Neural models that convince: Model hierarchies and other strategies to bridge the gap between behavior and the brain.

Computational modeling of the brain holds great promise as a bridge from brain to behavior. To fulfill this promise, however, it is not enough for models to be 'biologically plausible': models must be structurally accurate. Here, we analyze what this entails for so-called psychobiological models, models that address behavior as well as brain function in some detail. Structural accuracy may be supported by (1) a model's a priori plausibility, which comes from a reliance on evidence-based assumptions, (2) fitting existing data, and (3) the derivation of new predictions. All three sources of support require modelers to be explicit about the ontology of the model, and require the existence of data constraining the modeling. For situations in which such data are only sparsely available, we suggest a new approach. If several models are constructed that together form a hierarchy of models, higher-level models can be constrained by lower-level models, and low-level models can be constrained by behavioral features of the higher-level models. Modeling the same substrate at different levels of representation, as proposed here, thus has benefits that exceed the merits of each model in the hierarchy on its own

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified