Background Advance Care Planning via Group Visits (ACP-GV) is a patient-centered intervention facilitated by a clinician using a group modality to promote healthcare decision-making among veterans. Participants in the group document a “Next Step” to use in planning for their future care needs. The next step may include documentation of preferences in an advance directive, discussing plans with family, or anything else to fulfill their ACP needs. This evaluation seeks to determine whether there are identifiable subgroups of group participants with (...) differing needs prior to delivery of the ACP-GV program and, if so, to use information about the subgroups to enhance the program offered to veterans in United States Department of Veterans Affairs (VA) healthcare settings. Methods We conducted a secondary analysis of national data from a quality improvement evaluation. Patient- and provider-level data from administrative healthcare records for VA users in all 50 states, territories, and the District of Columbia provides data on veterans attending ACP-GV during federal fiscal years 2018–2022 (N = 26,857). Latent class analysis seeks to identify the various subgroups of veterans based on their level of ACP self-efficacy before attending ACP-GV and any demographic differences across the resulting subgroups of veterans attending ACP-GV. ACP self-efficacy is derived from seven items obtained from a participant worksheet used during the group. Results Analysis revealed two distinct groups of veterans, distinguishable by their pre-ACP-GV levels of one aspect of ACP self-efficacy: prior knowledge of ACP. Veterans with higher prior knowledge of ACP are associated with an identified next step focused on checking their current AD status and updating it, and veterans with lower ACP prior knowledge are associated with identifying a next step to discuss ACP more fully with family. Differences in age, sex, race, ethnicity, and marital status exist across subgroups of veterans. Conclusion Greater attention must be paid to ACP and veterans’ prior knowledge of ACP to consistently encourage annual review and status updates. (shrink)

Background: Although convolutional neural networks (CNNs) achieve high diagnostic accuracy for detecting Alzheimer’s disease (AD) dementia based on magnetic resonance imaging (MRI) scans, they are not yet applied in clinical routine. One important reason for this is a lack of model comprehensibility. Recently developed visualization methods for deriving CNN relevance maps may help to fill this gap as they allow the visualization of key input image features that drive the decision of the model. We investigated whether models with higher accuracy (...) also rely more on discriminative brain regions predefined by prior knowledge. Methods: We trained a CNN for the detection of AD in N = 663 T1-weighted MRI scans of patients with dementia and amnestic mild cognitive impairment (MCI) and verified the accuracy of the models via cross-validation and in three independent samples including in total N = 1655 cases. We evaluated the association of relevance scores and hippocampus volume to validate the clinical utility of this approach. To improve model comprehensibility, we implemented an interactive visualization of 3D CNN relevance maps, thereby allowing intuitive model inspection. Results: Across the three independent datasets, group separation showed high accuracy for AD dementia versus controls (AUC ≥ 0.91) and moderate accuracy for amnestic MCI versus controls (AUC ≈ 0.74). Relevance maps indicated that hippocampal atrophy was considered the most informative factor for AD detection, with additional contributions from atrophy in other cortical and subcortical regions. Relevance scores within the hippocampus were highly correlated with hippocampal volumes (Pearson’s r ≈ −0.86, p < 0.001). Conclusion: The relevance maps highlighted atrophy in regions that we had hypothesized a priori. This strengthens the comprehensibility of the CNN models, which were trained in a purely data-driven manner based on the scans and diagnosis labels. The high hippocampus relevance scores as well as the high performance achieved in independent samples support the validity of the CNN models in the detection of AD-related MRI abnormalities. The presented data-driven and hypothesis-free CNN modeling approach might provide a useful tool to automatically derive discriminative features for complex diagnostic tasks where clear clinical criteria are still missing, for instance for the differential diagnosis between various types of dementia. (shrink)

