.<\/p>\n\n<p>[64]Johns, Josephine M., et al. \u201cThe effects of dopaminergic\/serotonergic reuptake inhibition on maternal behavior, maternal aggression, and oxytocin in the rat.\u201d <em>Pharmacology Biochemistry and Behavior<\/em> 81.4 (2005): 769-785.<\/p>\n\n<p>[65]Olivier, Berend, Jan Mos, and Ruud Van Oorschot. \u201cMaternal aggression in rats: effects of chlordiazepoxide and fluprazine.\u201d <em>Psychopharmacology<\/em> 86.1-2 (1985): 68-76.<\/p>\n\n<p>[66]Trainor, Brian C., M. Sima Finy, and Randy J. Nelson. \u201cPaternal aggression in a biparental mouse: Parallels with maternal aggression.\u201d <em>Hormones and behavior<\/em> 53.1 (2008): 200-207.<\/p>\n\n<p>[67]Mos, Jan, and Berend Olivier. \u201cQuantitative and comparative analyses of pro-aggressive actions of benzodiazepines in maternal aggression of rats.\u201d <em>Psychopharmacology<\/em> 97.2 (1989): 152-153.<\/p>\n\n<p>[67]Mann, Martha A., and Bruce Svare. \u201cPrenatal testosterone exposure elevates maternal aggression in mice.\u201d <em>Physiology &amp; Behavior<\/em> 30.4 (1983): 503-507.<\/p>\n\n<p>[68]Mann, Martha A., and Bruce Svare. \u201cPrenatal testosterone exposure elevates maternal aggression in mice.\u201d <em>Physiology &amp; Behavior<\/em> 30.4 (1983): 503-507.<\/p>\n\n<p>[69]Yoshimura, Hiroyuki, and Nobuya Ogawa. \u201cAcute and chronic effects of psychotropic drugs on maternal aggression in mice.\u201d <em>Psychopharmacology<\/em> 97.3 (1989): 339-342.<\/p>\n\n<p>[70]Ieni, John R., and John B. Thurmond. \u201cMaternal aggression in mice: effects of treatments with PCPA, 5-HTP and 5-HT receptor antagonists.\u201d <em>European journal of pharmacology<\/em> 111.2 (1985): 211-220.<\/p>\n\n<p>[71]Bayerl, Doris S., Stefanie M. Klampfl, and Oliver J. Bosch. \u201cMore than reproduction: Central gonadotropin\u2010releasing hormone antagonism decreases maternal aggression in lactating rats.\u201d <em>Journal of neuroendocrinology<\/em> 31.9 (2019): e12709.<\/p>\n\n<p>[72]Gammie, Stephen C., Uade B. Olaghere-da Silva, and Randy J. Nelson. \u201c3-Bromo-7-nitroindazole, a neuronal nitric oxide synthase inhibitor, impairs maternal aggression and citrulline immunoreactivity in prairie voles.\u201d <em>Brain Research<\/em> 870.1-2 (2000): 80-86.<\/p>\n\n<p>[73]Cox, Elizabeth Thomas, et al. \u201cCombined norepinephrine\/serotonergic reuptake inhibition: effects on maternal behavior, aggression, and oxytocin in the rat.\u201d <em>Frontiers in psychiatry<\/em> 2 (2011): 34.<\/p>\n\n<p>[74]Harrison, Robert J., et al. \u201cChronic anabolic-androgenic steroid treatment during adolescence increases anterior hypothalamic vasopressin and aggression in intact hamsters.\u201d <em>Psychoneuroendocrinology<\/em> 25.4 (2000): 317-338.<\/p>\n\n<p>[75]Lynch, W. C., L. Libby, and H. F. Johnson. \u201cNaloxone inhibits intermale aggression in isolated mice.\u201d <em>Psychopharmacology<\/em> 79.4 (1983): 370-371.<\/p>\n\n<p>[76]Veenema, Alexa H., et al. \u201cLow inborn anxiety correlates with high intermale aggression: link to ACTH response and neuronal activation of the hypothalamic paraventricular nucleus.\u201d <em>Hormones and behavior<\/em> 51.1 (2007): 11-19.<\/p>\n\n<p>[77]Price, Edward O., and Paul L. Belanger. \u201cMaternal behavior of wild and domestic stocks of Norway rats.\u201d <em>Behavioral Biology<\/em> 20.1 (1977): 60-69.<\/p>\n\n<p>[78]Abel, Ernest L. \u201cCannabis and aggression in animals.\u201d <em>Behavioral biology<\/em> 14.1 (1975): 1-20.<\/p>\n\n<p>[79]Eichelman, Burr S. \u201cEffect of subcortical lesions on shock-induced aggression in the rat.\u201d <em>Journal of Comparative and Physiological Psychology<\/em> 74.3 (1971): 331.<\/p>\n\n<p>[80]Kovacsics, Colleen E., and Todd D. Gould. \u201cShock-induced aggression in mice is modified by lithium.\u201d <em>Pharmacology Biochemistry and Behavior<\/em> 94.3 (2010): 380-386.<\/p>\n\n<p>[81]Eichelman, Burr, and Jack Barchas. \u201cFacilitated shock-induced aggression following antidepressive medication in the rat.\u201d <em>Pharmacology Biochemistry and Behavior<\/em> 3.4 (1975): 601-604.<\/p>\n\n<p>[82]Geyer, Mark A., and David S. Segal. \u201cShock-induced aggression: opposite effects of intraventricularly infused dopamine and norepinephrine.\u201d <em>Behavioral Biology<\/em> 10.1 (1974): 99-104.<\/p>\n\n<p>[83]Cleary, James, Juan Herakovic, and Alan Poling. \u201cEffects of phencyclidine on shock-induced aggression in rats.\u201d <em>Pharmacology Biochemistry and Behavior<\/em> 15.5 (1981): 813-818.<\/p>\n\n<p>[84]Creer, Thomas L., and D. A. Powell. \u201cEffect of repeated shock presentations and different stimulus intensities on shock-induced aggression.\u201d <em>Psychonomic Science<\/em> 24.3 (1971): 133-134.<\/p>\n\n<p>[85]Sands, Jennifer, and Scott Creel. \u201cSocial dominance, aggression and faecal glucocorticoid levels in a wild population of wolves, Canis lupus.\u201d <em>Animal behaviour<\/em> 67.3 (2004): 387-396.<\/p>\n\n<p>[86]Cassidy, Kira A., et al. \u201cSexually dimorphic aggression indicates male gray wolves specialize in pack defense against conspecific groups.\u201d <em>Behavioural processes<\/em> 136 (2017): 64-72.<\/p>\n\n<p>[87]van Kesteren, Freya, et al. \u201cSex, stress and social status: patterns in fecal testosterone and glucocorticoid metabolites in male Ethiopian wolves.\u201d <em>General and comparative endocrinology<\/em> 179.1 (2012): 30-37.<\/p>\n\n<p>[88]Creel, Scott. \u201cDominance, aggression, and glucocorticoid levels in social carnivores.\u201d <em>Journal of Mammalogy<\/em> 86.2 (2005): 255-264.<\/p>\n\n<p>[89]MacLean, Evan L., et al. \u201cEndogenous oxytocin, vasopressin, and aggression in domestic dogs.\u201d <em>Frontiers in psychology<\/em> 8 (2017): 1613.<\/p>\n\n<p>[90]Beehner, Jacinta C., Jane E. Phillips\u2010Conroy, and Patricia L. Whitten. \u201cFemale testosterone, dominance rank, and aggression in an Ethiopian population of hybrid baboons.\u201d <em>American Journal of Primatology: Official Journal of the American Society of Primatologists<\/em> 67.1 (2005): 101-119.<\/p>\n\n<p>[91]Ferris, Craig F., and Michael Potegal. \u201cVasopressin receptor blockade in the anterior hypothalamus suppresses aggression in hamsters.\u201d <em>Physiology &amp; behavior<\/em> 44.2 (1988): 235-239.<\/p>\n\n<p>[92]Ross, Corinna N., and Jeffrey A. French. \u201cFemale marmosets\u2019 behavioral and hormonal responses to unfamiliar intruders.\u201d <em>American Journal of Primatology<\/em> 73.10 (2011): 1072-1081.<\/p>\n\n<p>[93]Girolami, L., et al. \u201cAgonistic behavior, plasma testosterone, and hypothalamic estradiol binding in male rabbits.\u201d <em>Aggressive Behavior: Official Journal of the International Society for Research on Aggression<\/em> 23.1 (1997): 33-40.<\/p>\n\n<p>[94]Emley, Grace S., and Ronald R. Hutchinson. \u201cEffects of phencyclidine on aggressive behavior in squirrel monkeys.\u201d <em>Pharmacology Biochemistry and Behavior<\/em> 18.2 (1983): 163-166.<\/p>\n\n<p>[95]Weerts, Elise M., and Klaus A. Miczek. \u201cPrimate vocalizations during social separation and aggression: effects of alcohol and benzodiazepines.\u201d <em>Psychopharmacology<\/em> 127.1-2 (1996): 255-264.<\/p>\n\n<p>[96]Miczek, Klaus A., et al. \u201cAlcohol, GABA A-benzodiazepine receptor complex, and aggression.\u201d <em>Recent developments in alcoholism<\/em>. Springer, Boston, MA, 2002. 139-171.<\/p>\n\n<p>[97]Sapolsky, Robert M. \u201cThe endocrine stress-response and social status in the wild baboon.\u201d <em>Hormones and behavior<\/em> 16.3 (1982): 279-292.<\/p>\n\n<p>[98]Muller, Martin N., and Richard W. Wrangham. \u201cDominance, aggression and testosterone in wild chimpanzees: a test of the \u2018challenge hypothesis\u2019.\u201d <em>Animal Behaviour<\/em> 67.1 (2004): 113-123.<\/p>\n\n<p>[99]Wrangham, Richard W., Michael L. Wilson, and Martin N. Muller. \u201cComparative rates of violence in chimpanzees and humans.\u201d <em>Primates<\/em> 47.1 (2006): 14-26.<\/p>\n\n<p>[100]Anestis, Stephanie F. \u201cTestosterone in juvenile and adolescent male chimpanzees (Pan troglodytes): Effects of dominance rank, aggression, and behavioral style.\u201d <em>American Journal of Physical Anthropology: The Official Publication of the American Association of Physical Anthropologists<\/em> 130.4 (2006): 536-545.<\/p>\n\n<p>[101]Strum, Shirley C. \u201cPrimate predation: Interim report on the development of a tradition in a troop of olive baboons.\u201d Science 187.4178 (1975): 755-757.<\/p>\n\n<p>[102]Richard, Rebecca, Brandon Boren, and Jeffrey Becker. \u201cThe use of citalopram hydrobromide to manage aggression in a male chimpanzee (pan troglodytes).\u201d <em>Journal of Zoo and Wildlife Medicine<\/em> 50.4 (2020): 1005-1007.<\/p>\n\n<p>[103]Shively, Carol A., et al. \u201cSertraline effects on cerebrospinal fluid monoamines and species-typical socioemotional behavior of female cynomolgus monkeys.\u201d <em>Psychopharmacology<\/em> 231.7 (2014): 1409-1416.<\/p>\n\n<p>[104]Shively, Carol A., Kathleen A. Grant, and Thomas C. Register. \u201cEffects of long-term moderate alcohol consumption on agonistic and affiliative behavior of socially housed female cynomolgus monkeys (Macaca fascicularis).\u201d <em>Psychopharmacology<\/em> 165.1 (2002): 1-8<\/p>\n\n<p>[105]Shively, Carol A., Kathleen A. Grant, and Thomas C. Register. \u201cEffects of long-term moderate alcohol consumption on agonistic and affiliative behavior of socially housed female cynomolgus monkeys (Macaca fascicularis).\u201d <em>Psychopharmacology<\/em> 165.1 (2002): 1-8..