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)

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)

Concern for the rights and safety of individuals has caused clinical researchers to develop informed consent protocols for research involving human subjects. The applicapability of these regulations to social science research is often tenuous, since such research usually focuses on populations rather than individuals, and potential damage is apt to be political rather than personal. In cross-cultural social research, the protocols developed by Western clinical researchers may be not only ludicrously inapplicable, but intrusive and disruptive within the cultural context, raising (...) questions of the intellectual imperialism of Western research ethics. (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)

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)

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)

C. S. Peirce's indictment that "the chief cause of [metaphysics'] backward condition is that its leading professors have been theo (Collected Papers 6:3) falls heavily at my door. For it logians" was out of reflection upon religious experience and its meaning that the present relational metaphysic was conceived. My hope, however, is that its scope is sufficiently wider than its theological origins to justify its appearance as a work in philosophy. Having been nurtured in existential philosophy and having reached some (...) measure of maturity with the wise counsel of Professor Dr. Fritz Buri, of Basel, I came to feel that theology as a modern discipline had reached an impasse owing to its overextended commitments to a subject-object paradigm of thought. Even those theologians who despaired of these ties seemed unable to find an independent alternative idiom for their ideas. A second tension in my thinking resulted from the inordinate neglect by theologians of the natural world. Also, my natural interest in physical understanding seemed unfulfilled within the narrow confines of theology, even of philosophical theology as then practiced. As I turned decisively toward the study of modern physics, and especially of cosmology, a new world seemed to open up to me. After extensive study with prominent astronomers and physicists, it began to dawn on me that the new physics has devised conceptual paradigms of thought which could be generalized into a metaphysical system of universal interest. (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)

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)

Our understanding of the behavioral and physiological mechanisms of monogamy largely comes from studies of behavioral interactions unique to pair-bonded individuals. By focusing on these highly marked behaviors, a remarkable conservation in the mechanisms underlying pair bonding has been revealed; however, we continue to know very little about the range of behavioral and neurobiological mechanisms that could explain the great diversity of pair-bonding phenotypes that exists both within and across species. In order to capture the dynamic nature of bonds over (...) time and across contexts, we need specific, operationally-defined behavioral variables relevant across such a diversity of scenarios. Additionally, we need to be able to situate these behavioral variables within broader frameworks that allow us to interpret and compare patterns seen across species. Here I review what is known about behavioral synchrony with respect to pair bonding and discuss using synchrony as such a variable as well as a framework to expand on our understanding of pair bonding across timescales, contexts and species. First, I discuss the importance of behavioral synchrony and parental coordination for reproductive success in monogamous biparental bird species. Second, I highlight research documenting the critical importance of interpersonal coordination for human social relationships. Finally, I present recent work that experimentally bridges these lines of research by quantifying moment-to-moment behavioral synchrony during brief social interactions in zebra finch dyads. All together, these distinct perspectives support the notion that synchrony (1) is a shared premise for sociality across species, (2) is deeply shaped by social experiences, and (3) exists across timescales, behaviors, and levels of physiology. Conceptualizing pair bonding through the framework of behavioral synchrony is likely to facilitate a deeper understanding of the nuances of how social experiences and interactions impact the brain and behavior. (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)

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)

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)

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)