Uncontrollable anger is common following an acquired brain injury, with impaired emotion regulation being one of the main contributors. Existing psychological interventions appear moderately effective, though studies typically include limitations such as small sample sizes, issues of long-term efficacy, and standardization of content. While ER has been a popular research field, the study of ER for anger management after ABI is less well investigated, and contains few interventions based on the widely used Process Model of ER. This review surveys the (...) efficacy of ER strategies in individuals with ABI, and proposes a novel research design for future interventions. Recommendations are made about: strategy number and type, shared decision-making, approaches to data analysis, and mode of delivery. (shrink)

On one hand, Chinese consumers are well known for conspicuous consumption and the adoption of luxury products and named brands. On the other hand, they also have a bad reputation for buying counterfeit products. Their simultaneous preferences for two contrasting types of product present a paradox that has not been addressed in the literature. This study attempts to present an explanation of this paradox by examining the effects of traditional Chinese cultural values and consumer values on consumers’ deontological judgment of (...) pirated CDs and the amount of social benefits they perceive they gain from them. We interviewed 300 Hong Kong Chinese consumers, and found that face consciousness increased materialism and risk aversion, thereby producing a favorable deontological judgment of pirated CDs. Face consciousness also has a direct effect on the amount of social benefits perceived in pirated CDs. Both favorable deontological judgment and perceived social benefits contributed to a strong intention to buy pirated CDs. The results are discussed in a cultural perspective. (shrink)

The study of emotional changes after brain injury has contributed enormously to the understanding of the neural basis of emotion. However, little attention has been placed on the methods used to elicit emotional responses in people with brain damage. Of particular interest are subjects with right hemisphere [RH] cortical lesions, who have been described as presenting impairment in emotional processing. In this article, an internal and external mood induction procedure [MIP] was used to trigger positive and negative emotions, in a (...) sample of 10 participants with RH damage, and 15 healthy controls. Emotional experience was registered by using a self-report questionnaire. As observed in previous studies, internal and external MIPs were equally effective in eliciting the target emotion, but the internal procedure generated higher levels of intensity. Remarkably, participants with RH lesions were equally able to experience both positive and negative affect. The results are discussed in relation to the role of the RH in the capacity to experience negative emotions. (shrink)

Our world is full of fictional devices that let people feel better about their situation - through deception and self-deception. The legal realist, Felix Cohen, argued that law and legal reasoning is full of similarly dubious labels and bad reasoning, though of a special kind. He argued that judges, lawyers and legal commentators allow linguistic inventions and conventions to distort their thinking. Like the ancient peoples who built idols out of stone and wood and then asked them for assistance and (...) guidance, Cohen argued that within the legal world people tend to create legal concepts and then think that these concepts do or should determine how social disputes must be The philosopher Ludwig Wittgenstein similarly spoke of the way we fool ourselves, when we use a noun for some matter, and then assume that, because nouns usually name objects, here as well there must be some entity that exists out in the world, whose nature can be discovered. Our grammar misleads us. This article explores some of the ways, particularly in contract law and family law, that we have been led astray by our legal language. Because we only rarely have an Oliver Wendell Holmes, Jr., or a Felix Cohen to keep us in line, we need to learn to do the important work ourselves. The great danger is the way that inaccurate language can so easily change our substantive views about what is natural or what is right. If transparency is difficult in legal language, much of the fault may lie with lawyers and judges who want to make their conclusions sound more reasonable, less controversial, and more appealing: so we call it "consent" and "waiver" and "meeting of the minds" and "best interests of the child," when it is in fact something quite different. And at least in the common law systems the process of reasoning and law-making is tied strongly to the past. The new case has to fit into the categories and concepts that we created for a prior case - fitting cases that came up hundreds of years before, in a different society, with different technology, facing a different set of problems. So judges often end up stretching the meaning of concepts, or using legal fictions to bridge the old rule with the new equities. We may never entirely escape the tendency of our own language to mislead us, but clarity in thought and analysis is something towards which we should struggle constantly, and with determination. (shrink)