<\/p>\n\n<p>[106]Gadeleta, S. J., et al. \u201cA physical, chemical, and mechanical study of lumbar vertebrae from normal, ovariectomized, and nandrolone decanoate-treated cynomolgus monkeys (Macaca fascicularis).\u201d <em>Bone<\/em> 27.4 (2000): 541-550.<\/p>\n\n<p>[107]Michopoulos, Vasiliki, et al. \u201cSocial subordination produces distinct stress-related phenotypes in female rhesus monkeys.\u201d <em>Psychoneuroendocrinology<\/em> 37.7 (2012): 1071-1085.<\/p>\n\n<p>[108]Patton, M. L., et al. \u201cAggression control in a bachelor herd of fringe\u2010eared oryx (Oryx gazella callotis), with melengestrol acetate: Behavioral and endocrine observations.\u201d <em>Zoo Biology: Published in affiliation with the American Zoo and Aquarium Association<\/em> 20.5 (2001): 375-388.<\/p>\n\n<p>[109]Kromrey, Sarah A., et al. \u201cPreclinical laboratory assessments of predictors of social rank in female cynomolgus monkeys.\u201d <em>American journal of primatology<\/em> 78.4 (2016): 402-417.<\/p>\n\n<p>[110]Rearden, John J. \u201cDominance and aggression in the Mongolian gerbil (Meriones unguiculatus).\u201d <em>Psychological reports<\/em> (1974).<\/p>\n\n<p>[111]Pi\u00f1a-Andrade, Sonia, et al. \u201cTestosterone dependent territorial aggression is modulated by cohabitation with a female in male Mongolian gerbils (Meriones unguiculatus).\u201d <em>Hormones and Behavior<\/em> 117 (2020): 104611.<\/p>\n\n<p>[111]Ginsburg, Harvey J., Steve A. Norris, and Gail Hudson. \u201cDelta-9-tetrahydrocannabinol affects consummatory but not appetitive sequence of interspecific aggression in the Mongolian gerbil (Meriones unguiculatus).\u201d <em>Bulletin of the Psychonomic Society<\/em> 10.5 (1977): 361-363.<\/p>\n\n<p>[112]Creel, Scott, David E. Wildt, and Steven L. Monfort. \u201cAggression, reproduction, and androgens in wild dwarf mongooses: a test of the challenge hypothesis.\u201d <em>The American Naturalist<\/em> 141.5 (1993): 816-825.<\/p>\n\n<p>[113]Winslow, James T., et al. \u201cA role for central vasopressin in pair bonding in monogamous prairie voles.\u201d <em>Nature<\/em> 365.6446 (1993): 545-548.<\/p>\n\n<p>[114]Winslow, James T., et al. \u201cA role for central vasopressin in pair bonding in monogamous prairie voles.\u201d <em>Nature<\/em> 365.6446 (1993): 545-548.<\/p>\n\n<p>[115]Demas, Gregory E., et al. \u201cCastration does not inhibit aggressive behavior in adult male prairie voles (Microtus ochrogaster).\u201d <em>Physiology &amp; Behavior<\/em> 66.1 (1999): 59-62.<\/p>\n\n<p>[116]Bertoglio, Leandro Jos\u00e9, Valquiria Camin de Bortoli, and H\u00e9lio Zangrossi Jr. \u201cCholecystokinin-2 receptors modulate freezing and escape behaviors evoked by the electrical stimulation of the rat dorsolateral periaqueductal gray.\u201d <em>Brain research<\/em> 1156 (2007): 133-138.<\/p>\n\n<p>[117]Naganuma, Fumito, et al. \u201cHistamine N-methyltransferase regulates aggression and the sleep-wake cycle.\u201d <em>Scientific reports<\/em> 7.1 (2017): 1-9.<\/p>\n\n<p>[118]De Felipe, Carmen, et al. \u201cAltered nociception, analgesia and aggression in mice lacking the receptor for substance P.\u201d <em>Nature<\/em> 392.6674 (1998): 394-397.<\/p>","author":{"name":{}},"category":{"@attributes":{"term":"lit-review"}},"summary":"Introduction"},{"title":"Chronic Mania and Persistent Euphoric States","link":{"@attributes":{"href":"https:\/\/srconstantin.github.io\/2020\/07\/29\/chronic-mania.html","rel":"alternate","type":"text\/html","title":"Chronic Mania and Persistent Euphoric States"}},"published":"2020-07-29T00:00:00+00:00","updated":"2020-07-29T00:00:00+00:00","id":"https:\/\/srconstantin.github.io\/2020\/07\/29\/chronic-mania","content":"<p>Can a human be happy all the time?<\/p>\n\n<p>Let me clarify; I don\u2019t mean \u201chappiness\u201d in any kind of complex sense. I don\u2019t mean wellbeing or eudaimonia or life satisfaction or anything like that.  I mean <em>being in a good mood<\/em> \u2013 better than good, \u201chigh\u201d, bubbly, enthusiastic.<\/p>\n\n<p>In the psychiatry literature they call this state \u201ceuphoria\u201d or \u201celation.\u201d  It can be produced by recreational drugs, or by placing electrodes in some locations in the brain, or by some brain injuries, or by neurological or psychiatric disorders.  It is common in manic and hypomanic episodes.  And, of course, it is a normal mood that healthy sober people can enter as well.<\/p>\n\n<p>But most euphoric states are transient, and most ways to deliberately induce euphoria don\u2019t work. Morphine, for instance, can produce euphoria, but not continuously for months at a time; you develop tolerance for the drug until the euphoria-producing dose and the fatal dose intersect.  And people who have a stroke of good fortune like <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hedonic_treadmill#Happiness_set_point\">winning the lottery<\/a> don\u2019t stay euphoric forever \u2013 they initially feel great but then <em>adapt<\/em> to their changed circumstances.<\/p>\n\n<p>So, you might ask, is there some kind of negative feedback loop in the brain such that euphoria is <em>always<\/em> temporary?  Is it literally impossible to feel awesome all the time, for months or years at a stretch?<\/p>\n\n<p>Turns out the answer is no.<\/p>\n\n<p>There is something called chronic mania, which is just what it sounds like: a manic state, including euphoria\/elation, which lasts for over 6 months, sometimes forever.<\/p>\n\n<p>The nineteenth-century psychiatrist Emil Kraepelin was the first to give a clinical description of chronic mania, though some modern neurologists think that today those patients would be diagnosed with frontotemporal dementia[1], and in his day, chronic mania was the second most common reason for a patient to be committed to a mental hospital.[2]<\/p>\n\n<p>Apart from the length of their episodes, chronic mania patients differ from bipolar patients in a few systematic ways.  Chronic mania generally doesn\u2019t alternate with depression, and is more likely than bipolar mania to come with an \u201celated mood.\u201d  Chronic mania, compared to bipolar mania, is more likely to come with delusions, especially delusions of grandeur, while bipolar mania is more likely to come with symptoms of psychomotor agitation like tension, pressured speech, loss of sleep, and elevated sex drive.[2] Chronic mania is more likely to begin after age 40.[3]<\/p>\n\n<p>The typical pattern, from case studies, seems to be of a person who may have had transient manic episodes in the past, \u201csettling into\u201d a chronic manic state where they are generally euphoric but out of touch with reality, engaging in reckless, inappropriate, or obnoxious behavior, until they come to the attention of psychiatrists when neighbors or relatives bring them to the hospital.<\/p>\n\n<p><strong>Case Studies<\/strong><\/p>\n\n<p>Kraepelin commented on the behavioral disinhibition and poor impulse control of chronic mania patients:<\/p>\n\n<p>\u201cOnly the coarser enjoyments, eating, drinking, smoking, snuffing, still arouse in them vivid feelings, further the satisfaction of their personal wishes and wants\u2026[they] talk more than their share, swagger, try to gain for themselves all possible little advantage.\u201d[1]<\/p>\n\n<p>He also notes that they engage in hoarding behavior:<\/p>\n\n<p>\u201cThey collect all possible rubbish in their pockets, make a mess with it all round about, rub and wipe things, adorn themselves with rags and scraps of ribbon.\u201d[1]<\/p>\n\n<p>Frederic Wertham, a psychiatrist writing in 1929, described cases of chronic mania that fit the overall pattern.[4]  In all seven cases, the chronic mania began after age 30 (later than the typical onset of bipolar disorder), and in all cases it lasted several years.  In several cases, the patients had previously had briefer manic episodes.<\/p>\n\n<p>Wertham describes traits such as \u201cpressure of activity, great sociability, lack of fatigue, good humor\u201d, \u201cnoisiness and talkativeness\u201d, \u201cbuoyant\u201d and \u201celated\u201d moods, \u201cwild schemes\u201d and delusions (of unrealistic business deals, religious revelations, million-dollar inheritances),  \u201cjoviality and playfulness with jokes and laughing\u201d, \u201cvulgar and profane\u201d language and sexual advances towards nurses.<\/p>\n\n<p>Like Kraepelin\u2019s patients, one of Wertham\u2019s patients collects useless items and decorates herself \u2013 she \u201cwore flowers in her hair and bits of colored wool tied to her buttons\u2026continued decorating herself with little objects.\u201d<\/p>\n\n<p>Wertham notes some patterns: chronic mania patients tend to be middle-aged at onset, tend to have highly sociable and active personalities even before their illness, have no sign of cognitive decline (as you\u2019d expect in dementia), and tend to be heavyset.<\/p>\n\n<p>Similar features show up in more recent case studies of chronic mania: older age, hoarding, delusions, disinhibited behavior.<\/p>\n\n<p>One 68-year-old woman[5] had been in an \u201celevated mood\u201d state for 30 years, during which she increasingly hoarded objects and lived in increasing squalor, refusing all help. She had no sign of dementia or memory loss when tested, and no history of drug abuse. Prior to her illness she had had one depressive episode after the death of her husband, and before that she had been a \u201crather jovial schoolmistress\u201d \u2013 like Wertham\u2019s patients, her baseline personality was cheerful.  She recovered after treatment with lithium.