Empirical philosophers of science aim to base their philosophical theories on observations of scientific practice. But since there is far too much science to observe it all, how can we form and test hypotheses about science that are sufficiently rigorous and broad in scope, while avoiding the pitfalls of bias and subjectivity in our methods? Part of the answer, we claim, lies in the computational tools of the digital humanities, which allow us to analyze large volumes of scientific literature. Here (...) we advocate for the use of these methods by addressing a number of large-scale, justificatory concerns—specifically, about the epistemic value of journal articles as evidence for what happens elsewhere in science, and about the ability of DH tools to extract this evidence. Far from ignoring the gap between scientific literature and the rest of scientific practice, effective use of DH tools requires critical reflection about these relationships. (shrink)

Stephan Joubert has already made his mark in South Africa with his solid way of doing Theology. In this Festschrift, we wanted to accord recognition to him for what he has already made and for what he is currently doing with e-kerk. His book, Jesus Radical, Righteous, Relevant, having initially been written in Afrikaans, was translated in 2012 into English and depicts his heart for the followers of Jesus and the familia Dei, specifically in South Africa. This article is a (...) journey through this book, with the current dilemma in our country and worldwide in the back of our minds, namely, the coronavirus disease starting in 2019. CONTRIBUTION: This article forms part of the Special Collection which will serve as a Festschrift for Prof Stephan Joubert to honour him for the tremendous work that he has done in Theology in South Africa. I took his book, Jesus, Radical, Righteous, Relevant as basis and applied it to our current situation with COVID-19. (shrink)

From the 15th century onwards, most of the countries in Africa have been colonised by theEuropean world powers, Great Britain, France, Portugal, Germany, Spain, Italy and Belgium.South Africa was officially colonised in 1652. Apart from the European colonisation beingexecuted from the south of the continent, South Africa also experienced a migration andinvasion of people groups from the north. The indigenous people groups, inhabiting thecountry long before these two groups arrived there, will be discussed as background to the restof the article. (...) A few factors that made the colonisation of South Africa unique within theAfrican context will be discussed. (shrink)

In South Africa, the implementation of serious games and gamification in the design of curricula, being presented in schools and institutions of higher education, is mostly a novelty. As we are in a transitional phase with education, especially on two levels, namely, with the decolonisation of education and preparing education for the Fourth Industrial Revolution, it would be fitting and high time to fully implement gaming into the curricula. This article takes a look at the implementation of a serious game (...) on an undergraduate level at a residential university. It focuses in a pragmatic way on applying the serious game on biblical languages – Greek, Hebrew and Latin – proposing that they should be presented to the student as paper behind the glass. (shrink)

The year 2017 is the year in which the Reformation, started by Martin Luther, is celebrating its 500th birthday. This depicts a milestone in the life of the Church of the Reformation and also in the life of Christians worldwide. This is a good time to ponder on the epistemological question of the validity and necessity of the Reformation. If this question is answered in a positive way, then it could bring us to the realisation that the time is ripe (...) for an African Reformation. This article will argue that this is indeed the case. A reformation, transformation and change is needed for the African Christian context. However, the question could well be asked: Who will be the 'second Luther?'. (shrink)

In the book of Romans, also called ‘Paul’s Letter/Epistle to the Romans’, it is clear that Paul created a very close lexical semantic relation between the concepts πίστις/πιστεύω [faith, believe], δίκαιος/δικαιοσύνη [righteous, righteousness] and σωτηρία/σῴζω [salvation, save]. Although it is said that the theme of righteousness (by or through faith) is the focal point of Paul’s theology, especially in Romans, this term is very closely linked to the two concepts, faith and salvation, in this letter. The aim of this article (...) is to investigate that relation, specifically in the two passages of Romans 1:16–17 and 10:6a, 8b–10, in an attempt to come to an understanding of what Paul had in mind when he used these three terms together in these passages. (shrink)