<\/p>\n\n<p>A 65-year-old Indian man had been manic for 48 years,[6] with the onset beginning after a fever at age 12.  He was \u201ccheerful, optimistic, talkative, outgoing, and overly confident,\u201d and became involved in politics with some success. But he also engaged in reckless behavior, traveling by train across India without paying his fare, stealing objects and giving them away to the poor. He \u201cwould often describe himself as a messenger of God with special powers, stating God had created him for the welfare of poor people\u201d.  He couldn\u2019t hold down a job and he was divorced twice, but his mood was \u201cpersistently cheerful or irritable.\u201d  He was eventually hospitalized due to complaints by neighbors and relatives, and recovered after a temporary course of treatment with antipsychotics.<\/p>\n\n<p>A 33-year-old woman who had been manic for 17 years[7] \u201cexpressed grandiose beliefs and evidenced a euphoric mood\u201d, and had been unable to keep a job due to her \u201cover-familiar\u201d behavior.  She had never abused drugs.  \u201cHer parents described her premorbid personality as generally affable, co-operative and creative but occasionally forceful and stubborn.\u201d<\/p>\n\n<p><strong>Chronic Mania and Brain Damage<\/strong><\/p>\n\n<p>A variety of case studies of chronic mania identified a neurological cause.<\/p>\n\n<p>One young woman who had mania-like symptoms since childhood (behavior problems, restlessness, talkativeness, labile and disinhibited mood, sexually provocative behavior starting at adolescence) was found upon radiological examination to have severe degeneration of the cerebellum.[8]<\/p>\n\n<p>Another patient, a young man who had been electrocuted by getting entangled with a wire two years previously, developed manic symptoms of grandiose and persecutory delusions, hallucinations, poor judgment, and increased appetite.[9]<\/p>\n\n<p>A 55-year-old man who had become irritable, extremely sociable, and extravagant with money was found to have an oligodendroglioma, a large brain tumor in the left temporoparietal lobe, and his symptoms improved after surgery.[10]<\/p>\n\n<p>An eight-year-old child who had been ill with polioencephalomyelitis had a marked personality change \u2013 \u201che started talking excessively, singing songs and dancing. The symptoms became worse once he came home. He started talking with relatives, neighbours and strangers, content of talk was how he would act in a movie, how he would build a big house, that he would marry a beautiful lady, etc. He was singing film songs, was going out of the house and it used to be very difficult to locate and bring him back. His appetite was increased, sleep was disturbed. Majority of the time, he was very happy and cheerful.\u201d[11]<\/p>\n\n<p>A patient with a stroke damaging the periventricular zone of the hypothalamus was reported to have developed \u201cpersistent euphoria\u201d, while in another case of brain surgery on the hypothalamus, \u201cevery time the surgeon gently wiped coagulated blood from the ventricle floor the patient burst out laughing, whistled, made jokes, and uttered obscene remarks.\u201d[12]<\/p>\n\n<p>An 81-year-old woman with a stroke in the right thalamus \u201cbecame increasingly euphoric and talkative, and had grandiose delusions\u2026believed that her health was better than ever and joked inappropriately. She also reported a decreased need for sleep.\u201d After treatment with a temporary course of antipsychotics, she recovered but was still \u201cmildly euthymic.\u201d[13]<\/p>\n\n<p>Out  of 66 consecutive patients treated for head trauma, 6 (9%) developed mania[14]. The only lesion location significantly associated with mania was the temporal pole (p = 0.0005), which is also one of the first areas damaged in frontotemporal dementia and Alzheimer\u2019s disease.<\/p>\n\n<p>Compared to patients who developed bipolar disorder after brain injury, patients who developed only mania after brain injury were significantly more likely to have cortical lesions (esp. the orbitofrontal cortex and the right basotemporal cortex.)[15]<\/p>\n\n<p>Another study found that mania after brain injury was \u201cwas associated primarily with orbitofrontal, thatamic, caudate, and basotemporal lesions in the right hemisphere.\u201d[16]<\/p>\n\n<p>The most common locations of lesions for patients with post-stroke mania (out of 74 cases) are the right frontal lobe and basal ganglia. Out of 16 patients who developed mania after a brain tumor, the tumor was in the frontal lobe, temporal lobe, or subcortical limbic structure in 13 patients, and two patients (12.5%) had chronic mania.  [17]<\/p>\n\n<p>One of the symptoms of multiple sclerosis is reported to be euphoria, or \u201ceuphoria sclerotica\u201d, an unusual cheerfulness, optimism, and lack of awareness of their physical disability.<\/p>\n\n<p>In a study of 44 MS patients and 22 healthy controls, 13% of MS patients had euphoria and 13% had disinhibition while no control subjects had either.  There was a significant (p &lt; 0.01) correlation between the degree of euphoria in the MS patients and the severity of frontotemporal degeneration observable on an MRI. [18]<\/p>\n\n<p>Charcot\u2019s original definition of multiple sclerosis in 1873 described \u201cfoolish laughter without cause\u201d as one of the symptoms; Brown and Davis, in their survey of 100 cases in 1926, reported 63% of patients were euphoric.  In an 1986 study of 76 MS patients, 48% were found to be euphoric, and the euphoric patients were more likely than the non-euphoric ones to have a progressive course of disease, to have brain involvement, and to have more severe physical &amp; functional disability.[19]<\/p>\n\n<p>Brain damage can cause mania, including chronic mania, in patients with no psychiatric history, particularly damage to the frontal and temporal lobes. Damage to other locations such as the cerebellum, thalamus, and hypothalamus can also cause mania.  There also seems to be a tendency for mania to be more common as a result of damage to the right brain hemisphere.<\/p>\n\n<p>The frontal and temporal lobes are involved in self-restraint and appropriate behavior, so it\u2019s not surprising that damage to them should cause some of the disinhibitory and compulsive aspects of mania. Apparently, brain damage can also cause persistently euphoric states.<\/p>\n\n<p><strong>Conclusions<\/strong><\/p>\n\n<p>I think we can safely say that it <em>is<\/em> possible for humans to remain in a euphoric state, continuously for months or years on end.  (Often in these case studies the euphoria is punctuated by irritability, but <em>not<\/em> sadness or depressed mood.)<\/p>\n\n<p>Now, most of the examples we know of these prolonged euphoric states are undesirable. They often come with reckless or harmful behavior, delusions, and cognitive impairment.<\/p>\n\n<p>They\u2019re also unpredictable \u2013 some but not all people who get strokes, tumors, or injuries to these brain areas will become manic or otherwise euphoric.<\/p>\n\n<p>But the existence of persistent euphoric states suggests that it could be in principle possible to deliberately induce a long-lasting elevated mood without some of the problematic side effects.<\/p>\n\n<p>It\u2019s a common finding that deep brain stimulation of the nucleus accumbens or subthalamic nucleus can cause transient feelings of euphoria, and sometimes outright manic episodes.[21][22][23][24][25][26][27][28]  However, there is a tolerance effect here \u2013 with continuous stimulation for a year, the same stimulus that initially caused euphoria produced no perceivable effect at 12 months.[29]  It\u2019s not impossible that some variant on this type of electrical stimulation could produce long-term euphoria, though, at a deliberately tuned dose (since higher voltages cause stronger mood effects).  So I\u2019m intrigued by the prospects of developing a form of \u201c<a href=\"https:\/\/qualiacomputing.com\/2016\/08\/20\/wireheading_done_right\/\">wireheading done right<\/a>.\u201d<\/p>\n\n<p><strong>References<\/strong><\/p>\n\n<p>[1]Gambogi, Leandro Boson, et al. \u201cKraepelin\u2019s description of chronic mania: a clinical picture that meets the behavioral variant frontotemporal dementia phenotype.\u201d <em>Arquivos de neuro-psiquiatria<\/em> 74.9 (2016): 775-777.<\/p>\n\n<p>[2]Perugi, Giulio, et al. \u201cChronic mania.\u201d <em>The British journal of psychiatry<\/em> 173.6 (1998): 514-518.<\/p>\n\n<p>[3]Cameron, Kenneth. \u201cChronic mania.\u201d <em>Journal of Mental Science<\/em> 82.340 (1936): 592-594.<\/p>\n\n<p>[4]Wertham, F. I. \u201cA group of benign chronic psychoses: prolonged manic excitements: with a statistical study of age, duration and frequency in 2000 manic attacks.\u201d <em>American Journal of Psychiatry<\/em> 86.1 (1929): 17-78.<\/p>\n\n<p>[5]Fond, G., F. Jollant, and M. Abbar. \u201cThe need to consider mood disorders, and especially chronic mania, in cases of Diogenes syndrome (squalor syndrome).\u201d <em>International psychogeriatrics<\/em> 23.3 (2011): 505.<\/p>\n\n<p>[6]Mendhekar, D. N., et al. \u201cChronic but not resistant mania: a case report.\u201d <em>Acta Psychiatrica Scandinavica<\/em> 109.2 (2004): 147-149.<\/p>\n\n<p>[7]Malhi, G. S., P. B. Mitchell, and G. B. Parker. \u201cRediscovering chronic mania.\u201d <em>Acta Psychiatrica Scandinavica<\/em> 104.2 (2001): 153-156.<\/p>\n\n<p>[8]Cutting, J. C. \u201cChronic mania in childhood: case report of a possible association with a radiological picture of cerebellar disease.\u201d <em>Psychological medicine<\/em> 6.4 (1977): 635-642.<\/p>\n\n<p>[9]Ameen, Shahul, Siddhartha Dutta, and Vinod Kumar Sinha. \u201cElectroencephalogram changes and its improvement with sodium valproate in a patient with electrocution-induced chronic mania.\u201d <em>Bipolar disorders<\/em> 5.3 (2003): 228-229.<\/p>\n\n<p>[10]Rahul, S. A. H. A., and Kiran Jakhar. \u201cOligodendroglioma presenting as chronic mania.\u201d <em>Shanghai archives of psychiatry<\/em> 27.3 (2015): 183.<\/p>\n\n<p>[11]Subrahmanya, B., and Shivaprakash HS Narayana. \u201cCHRONIC MANIA FOLLOWING POLIOENCEPHALOMYELITIS\u2014A CASE REPORT.\u201d <em>Indian journal of psychiatry<\/em> 23.3 (1981): 266.<\/p>\n\n<p>[12]Barbosa, Daniel AN, et al. \u201cThe hypothalamus at the crossroads of psychopathology and neurosurgery.\u201d <em>Neurosurgical focus<\/em> 43.3 (2017): E15.<\/p>\n\n<p>[13]Kulisevsky, Jaime, Marcelo L. Berthier, and Jes\u00fas Pujol. \u201cHemiballismus and secondary mania following a right thalamic infarction.\u201d <em>Neurology<\/em> 43.7 (1993): 1422-1422.<\/p>\n\n<p>[14]Jorge, Ricardo E., et al. \u201cSecondary mania following traumatic brain injury.\u201d <em>American Journal of Psychiatry<\/em> 150 (1993): 916-916.<\/p>\n\n<p>[15]Starkstein, Sergio E., et al. \u201cManic-depressive and pure manic states after brain lesions.\u201d <em>Biological Psychiatry<\/em> 29.2 (1991): 149-158.<\/p>\n\n<p>[16]Robinson, Robert G., et al. \u201cComparison of mania and depression after brain injury: causal factors.\u201d <em>Am J Psychiatry<\/em> 145.2 (1988): 172-178.<\/p>\n\n<p>[17]Satzer, David, and David J. Bond. \u201cMania secondary to focal brain lesions: implications for understanding the functional neuroanatomy of bipolar disorder.\u201d <em>Bipolar Disorders<\/em> 18.3 (2016): 205-220.<\/p>\n\n<p>[18]Diaz-Olavarrieta, Claudia, et al. \u201cNeuropsychiatric manifestations of multiple sclerosis.\u201d <em>The Journal of neuropsychiatry and clinical neurosciences<\/em> 11.1 (1999): 51-57.<\/p>\n\n<p>[19]Rabins, PETER V. \u201cEuphoria in multiple sclerosis.\u201d <em>Neurobehavioral aspects of multiple sclerosis<\/em> (1990): 180-185.<\/p>\n\n<p>[20]Mosley, Philip E., et al. \u201cPersistence of mania after cessation of stimulation following subthalamic deep brain stimulation.\u201d <em>The Journal of neuropsychiatry and clinical neurosciences<\/em> 30.3 (2018): 246-249.<\/p>\n\n<p>[21]Synofzik, Matthis, Thomas E. Schlaepfer, and Joseph J. Fins. \u201cHow happy is too happy? Euphoria, neuroethics, and deep brain stimulation of the nucleus accumbens.\u201d <em>AJOB Neuroscience<\/em> 3.1 (2012): 30-36<\/p>\n\n<p>[22]Haq, Ihtsham U., et al. \u201cSmile and laughter induction and intraoperative predictors of response to deep brain stimulation for obsessive-compulsive disorder.\u201d <em>Neuroimage<\/em> 54 (2011): S247-S255.<\/p>\n\n<p>[23]Anderson, Karen E., and Jake Mullins. \u201cBehavioral changes associated with deep brain stimulation surgery for Parkinson\u2019s disease.\u201d <em>Current neurology and neuroscience reports<\/em> 3.4 (2003): 306-313.<\/p>\n\n<p>[24]Greenberg, Benjamin D., et al. \u201cThree-year outcomes in deep brain stimulation for highly resistant obsessive\u2013compulsive disorder.\u201d <em>Neuropsychopharmacology<\/em> 31.11 (2006): 2384-239<\/p>\n\n<p>[25]Kuhn, Jens, et al. \u201cTransient Manic\u2010like Episode Following Bilateral Deep Brain Stimulation of the Nucleus Accumbens and the Internal Capsule in a Patient With Tourette Syndrome.\u201d <em>Neuromodulation: Technology at the Neural Interface<\/em> 11.2 (2008): 128-131.<\/p>\n\n<p>[26]Mosley, Philip E., et al. \u201cPersistence of mania after cessation of stimulation following subthalamic deep brain stimulation.\u201d _The Journal of neuropsychiatry and clinical neurosciences _30.3<\/p>\n\n<p>[27]Chopra, Amit, et al. \u201cVoltage-dependent mania after subthalamic nucleus deep brain stimulation in Parkinson\u2019s disease: a case report.\u201d <em>Biological psychiatry<\/em> 70.2 (2011): e5-e7.<\/p>\n\n<p>[28]Tsai, Hsin-Chi, et al. \u201cHypomania following bilateral ventral capsule stimulation in a patient with refractory obsessive-compulsive disorder.\u201d <em>Biological psychiatry<\/em> 68.2 (2010): e7-e8.<\/p>\n\n<p>[29]Springer, Utaka S., et al. \u201cLong-term habituation of the smile response with deep brain stimulation.\u201d <em>Neurocase<\/em> 12.3 (2006): 191-196.<\/p>","author":{"name":{}},"category":[{"@attributes":{"term":"lit-review"}},{"@attributes":{"term":"medicine"}}],"summary":"Can a human be happy all the time?"},{"title":"COVID-19 Vaccine Update","link":{"@attributes":{"href":"https:\/\/srconstantin.github.io\/2020\/07\/24\/COVID-19-vaccine-update.html","rel":"alternate","type":"text\/html","title":"COVID-19 Vaccine Update"}},"published":"2020-07-24T00:00:00+00:00","updated":"2020-07-24T00:00:00+00:00","id":"https:\/\/srconstantin.github.io\/2020\/07\/24\/COVID-19-vaccine-update","content":"<p>So far I\u2019ve found 6 vaccine candidates that are reporting positive results from clinical trials.<\/p>\n\n<p>Moderna [1] has been testing an mRNA vaccine called mRNA-1273, consisting of the RNA encoding a portion of the COVID-19 virus\u2019s spike protein, wrapped in a lipid nanoparticle. Their Phase 1 study on 45 healthy adults aged 18-55 found that there was a dose-dependent antibody response (relative to baseline) lasting until the end of the 60-day study, and that all participants\u2019 antibodies were able to neutralize at least 80% of the COVID-19 virus in vitro. The antibodies were as effective at neutralizing virus as those in convalescent plasma from patients who had recovered.<\/p>\n\n<p>AstraZeneca [2] in collaboration with researchers from Oxford University, has been testing a vaccine called ChAdOx1, and has released interim results from a Phase 1 \/ 2 study on 1077 healthy adults aged 18-55. This vaccine is an adenovirus vector expressing the spike protein of the COVID-19 virus.  The trial found that the antibody levels were higher in vaccinated subjects than controls, with a comparable magnitude of antibody response to convalescent plasma, and with the elevated response lasting throughout the 60-day trial. Of the 35 vaccinated patients tested for a neutralizing response, all were able to neutralized COVID-19, while none of the control patients were.<\/p>\n\n<p>A Chinese group [3] also tested a vaccine consisting of an adenovirus vector expressing a part of the COVID-19 virus\u2019 spike protein, on 508 adults aged 18-60. The vaccinated subjects had significantly more antibody response and neutralizing ability than the placebo group. 96-97% of vaccinated subjects had antibodies against spike protein; 59% had neutralizing antibodies.  The vaccine also produced significantly more T-cell response than placebo.<\/p>\n\n<p>A German company, BioNTek, produced another vaccine candidate based on mRNA of a portion of the spike protein, this one attached to a \u201cfoldon\u201d peptide to improve immunogenicity. In an un-peer-reviewed preprint [4] they report an uncontrolled trial on 60 healthy adults age 18-55. Their average antibody response to the virus was significantly higher and more effective at neutralizing COVID-19 than the antibodies in convalescent plasma.<\/p>\n\n<p>Two other biotech companies, Sinovac [5] and Inovio [6], have announced in press releases that their initial human vaccine trials had positive results; Sinovac claims 90% of its vaccinated subjects had neutralizing antibodies and Inovio claims 94% of its vaccinated subjects had an antibody response to the vaccine.  Neither company has released a paper or additional data.<\/p>\n\n<p>Ok, so what does this mean?<\/p>\n\n<p>Looking for antibody response is a pretty standard way to test vaccines.  The purpose of a vaccine is to stimulate the immune system to produce antibodies (and potentially other responses) to the virus, so that when you get the actual virus you\u2019ll be able to produce the right antibodies faster, in greater quantities, and for a greater length of time. So, given that experimental ethics rules make it hard to actually <em>infect<\/em> people with the virus and seeing if the vaccine protects them, researchers usually use antibody response as a proxy.<\/p>\n\n<p>Do the vaccinated subjects <em>produce<\/em> antibodies that actually bind to the viral antigen? How much do they produce?  And do those antibodies <em>neutralize<\/em> the virus, i.e. prevent it from spreading in a petri dish full of cells?<\/p>\n\n<p>Like all proxy metrics, antibody response is not a perfect substitute for finding out what happens in a real world scenario \u2013 in this case, how well the vaccine will protect against infection.  But I think it\u2019s a reasonable proxy to use.<\/p>\n\n<p>The base rates of vaccines that enter clinical trials ultimately getting approved by the FDA are actually not bad \u2013 quite a bit higher than the clinical success rates of other drugs.<\/p>\n\n<p>Based on a dataset of clinical trials between 2000 and 2015, [7] it turns out that vaccines for infectious diseases have an overall success rate of 33.7% from Phase I trials to approval; that is, once a vaccine _enters _ clinical trials, it has about a \u2153 chance of being found safe and effective enough to satisfy the FDA.  For all drugs and vaccines taken as a whole, that number is more like 1\/20.<\/p>\n\n<p>Another study on a clinical trial database ranging from 1995 to 2017 [8] reached a similar conclusion: a vaccine for infectious disease that enters clinical trials has a 31% chance of ultimately reaching approval.