Advanced old age has been characterized as a biologically highly vulnerable life phase. Biological, morbidity-, and cognitive impairment-related factors play an important role as mortality predictors among very old adults. However, it is largely unknown whether previous findings confirming the role of different wellbeing domains for mortality translate to survival among the oldest-old individuals. Moreover, the distinction established in the wellbeing literature between hedonic and eudaimonic wellbeing as well as the consideration of within-person variability of potentially relevant mortality predictors has (...) not sufficiently been addressed in prior mortality research. In this study, we examined a broad set of hedonic and eudaimonic wellbeing indicators, including their levels, their changes, as well as their within-person variability, as predictors of all-cause mortality in a sample of very old individuals. We used data from the LateLine study, a 7-year longitudinal study based on a sample of n = 124 individuals who were living alone and who were aged 87–97 years at baseline. Study participants provided up to 16 measurement occasions between 2009 and 2016. Dates of death were available for 118 individuals who had deceased between 2009 and 2021. We ran longitudinal multilevel structural equation models and specified between-person level differences, within-person long-term linear change trends, as well as the “detrended” within-person variability in three indicators of hedonic and four indicators of eudaimonic wellbeing as all-cause mortality predictors. Controlling for age, gender, education, and physical condition and testing our sets of hedonic and eudaimonic indictors separately in terms of their mortality impact, solely one eudaimonic wellbeing indicator, namely, autonomy, showed significant effects on survival. Surprisingly, autonomy appeared “paradoxically” related with mortality, with high individual levels and intraindividual highly stable perceptions of autonomy being associated with a shorter residual lifetime. Thus, it seems plausible that accepting dependency and changing perceptions of autonomy over time in accordance with objectively remaining capabilities might become adaptive for survival in very old age. (shrink)

The chapters in this section of the volume reveal the striking variety of human numerical cognition. The section comprises four chapters that focus on different aspects of the representation of numerical knowledge, as well as three chapters that examine the several cognitive processes involved in the manipulation of numbers during simple mental arithmetic. They show how chronometric analyses, in combination with clever experimental designs, can reveal the cognitive processes and representations underlying this impressive collection of cognitive skills. Our goal in (...) this overview chapter is to highlight common themes that connect these contributions. In particular, we suggest links between the present contributions, all of which are firmly grounded in the traditional information-processing approach to the human mind, and the more recently emerged embodied cognition perspective, according to which all knowledge representations remain associated with those sensory and motor features that were activated during acquisition of that knowledge. (shrink)

This article examines a neglected ancient source for desire between women that nonetheless has a rich reception history in the context of female homoeroticism: the Callisto episode in Ovid’s Metamorphoses. The article argues that the relationship between Diana and her hunting companion Callisto can be read as homoerotic and that, unlike many ancient accounts of female-female eroticism, neither character is represented as a tribas (a gender-deviant “woman” with a masculinized body, who seeks to penetrate other women). The Callisto episode is (...) therefore an invaluable piece of evidence for ancient discourses on sexuality exceeding the bounds of the active/passive model. (shrink)

The current behavioral consultation case demonstrates how functional behavioral assessment (FBA) data, basic and applied research, teacher preferences, and contextual variables contribute to the decision making process when developing classroom intervention procedures. A male, African-American, fifth-grade general education student was initially referred for his inappropriate vocalizations duringtime designated for independent seatwork. FBA data suggested that this behavior was being reinforced with teacher attention. Additional data showed that he was failing to complete his assignments. An intervention was implemented where the student (...) was given assignments one a time. He was instructed to solicit teacher attention and his next assignment after completing each assignment. Analysis ofteacher ratings for inappropriate vocalizations and assignment performance data suggest that the intervention was effective in increasing assignment completion and decreasing inappropriate verbalizations. Discussion focuses on how the various data playa role in the development and implementation of classroom intervention procedures. (shrink)