<\/p>\n\n<p>The riskiest stage in this process is going from phase 2 to phase 3, which is a 61% probability; Moderna has already passed that test, having begun its phase 3 trial, and now, on priors alone, it has an 80% chance of approval.<\/p>\n\n<p>There\u2019s a more pessimistic number floating around, that says vaccine candidates have only a 6% chance of success, but I don\u2019t think it\u2019s applicable to the current COVID-19 situation.  The number comes from a study [9] that looks at the probability that a _preclinical _vaccine candidate will ultimately be approved \u2013 that means, candidates that have only been tested on animals so far, which are obviously riskier than candidates that showed positive enough results to start testing in humans.  Moreover, that study included vaccines for _noninfectious _diseases in that group, including cancer vaccines, which have a dismal track record.<\/p>\n\n<p>If we\u2019re thinking about how hopeful to be about COVID-19 vaccine candidates, we shouldn\u2019t be lumping them in with chronic disease \u201cvaccines\u201d, which don\u2019t work the same way and aren\u2019t nearly as effective.<\/p>\n\n<p>With as many vaccine candidates as are currently in the pipeline, I think chances are quite good that we\u2019re going to see an approval somewhere.<\/p>\n\n<p>The other big question, though, which _isn\u2019t _going to show up in the clinical success rates, is how well this vaccine is going to work on the elderly.<\/p>\n\n<p>COVID-19 is deadlier the older you get. Also, because immune system function declines with age, vaccines are less effective the older you get. Flu vaccines are basically ineffective on the old. And you don\u2019t need to prove that a vaccine is effective on the elderly to get it approved.<\/p>\n\n<p>Both the Moderna and Oxford vaccine teams are enrolling older adults in trials, so we\u2019ll actually find out how well they work soon enough.<\/p>\n\n<p><strong>References<\/strong><\/p>\n\n<p>[1] Jackson, Lisa A., et al. \u201cAn mRNA Vaccine against SARS-CoV-2\u2014Preliminary Report.\u201d  <em>New England Journal of Medicine<\/em> (202)<\/p>\n\n<p>[2]Folegatti, Pedro M. et al. \u201cSafety and immunogenicity of the ChAdOx1 nCoV-19 vaccine against SARS-CoV-2: a preliminary report of a phase 1\/2, single-blind, randomised controlled trial\u201d <em>The Lancet<\/em> (2020)<\/p>\n\n<p>[3] Zhu, Feng-Cai, et al. \u201cSafety, tolerability, and immunogenicity of a recombinant adenovirus type-5 vectored COVID-19 vaccine: a dose-escalation, open-label, non-randomised, first-in-human trial.\u201d <em>The Lancet<\/em> (2020).<\/p>\n\n<p>[4]Sahin, Ugur, et al. \u201cConcurrent human antibody and TH1 type T-cell responses elicited by a COVID-19 RNA vaccine.\u201d <em>medRxiv,<\/em> 2020<\/p>\n\n<p>[5] <a href=\"https:\/\/www.clinicaltrialsarena.com\/news\/sinovac-coronavac-data\/\">https:\/\/www.clinicaltrialsarena.com\/news\/sinovac-coronavac-data\/<\/a><\/p>\n\n<p>[6] <a href=\"https:\/\/www.statnews.com\/2020\/06\/30\/inovio-claims-positive-results-on-covid-19-vaccine-but-critical-data-are-missing\/\">https:\/\/www.statnews.com\/2020\/06\/30\/inovio-claims-positive-results-on-covid-19-vaccine-but-critical-data-are-missing\/<\/a><\/p>\n\n<p>[7]Wong, Chi Heem, Kien Wei Siah, and Andrew W. Lo. \u201cEstimation of clinical trial success rates and related parameters.\u201d <em>Biostatistics<\/em> 20.2 (2019): 273-286.<\/p>\n\n<p>[8]DiMasi, Joseph A., et al. \u201cDevelopment times and approval success rates for drugs to treat infectious diseases.\u201d <em>Clinical Pharmacology &amp; Therapeutics<\/em> 107.2 (2020): 324-332<\/p>\n\n<p>[9]Pronker, Esther S., et al. \u201cRisk in vaccine research and development quantified.\u201d <em>PloS one<\/em> 8.3 (2013): e57755.<\/p>","author":{"name":{}},"category":[{"@attributes":{"term":"lit-review"}},{"@attributes":{"term":"medicine"}},{"@attributes":{"term":"covid-19"}}],"summary":"So far I\u2019ve found 6 vaccine candidates that are reporting positive results from clinical trials."},{"title":"Moving to New York","link":{"@attributes":{"href":"https:\/\/srconstantin.github.io\/2020\/07\/20\/moving-to-new-york.html","rel":"alternate","type":"text\/html","title":"Moving to New York"}},"published":"2020-07-20T00:00:00+00:00","updated":"2020-07-20T00:00:00+00:00","id":"https:\/\/srconstantin.github.io\/2020\/07\/20\/moving-to-new-york","content":"<p>Well, it\u2019s official \u2013 I\u2019m going to start a new position at the R&amp;D department of <a href=\"https:\/\/nanotronics.co\/\">Nanotronics<\/a>, a company that does automation and AI for manufacturing process control.<\/p>\n\n<p>I\u2019m going to be researching new applications for their core technology, a system that uses machine learning to tune parameters along a manufacturing pipeline \u2013 or to guide a human worker \u2013 to optimize output and quality.  I\u2019m really excited about the possibilities here.  I\u2019ve known some of the Nanotronics people for a long time, and feel lucky to be working with such brilliant and high-integrity folks.<\/p>\n\n<p>The new job is in Brooklyn, so that\u2019s where my family &amp; I are going, at the end of the month. I\u2019d love to catch up with New York friends (and make new ones) \u2013 outside, of course!<\/p>\n\n<p>Does this mean Daphnia Labs is dead?<\/p>\n\n<p>Unfortunately, yes.<\/p>\n\n<p>To recap, I started a company about a year ago with the goal of building an automated platform for drug screening in invertebrates, with the goal of discovering new life-extending drugs.<\/p>\n\n<p>I still think that research thesis should be done, but we weren\u2019t able to make it work as a business. We may have been too early; a new model organism <em>and<\/em> a new technology platform <em>and<\/em> being in the relatively new and controversial field of longevity means we had some skepticism to overcome.  Not to mention we were hit with a global pandemic before we could really get sales off the ground.<\/p>\n\n<p>I\u2019m disappointed that I couldn\u2019t figure out a way to make Daphnia Labs work, but I\u2019m moving on and excited for what lies ahead.<\/p>","author":{"name":{}},"category":{"@attributes":{"term":"personal"}},"summary":"Well, it\u2019s official \u2013 I\u2019m going to start a new position at the R&amp;D department of Nanotronics, a company that does automation and AI for manufacturing process control."},{"title":"Dose-Response Effects of Viral Exposure in COVID-19","link":{"@attributes":{"href":"https:\/\/srconstantin.github.io\/2020\/06\/02\/Dose-Response.html","rel":"alternate","type":"text\/html","title":"Dose-Response Effects of Viral Exposure in COVID-19"}},"published":"2020-06-02T00:00:00+00:00","updated":"2020-06-02T00:00:00+00:00","id":"https:\/\/srconstantin.github.io\/2020\/06\/02\/Dose-Response","content":"<p><img src=\"\/images\/virus-infection.jpg\" alt=\"virus\" \/><\/p>\n\n<p>Does being exposed to a small quantity of SARS-CoV-2 virus result in less severe disease than being exposed to a large quantity?<\/p>\n\n<p>The answer is relevant to how we should respond to COVID-19.<\/p>\n\n<p>If high dose exposures are worse than low-dose exposures, then:<\/p>\n\n<ul>\n  <li>We should consider people who spend a lot of time with infected people, like healthcare workers and family members of COVID-19 patients, to be more at risk than people who get briefly exposed to the virus\n    <ul>\n      <li>Reopening lower-risk public spaces (like outdoor cafes or parks) may be low-risk compared to reopening spaces that involve a lot of close contact (like gyms and nightclubs)<\/li>\n      <li>We should prioritize PPE even <em>more<\/em> for people who regularly interact with COVID-19 patients<\/li>\n    <\/ul>\n  <\/li>\n  <li>Low dose exposure to SARS-CoV-2 may produce immunity without producing serious illness.\n    <ul>\n      <li>If low dose exposure is safe and produces immunity, it may be good for people and available faster than a vaccine can be manufactured and approved.<\/li>\n    <\/ul>\n  <\/li>\n<\/ul>\n\n<p><strong>Bottom Lines<\/strong><\/p>\n\n<p>People who have higher respiratory <em>viral loads<\/em> are significantly more likely to have severe COVID-19; the same pattern held in both the SARS and MERS coronavirus epidemics.  More virus in the body does tend to correspond to more severe disease.<\/p>\n\n<p>There\u2019s far less data about how different forms of <em>exposure<\/em> correlate to disease severity, but there are a few studies pointing towards a greater chance of severe COVID-19 from household contacts than from travel, and one study indicates that mask usage increases the probability that a SARS case will be asymptomatic.  These constitute weak evidence that larger doses of exposure to human coronaviruses cause more severe disease.<\/p>\n\n<p>When human volunteers are experimentally exposed to viruses, some viruses cause more severe symptoms at higher doses, while some viruses don\u2019t.  None of the relevant studies were on coronaviruses, however.<\/p>\n\n<p>In <em>animal<\/em> experimental exposures to virus, higher doses consistently cause more severe symptoms, including in experiments on the coronaviruses SARS, MERS, and PEDV.<\/p>\n\n<p>The available evidence is highly incomplete, but tends towards the conclusion that lower dose exposure to COVID-19 should result in less severe disease.<\/p>\n\n<p><strong>Viral Load in COVID-19<\/strong><\/p>\n\n<p>Here\u2019s a table of studies that compared viral load in mild and severe COVID-19 patients.<\/p>\n\n<table>\n  <tr>\n   <td><strong>N<\/strong>\n   <\/td>\n   <td><strong>Mean Viral Load, Mild<\/strong>\n   <\/td>\n   <td><strong>Mean Viral Load, Severe<\/strong>\n   <\/td>\n   <td><strong>Significance<\/strong>\n   <\/td>\n   <td><strong>Location of Sample<\/strong>\n   <\/td>\n   <td><strong>Context<\/strong>\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>15\n   <\/td>\n   <td>Ct = 25 (n = 6, range 17-32)\n   <\/td>\n   <td>Ct = 27 (n = 9, range 19-33)\n   <\/td>\n   <td>n.s. \n   <\/td>\n   <td>Nasopharyngeal swab\n   <\/td>\n   <td>Private hospital, Mumbai, India[1]\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>92\n   <\/td>\n   <td>Ct = 28 (n = 62, sigma = 0.5)\n   <\/td>\n   <td>Ct = 25 (n = 30, sigma = 0.5)\n   <\/td>\n   <td>p = 0.017\n   <\/td>\n   <td>Sputum\n   <\/td>\n   <td>Zhejiang, China; severe patients older &amp; with more comorbidities but not different exposure histories. [2]\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>96\n   <\/td>\n   <td>4.1 log copies\/mL (n = 22, sigma = 1.4 )\n   <\/td>\n   <td>5.1 log copies\/mL (n = 74, sigma = 1.4)\n   <\/td>\n   <td>p = 0.03\n   <\/td>\n   <td>Sputum (no difference between mild &amp; severe pts  in serum or stool)\n   <\/td>\n   <td>Zhejiang, China; severe patients more likely to be from Wuhan[3]\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>76\n   <\/td>\n   <td>delta-CT = -1.25 (n = 30, sigma = 5.2)\n   <\/td>\n   <td>delta-CT = 4.48(n = 46, sigma = 3.0)\n   <\/td>\n   <td>p &lt; 0.001\n   <\/td>\n   <td>nasopharyngeal\n   <\/td>\n   <td>Nanchang, China; median time from disease onset = 4 days[4]\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>23\n   <\/td>\n   <td>5 log copies\/mL (n = 10, sigma = 2.2)\n   <\/td>\n   <td>6 log copies\/mL (n = 13, sigma = 3.0)\n   <\/td>\n   <td>n.s. \n   <\/td>\n   <td>oropharyngeal\n   <\/td>\n   <td>Hong Kong[5]; mild &amp; severe patients had similar duration of illness at admission, age, sex, &amp; comorbidities\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>12\n   <\/td>\n   <td>Ct = 35.2 (n = 10, sigma = 5)\n   <\/td>\n   <td>Ct = 26 (n = 3, sigma = 5.1)\n   <\/td>\n   <td>p = 0.0177\n   <\/td>\n   <td>nasal\n   <\/td>\n   <td>Guangdong, China [6]\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>18\n   <\/td>\n   <td>Ct = 30.9(n = 12, sigma = 5.6)\n   <\/td>\n   <td>Ct = 30.3 (n = 6, sigma = 5.3)\n   <\/td>\n   <td>n.s. \n   <\/td>\n   <td>nasopharyngeal\n   <\/td>\n   <td>Singapore[7]\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>6\n   <\/td>\n   <td>Ct = 39 (n = 2, sigma = 1.2)\n   <\/td>\n   <td>Ct = 39 (n = 4, sigma = 1.1)\n   <\/td>\n   <td>n.s.\n   <\/td>\n   <td>nasopharyngeal\n   <\/td>\n   <td>Chongqing, China; all patients had previously recovered from COVID-19 and had reoccurence of disease.[8]\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>94\n   <\/td>\n   <td>Ct=30 (n = 76, sigma = 5) \n   <\/td>\n   <td>Ct = 30 (n = 18, sigma = 4)\n   <\/td>\n   <td>n.s\n   <\/td>\n   <td>Throat swabs\n   <\/td>\n   <td>Guangzhou, China [9]\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>11\n   <\/td>\n   <td>6.39 log copies\/mL (n = 5, sigma = 0.9)\n   <\/td>\n   <td>6.15 log copies\/mL (n = 6, sigma = 1.6)\n   <\/td>\n   <td>n.s.\n   <\/td>\n   <td>nasopharyngeal\n   <\/td>\n   <td>Hong Kong [10]; first 11 patients diagnosed with COVID-19\n   <\/td>\n  <\/tr>\n  <tr>\n   <td>5\n   <\/td>\n   <td>6.3 log copies\/ 1000 cells (n = 2, sigma = 1.25)\n   <\/td>\n   <td>5.3 log copies\/1000 cells (n = 3, sigma = 2.4)\n   <\/td>\n   <td>n.s.\n   <\/td>\n   <td>nasopharyngeal\n   <\/td>\n   <td>France [11]; patients traveling from Wuhan\n   <\/td>\n  <\/tr>\n<\/table>\n\n<p>Do severe COVID-19 patients have higher viral loads than mild patients?<\/p>\n\n<p>This is a flawed proxy for the question of initial exposure, since patients are usually not tested for COVID-19 until at least several days after infection. Higher viral load could indicate that the virus replicated faster inside the body, or simply that the patients were later in their course of disease, rather than that the initial exposure was lower.<\/p>\n\n<p>Still, the correlation between viral load and disease severity is suggestive as to whether there\u2019s a dose-response effect in COVID-19.<\/p>\n\n<p>Viral load can be measured with Ct, the number of PCR amplification cycles necessary before viral RNA is detectable. Lower Ct numbers mean exponentially more virus.  It can also be measured by delta-Ct, the difference between the number of cycles to detection in a control sample (without virus) and the test sample.  Finally, it can be measured by the absolute concentration of viral particles per mL.  These numbers cannot be directly compared because the sensitivity of RT-PCR equipment varies and isn\u2019t always given in the papers.<\/p>\n\n<p>For all studies measured in Ct value, mean Ct score is 29.6 for mild cases and 26.1 for severe cases; this is a significant effect, p = 0.0004.<\/p>\n\n<p>For the 4 studies measured in absolute concentration, mean concentration was 4.7 log copies\/mL for mild cases and 5.3 log copies\/mL for severe cases, which was not statistically significant, possibly because the sample size was too small.<\/p>\n\n<p>Also note that the two studies which looked at sputum samples both found significant effects, and sputum samples reliably contain more virus RNA than nasopharyngeal samples.  This suggests that viral load in the lungs is more predictive of the amount of lung damage &amp; thus the severity of respiratory illness than viral load in the upper respiratory tract.<\/p>\n\n<p><em>Severe COVID-19 patients have significantly higher initial viral loads than mild COVID-19 patients.<\/em><\/p>\n\n<p><strong>Exposure Effects in COVID-19<\/strong><\/p>\n\n<p>Another question we might ask is whether people with extensive exposure to the virus had more severe illness than people with transient or low-dose exposure.<\/p>\n\n<p>In a study of 36 children with COVID-19, there was no significant difference in disease severity between those who had close contact with a family member with COVID-19 and those who had traveled to an area affected by COVID-19.[12]<\/p>\n\n<p>In 1663 patients with COVID-19 in Wuhan, China, there was no significant difference in severity between those who did and did not have a family member with the disease or exposure to the Wuhan seafood market, but were significantly (p&lt;0.0001) less likely to have severe disease if they were healthcare workers compared to the general population.  On the other hand this may be because healthcare workers are younger (most of the patients were retirees.)[13]<\/p>\n\n<p>In 568 COVID-19 patients in Wuhan, China, there was a nonsignificant trend (p = 0.06) for severe cases to be more likely to have had household exposure to the virus, while non-severe cases were more likely to have had hospital exposure to the virus.[14]<\/p>\n\n<p>In another study of 487 patients with COVID-19 in Zhejiang Province, China, patients with severe disease were significantly less likely to have traveled to an affected area (49.0% vs. 65.1%, p = 0.027) but significantly more likely to be part of a family cluster of three or more patients (10.2% vs. 2.5%).[15]<\/p>\n\n<p>Overall it doesn\u2019t seem that the relationship between disease severity and magnitude of exposure to infected people has been much studied in COVID-19.<\/p>\n\n<p>However we do have two Chinese studies indicating that severe cases of COVID-19 are more common in those who had frequent long-term exposure to other patients (i.e. sharing a household with many other patients) and less likely in those who have had transient contact with patients (as in travel to an epidemic-affected province.)<\/p>\n\n<p><strong>Viral Load in Other Human Coronaviruses<\/strong><\/p>\n\n<p><em>SARS<\/em><\/p>\n\n<p>In 75 SARS patients, there was no difference in the rate of positive viral RNA samples at diagnosis between patients who later developed ARDS and those who did not.[16]<\/p>\n\n<p>In 133 SARS patients, initial viral load was significantly (p = 0.025) associated with developing ARDS, and with shorter survival time (p = 0.006).[17]<\/p>\n\n<p>In 12 SARS patients, viral RNA levels were 30x higher in patients who required ICU admission than in those who didn\u2019t (p &lt; 0.005).[18]<\/p>\n\n<p>In 154 SARS patients, viral load in nasopharyngeal aspirated was associated (p &lt; 0.01) with diarrhea, oxygen desaturation, mechanical ventilation, and death. Death was 54x as likely in patients positive for viral RNA than negative. [19]<\/p>\n\n<p><em>MERS<\/em><\/p>\n\n<p>In 17 MERS patients, viral load was nonsignificantly (p = 0.06) higher in severe than mild cases.[20]<\/p>\n\n<p>In 21 MERS patients, blood positivity for MERS RNA was associated with much lower survival (p = 0.017) and higher rates of needing mechanical ventilation (p = 0.003).  Higher respiratory viral load was not associated with survival.[21]<\/p>\n\n<p>In 14 MERS patients, viral load was not significantly associated with mortality but plasma and respiratory viral loads were significantly higher in severe than mild cases.[22]<\/p>\n\n<p>In 102 MERS patients, respiratory viral titers were significantly (p = 0.0087) higher in patients who died than patients who survived.[23]<\/p>\n\n<p>The evidence seems very consistent that_ higher viral load correlates with more severe and deadly disease_ in both SARS and MERS.<\/p>\n\n<p><strong>Exposure Effects in Other Human Coronaviruses<\/strong><\/p>\n\n<p>Among 80 health care workers in Singapore exposed to SARS, 45 were serologically positive for the virus. Of those 45, healthcare workers were significantly more likely to be asymptomatic (p = 0.025) if they used masks.