Associative memory is the ability to link together components of stimuli. Previous evidence suggests that prior familiarization with study items affects the nature of the association between stimuli. More specifically, novel stimuli are learned in a more context-dependent fashion than stimuli that have been encountered previously without the current context. In the current study, we first acquired behavioral data from 62 human participants to conceptually replicate this effect. Participants were instructed to memorize multiple object-scene pairs and were then tested (...) on their recognition memory for the objects. Importantly, 1 day prior, participants had been familiarized with half of the object stimuli. During the test phase, the objects were either matched to the same scene as during study or swapped with a different object’s scene. Our results conceptually replicated the context-dependency effect by showing that breaking up a studied object-context pairing is more detrimental to object recognition performance for non-familiarized objects than for familiarized objects. Second, we used functional magnetic resonance imaging to determine whether medial temporal lobe encoding-related activity patterns are reflective of this familiarity-related context effect. Data acquired from 25 human participants indicated a larger effect of familiarization on encoding-related hippocampal activity for objects presented within a scene context compared to objects presented alone. Our results showed that both retrieval-related accuracy patterns and hippocampal activation patterns were in line with a familiarization-mediated context-dependency effect. (shrink)

According to the received view Feynman diagrams are a bookkeeping device in complex perturbative calculations. Thus, they do not provide a representation or model of the underlying physical process. This view is in apparent tension with scientific practice in high energy physics, which analyses its data in terms of “channels”. For example the Higgs discovery was based on the observation of the decay H → γγ – a process which can be easily represented by the corresponding Feynman diagrams. I take (...) issue with this tension and show that on closer analysis the story of the Higgs discovery should be told differently. (shrink)

The society in which we currently live and operate is globally the Fourth Industrial Revolution and locally our environment or community. Although we are still in a lag period between the 3IR and 4IR, the 4IR already has a global disruptive effect, with artificial intelligence being gradually implemented, with fluid contexts, and where nobody agrees on anything. Deep learning, unlearning and relearning must take place on a daily basis. The question could well be asked if there is any place for (...) the Bible and Christianity in this new vibrant global community.All theology is contextual. Although theology deals with what is most absolute in reality, citing Mellert, it is also relative in that there is never a final or last answer to most religious questions. The handbook and norm for our theology and religion is still the Bible – a compendium of books written approximately 2000 years ago with no new information added to it ever since. The challenge of the church is to make that information contextual in this ‘disruptive’ era and to bring the gospel in a new and fresh way to everybody without compromising the basic truths and normativity of the Bible.This article argues that the Bible should still take centre stage in the academic training of our theological students, in our preaching of the gospel on a daily basis, in our engagement with people in need and in the transformation of our societies in general. As the centre of Jesus’ preaching on earth was the kingdom of God, he also acted as the perfect example of how to establish the kingdom of God and the flourishing life on earth.Contribution: This is a more practical article and puts the notion of the significance of the Bible within the environment of the Fourth Industrial Revolution. As this is a disruptive era, it requires from us to also present the word of God in a ‘disruptive’ way. We will have to present the ‘old’ word of God in a brand-new way so as to make sure that the people of this era will grasp it. (shrink)

Post-school education in South Africa mostly takes place within an industrial-age factory environment as has been done for the past 50 years or longer. This is the case despite the fact that the world is on the brink of, or already part of, the Fourth Industrial Revolution, called by some an ‘emerging new world order’. Educating students today like we did it half a century ago has now become education to a ‘quickly vanishing world’. Although one may argue that the (...) content of Theology will not be much affected by the 4IR, it is proposed that the way in which that content is communicated and educated should change drastically. Doing this will prepare our students to become relevant preachers or theologians in the current postmodern society. The proposed model in this article is called an outside-in model – contrasted to the current inside-out model of education – in which our students should be taught to develop a sense of deep learning, to effectively learn and work in and with groups, to use their mobile devices and social media within the environment of education and to discuss new ways of gathering God’s people.The question that each educator should ask themselves nowadays is: Am I really preparing my students for the future that they are facing?Contribution: A new way of teaching Theology in the 4IR is imperative for our students. This article suggests how it could be done. Although this entails willpower and persuading the mostly ‘old’ lecturers in Theology to engage with real technology, it is all about the student, because many of these students will become the lecturers of tomorrow. Our faculties or departments of Theology are therefore urged to fit themselves into the new mould and to train our future theologians in a 4IR way. (shrink)