[24]<\/p>\n\n<p>During the SARS epidemic in Hong Kong, there was no significant association between the risk of death and any disease source (household, hospital, community-acquired, airplane, or none of the above.)[25]<\/p>\n\n<p>In 1649 SARS patients in Beijing, contact with a SARS patient prior to illness was not a significant predictor of mortality.[26]<\/p>\n\n<p>Healthcare workers with confirmed MERS infection were younger, more likely to be female, and less likely to have comorbidities disease than other cases of MERS. They also had significantly (p &lt; 0.001) lower risk of death and higher chance of being asymptomatic.[27]<\/p>\n\n<p>MERS patients have a higher risk of mortality (HR = 2.9, p= 0.001) from hospital-acquired infections as opposed to other routes of infection such as household contacts or camels; even after adjusting for age and comorbidities.[28]<\/p>\n\n<p>Healthcare workers may be exposed to larger doses of SARS or MERS, but it doesn\u2019t show up in increased risk of death or severe disease for healthcare workers, possibly because healthcare workers tend to be younger than other patients.<\/p>\n\n<p>Hospital-acquired MERS infections are more deadly than other sources of infection, but this may be confounded by the fact that patients who are already in hospitals for other reasons tend to be sicker.<\/p>\n\n<p>The one piece of evidence from SARS and MERS that points to low-dose exposure being safer is that wearing masks is more likely to result in asymptomatic SARS infection than not wearing masks.<\/p>\n\n<p><strong>Dose-Response Effects in Other Viruses: Human Studies<\/strong><\/p>\n\n<p>Humans have been experimentally exposed to viruses (usually with milder effects than SARS or MERS) in a few challenge trials; this can help us ascertain whether there\u2019s a dose-response effect to the quantity of initial viral exposure on the severity of the disease symptoms.<\/p>\n\n<p><em>Adenovirus Type 4<\/em><\/p>\n\n<p>In 16 military recruits, the probability of infection varied with the dose of adenovirus they were exposed to, but the probability of illness did not.[29]<\/p>\n\n<p><em>Echovirus<\/em><\/p>\n\n<p>In 127 adult volunteers inoculated with various doses of ECHO-11 virus, there was a dose-response relationship with infectivity, but dose had no effect on the severity of upper respiratory symptoms in the infected group.  On the other hand, high-dose cases were significantly more likely than low-dose cases to have lower respiratory symptoms (cough, sore throat, laryngitis).  Prior challenge reduced symptoms upon rechallenge, and more for the high-dose-prior-exposed than the low-dose-prior-exposed group.[30]<\/p>\n\n<p><em>Influenza<\/em><\/p>\n\n<p>Across 36 studies with different doses and strains, there was no association of higher doses of influenza with higher chance of the subjects becoming ill.[31]<\/p>\n\n<p><em>Norovirus<\/em><\/p>\n\n<p>In a study of 57 adults infected with different doses of Norwalk virus, higher doses were associated with significantly (p =0.001) faster time before symptom onset and longer (p = 0.04) duration of illness, as well as a dose-response relationship in probability of infection.[32]<\/p>\n\n<p><em>Respiratory Synctial Virus<\/em><\/p>\n\n<p>In 35 adult volunteers, there was no association between the dose of RSV administered and the viral load or the probability of infection.  Symptom severity, however, as well as cytokine levels, correlated closely with viral load, both across patients and within patients over time.[33]<\/p>\n\n<p>Volunteers infected with low-dose RSV did not develop illness (0\/16), while volunteers infected with high-dose RSV did develop colds (6\/17). Illness was independent of the amount of viral shedding.[34]<\/p>\n\n<p>In 36 volunteers infected with high or low dose RSV, higher doses were associated with higher risk of infection but not higher risk of symptomatic illness.[35]<\/p>\n\n<p><em>Rhinovirus<\/em><\/p>\n\n<p>In 155 young adult volunteers infected with different doses of rhinovirus, daily symptom scores were consistently higher in those exposed to higher doses.  Higher antibody titers and higher doses of virus were associated with higher rates of infection.[36]<\/p>\n\n<p><em>Rotavirus<\/em><\/p>\n\n<p>In a study of 62 adult volunteers experimentally infected with different doses of rotavirus, there was a dose-response relationship between the concentration of virus and the probability of infection, but there was no relationship between the virus dose and the probability of experiencing symptoms.[37]<\/p>\n\n<p>Whether higher initial doses of virus correlate with more severe symptoms or higher probability of having symptoms at all, seems to depend on the virus.  There is no relationship between dose and symptom severity in human volunteers exposed to adenovirus, influenza, and rotavirus, but there is a relationship in echovirus, rhinovirus, and norovirus, and the results are ambiguous in respiratory synctial virus.<\/p>\n\n<p>It remains unclear how well any of these observations translate to COVID-19.  Unfortunately there were no studies comparing the effect of dose on the symptoms of any of the mild human coronaviruses.<\/p>\n\n<p><strong>Dose-Response Effects in Other Viruses: Animal Studies<\/strong><\/p>\n\n<p><em>Ebola<\/em><\/p>\n\n<p>Exposure to 100 plaque-forming units of Ebola virus in the nose was lethal to macaques; but exposure to 10 plaque-forming units caused no clinical symptoms or detectable antibodies or viral RNA.[38]<\/p>\n\n<p><em>EEV<\/em><\/p>\n\n<p>Eastern Equine Encephalitis Virus is lethal in high doses in macaques (6\/6 animals died) but less severe in low-dose exposure (2\/6 animals died and clinical scores were lower). [39]<\/p>\n\n<p><em>Herpes<\/em><\/p>\n\n<p>Serial dilutions of the baboon herpesvirus HPV2 inoculated into mice showed a dose-response curve with higher doses resulting in higher rates of infection, CNS symptoms, and death.[40]<\/p>\n\n<p><em>Influenza<\/em><\/p>\n\n<p>There was a dose-response relationship between initial inoculation dose, probability of infection, and probability of death, in H5N1 and H7N1 influenza  in turkeys, chickens, and ducks.[41]<\/p>\n\n<p>Probability of infection, probability of clinical signs, and survival time all varied dose-dependently by the inoculation dose of H5N1 in pigeons.[42]<\/p>\n\n<p>A H0N1 strain of influenza in mice had a dose-response relationship for both infectiousness and mortality; it was more deadly when introduced to the respiratory tract than intranasally.[43]<\/p>\n\n<p>A PR8 strain of influenza has a dose-response relationship with serum viral load, weight loss, clinical score, and mortality. The low dose and high dose groups had similar antibody and leukocyte recruitment levels as the high dose, but no mortality. [44]<\/p>\n\n<p><em>MERS<\/em><\/p>\n\n<p>In transgenic mice, there was a dose-response effect in lethality for exposure to MERS virus: it killed 50% of the mice at a dose of 10 TCID50, compared to 25% at 1.25 TCID50 and 100% at 100 TCID50.[45]<\/p>\n\n<p><em>PEDV<\/em><\/p>\n\n<p>PEDV is a coronavirus that causes diarrhea in pigs. It has a dose-response relationship to symptoms: 0.056 TCID50 caused diarrhea in 25% of piglets while 0.56 TCID50 and higher caused diarrhea in 100% of piglets.[46]<\/p>\n\n<p><em>SARS<\/em><\/p>\n\n<p>Both mice and guinea pigs exposed to SARS virus had a higher probability of increased rectal temperature at higher doses of virus exposure.  For guinea pigs, ID50 = 5.47 log CPE50, or 50% of guinea pigs were infected at 5.47 * log (the dose at which 50% of cells died).[47]<\/p>\n\n<p><em>SIV<\/em><\/p>\n\n<p>Simian immunodeficiency virus, closely related to HIV, had a dose-response relationship with the probability of infection in macaque monkeys, but steady-state (2-week) viral load among those infected did not correlate with initial dose.  There was no correlation between survival time and dose.[48]<\/p>\n\n<p>Low-dose challenge with SIV successfully produced \u201csilent infection\u201d (no symptoms or viral RNA but virus-specific T cell proliferation.) However, when these monkeys were exposed to a high dose of SIV, they were not immune but became infected and developed AIDS-like disease at the same rate as naive monkeys.[49]<\/p>\n\n<p>Dose-response relationships between virus inoculum and infection rate or death seem to be common in animal studies, and consistently, including in coronaviruses, higher doses cause more severe symptoms.<\/p>\n\n<p>However, in at least one case (SIV) a dose of virus that was low enough to produce asymptomatic infection did <em>not<\/em> produce immunity to future exposures, so we can\u2019t assume that low-dose exposure always brings immunity.<\/p>\n\n<p><strong>References<\/strong><\/p>\n\n<p>[1]Shah, Sweta, et al. \u201cInitial Observations with Molecular Testing for COVID-19 in a Private Hospital in Mumbai, India.\u201d<\/p>\n\n<p>[2]Yu, Xia, et al. \u201cSARS-CoV-2 viral load in sputum correlates with risk of COVID-19 progression.\u201d <em>Critical Care<\/em> 24.1 (2020): 1-4.<\/p>\n\n<p>[3]Zheng, Shufa, et al. \u201cViral load dynamics and disease severity in patients infected with SARS-CoV-2 in Zhejiang province, China, January-March 2020: retrospective cohort study.\u201d <em>bmj<\/em> 369 (2020).<\/p>\n\n<p>[4]Liu, Yang, et al. \u201cCorrelation Between Relative Nasopharyngeal Virus RNA Load and Lymphocyte Count Disease Severity in Patients with COVID-19.\u201d <em>Viral Immunology<\/em> (2020).<\/p>\n\n<p>[5]To, Kelvin Kai-Wang, et al. \u201cTemporal profiles of viral load in posterior oropharyngeal saliva samples and serum antibody responses during infection by SARS-CoV-2: an observational cohort study.\u201d <em>The Lancet Infectious Diseases<\/em> (2020).<\/p>\n\n<p>[6]Zou, Lirong, et al. \u201cSARS-CoV-2 viral load in upper respiratory specimens of infected patients.\u201d <em>New England Journal of Medicine<\/em> 382.12 (2020): 1177-1179.<\/p>\n\n<p>[7]Young, Barnaby Edward, et al. \u201cEpidemiologic features and clinical course of patients infected with SARS-CoV-2 in Singapore.\u201d <em>Jama<\/em> 323.15 (2020): 1488-1494.<\/p>\n\n<p>[8]Wu, Jing, et al. \u201cClinical Characteristics and Outcomes of Discharged COVID-19 Patients with Reoccurrence of SARS-CoV-2 RNA in a County Hospital of Western Chongqing, China.\u201d <em>China (4\/14\/2020)<\/em> (2020).<\/p>\n\n<p>[9]He, Xi, et al. \u201cTemporal dynamics in viral shedding and transmissibility of COVID-19.\u201d <em>Nature medicine<\/em> (2020): 1-4.<\/p>\n\n<p>[10]Lui, Grace, et al. \u201cViral dynamics of SARS-CoV-2 across a spectrum of disease severity in COVID-19.\u201d <em>The Journal of Infection<\/em> (2020).<\/p>\n\n<p>[11]Lescure, Francois-Xavier, et al. \u201cClinical and virological data of the first cases of COVID-19 in Europe: a case series.\u201d <em>The Lancet Infectious Diseases<\/em> (2020).<\/p>\n\n<p>[12]Qiu, Haiyan, et al. \u201cClinical and epidemiological features of 36 children with coronavirus disease 2019 (COVID-19) in Zhejiang, China: an observational cohort study.\u201d <em>The Lancet Infectious Diseases<\/em> (2020).<\/p>\n\n<p>[13]Xu, Xiao-Wei, et al. \u201cClinical findings in a group of patients infected with the 2019 novel coronavirus (SARS-Cov-2) outside of Wuhan, China: retrospective case series.\u201d <em>bmj<\/em> 368 (2020).<\/p>\n\n<p>[14]Li, Xiaochen, et al. \u201cRisk factors for severity and mortality in adult COVID-19 inpatients in Wuhan.\u201d <em>Journal of Allergy and Clinical Immunology<\/em> (2020).<\/p>\n\n<p>[15]Shi, Y., et al. \u201cHost susceptibility to severe COVID-19: a retrospective analysis of 487 case outside Wuhan.\u201d (2020).<\/p>\n\n<p>[16]Peiris, Joseph Sriyal Malik, et al. \u201cClinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia: a prospective study.\u201d <em>The Lancet<\/em> 361.9371 (2003): 1767-1772.<\/p>\n\n<p>[17]Chu, Chung-Ming, et al. \u201cInitial viral load and the outcomes of SARS.\u201d <em>Cmaj<\/em> 171.11 (2004): 1349-1352.<\/p>\n\n<p>[18] Ng, Enders KO, et al. \u201cQuantitative analysis and prognostic implication of SARS coronavirus RNA in the plasma and serum of patients with severe acute respiratory syndrome.\u201d <em>Clinical chemistry<\/em> 49.12 (2003): 1976-1980.<\/p>\n\n<p>[19]Hung, I. F. N., et al. \u201cViral loads in clinical specimens and SARS manifestations.\u201d Emerging infectious diseases 10.9 (2004): 1550.<\/p>\n\n<p>[20]Oh, Myoung-don, et al. \u201cViral load kinetics of MERS coronavirus infection.\u201d <em>New England Journal of Medicine<\/em> 375.13 (2016): 1303-1305.<\/p>\n\n<p>[21]Kim, So Yeon, et al. \u201cViral RNA in blood as indicator of severe outcome in Middle East respiratory syndrome coronavirus infection.\u201d <em>Emerging infectious diseases<\/em> 22.10 (2016): 1813.<\/p>\n\n<p>[22]Min, Chan-Ki, et al. \u201cComparative and kinetic analysis of viral shedding and immunological responses in MERS patients representing a broad spectrum of disease severity.\u201d Scientific reports 6.1 (2016): 1-12.<\/p>\n\n<p>[23] Feikin, Daniel R., et al. \u201cAssociation of higher MERS-CoV virus load with severe disease and death, Saudi Arabia, 2014.\u201d Emerging infectious diseases 21.11 (2015): 2029.<\/p>\n\n<p>APA<\/p>\n\n<p>[24] Wilder-Smith, Annelies, et al. \u201cAsymptomatic SARS coronavirus infection among healthcare workers, Singapore.\u201d Emerging infectious diseases 11.7 (2005): 1142.<\/p>\n\n<p>[25]Leung, Gabriel M., et al. \u201cThe epidemiology of severe acute respiratory syndrome in the 2003 Hong Kong epidemic: an analysis of all 1755 patients.\u201d Annals of internal medicine 141.9 (2004): 662-673.<\/p>\n\n<p>[26]Liu, Min, et al. \u201cRisk factors for SARS-related deaths in 2003, Beijing.\u201d Biomedical and Environmental Sciences 19.5 (2006): 336.<\/p>\n\n<p>[27]Elkholy, Amgad A., et al. \u201cMERS-CoV infection among healthcare workers and risk factors for death: Retrospective analysis of all laboratory-confirmed cases reported to WHO from 2012 to 2 June 2018.\u201d Journal of infection and public health (2019).<\/p>\n\n<p>[28]Ahmed, Anwar E. \u201cThe predictors of 3-and 30-day mortality in 660 MERS-CoV patients.\u201d BMC infectious diseases 17.1 (2017): 615.<\/p>\n\n<p>[29]Couch, R. B., et al. \u201cThe minimal infectious dose of adenovirus type 4; the case for natural transmission by viral aerosol.\u201d <em>Transactions of the American Clinical and Climatological Association<\/em> 80 (1969): 205.<\/p>\n\n<p>[30]Saliba, Gilbert S., Sylvia L. Franklin, and George Gee Jackson. \u201cECHO-11 as a respiratory virus: quantitation of infection in man.\u201d <em>The Journal of clinical investigation<\/em> 47.6 (1968): 1303-1313.<\/p>\n\n<p>[31]Yezli, Saber, and Jonathan A. Otter. \u201cMinimum infective dose of the major human respiratory and enteric viruses transmitted through food and the environment.\u201d <em>Food and Environmental Virology<\/em> 3.1 (2011): 1-30.<\/p>\n\n<p>[32]Atmar, Robert L., et al. \u201cDetermination of the 50% human infectious dose for Norwalk virus.\u201d <em>The Journal of infectious diseases<\/em> 209.7 (2014): 1016-1022.<\/p>\n\n<p>[33]DeVincenzo, John P., et al. \u201cViral load drives disease in humans experimentally infected with respiratory syncytial virus.\u201d <em>American journal of respiratory and critical care medicine<\/em> 182.10 (2010): 1305-1314.<\/p>\n\n<p>[34]Mills, John, et al. \u201cExperimental respiratory syncytial virus infection of adults: possible mechanisms of resistance to infection and illness.\u201d <em>The Journal of Immunology<\/em> 107.1 (1971): 123-130.<\/p>\n\n<p>[35]Lee, F. Eun-Hyung, et al. \u201cExperimental infection of humans with A2 respiratory syncytial virus.\u201d <em>Antiviral research<\/em> 63.3 (2004): 191-196.<\/p>\n\n<p>[36]Hendley, J. Owen, William P. Edmondson Jr, and Jack M. Gwaltney Jr. \u201cRelation between naturally acquired immunity and infectivity of two rhinoviruses in volunteers.\u201d <em>Journal of Infectious Diseases<\/em> 125.3 (1972): 243-248.<\/p>\n\n<p>[37]Ward, Richard L., et al. \u201cHuman rotavirus studies in volunteers: determination of infectious dose and serological response to infection.\u201d <em>Journal of Infectious Diseases<\/em> 154.5 (1986): 871-880.<\/p>\n\n<p>[38]Mire, Chad E., et al. \u201cOral and conjunctival exposure of nonhuman primates to low doses of Ebola Makona virus.\u201d The Journal of infectious diseases 214.suppl_3 (2016): S263-S267.<\/p>\n\n<p>[39]Reed, Douglas S., et al. \u201cSevere encephalitis in cynomolgus macaques exposed to aerosolized eastern equine encephalitis virus.\u201d The Journal of infectious diseases 196.3 (2007): 441-450.<\/p>\n\n<p>[40]Ritchey, J. W., et al. \u201cComparative pathology of infections with baboon and African green monkey \u03b1-herpesviruses in mice.\u201d <em>Journal of comparative pathology<\/em> 127.2-3 (2002): 150-161.<\/p>\n\n<p>[41]Aldous, E. W., et al. \u201cInfection dynamics of highly pathogenic avian influenza and virulent avian paramyxovirus type 1 viruses in chickens, turkeys and ducks.\u201d <em>Avian Pathology<\/em> 39.4 (2010): 265-273.<\/p>\n\n<p>[42] Phonaknguen, Rassameepen, et al. \u201cMinimal susceptibility to highly pathogenic avian influenza H5N1 viral infection of pigeons (Columba livia) and potential transmission of the virus to comingled domestic chickens.\u201d <em>Kasetsart J-Nat Sci<\/em> 47 (2013): 720-732.<\/p>\n\n<p>[43]Yetter, Robert A., et al. \u201cOutcome of influenza infection: effect of site of initial infection and heterotypic immunity.\u201d <em>Infection and immunity<\/em> 29.2 (1980): 654-662.<\/p>\n\n<p>[44]Powell, Timothy J., et al. \u201cThe immune system provides a strong response to even a low exposure to virus.\u201d Clinical immunology 119.1 (2006): 87-94<\/p>\n\n<p>[45]Tao, Xinrong, et al. \u201cCharacterization and demonstration of the value of a lethal mouse model of Middle East respiratory syndrome coronavirus infection and disease.\u201d <em>Journal of virology<\/em> 90.1 (2016): 57-67.<\/p>\n\n<p>[46]Neumann, Eric J., and William F. Hall. \u201cDisease Control, Prevention, and Elimination.\u201d <em>Diseases of Swine<\/em> (2019): 123-157.<\/p>\n\n<p>[47]Chepurnov, A. A., A. A. Dadaeva, and E. M. Malkova. \u201cSymptoms of infection caused by SARS coronavirus in laboratory mice and guinea pigs.\u201d <em>Doklady Biological Sciences<\/em>. Vol. 397. No. 1. Nature Publishing Group, 2004.<\/p>\n\n<p>[48]Holterman, Lennart, et al. \u201cThe rate of progression to AIDS is independent of virus dose in simian immunodeficiency virus-infected macaques.\u201d <em>Journal of General Virology<\/em> 81.7 (2000): 1719-1726<\/p>\n\n<p>[49]Dittmer, Ulf, et al. \u201cRepeated exposure of rhesus macaques to low doses of simian immunodeficiency virus (SIV) did not protect them against the consequences of a high-dose SIV challenge.\u201d Journal of general virology 76.6 (1995): 1307-1315.<\/p>","author":{"name":{}},"category":[{"@attributes":{"term":"covid-19"}},{"@attributes":{"term":"lit-review"}}],"summary":{"@attributes":{"type":"html"}}}]}