It is widely recognized that police performance may be hindered by psychophysiological state changes during acute stress. To address the need for awareness and control of these physiological changes, police academies in many countries have implemented Heart-Rate Variability biofeedback training. Despite these trainings now being widely delivered in classroom setups, they typically lack the arousing action context needed for successful transfer to the operational field, where officers must apply learned skills, particularly when stress levels rise. The study presented here aimed (...) to address this gap by training physiological control skills in an arousing decision-making context. We developed a Virtual-Reality breathing-based biofeedback training in which police officers perform deep and slow diaphragmatic breathing in an engaging game-like action context. This VR game consisted of a selective shoot/don’t shoot game designed to assess response inhibition, an impaired capacity in high arousal situations. Biofeedback was provided based on adherence to a slow breathing pace: the slower and deeper the breathing, the less constrained peripheral vision became, facilitating accurate responses to the in-game demands. A total of nine male police trainers completed 10 sessions over a 4-week period as part of a single-case experimental ABAB study-design. Results showed that eight out of nine participants showed improved breathing control in action, with a positive effect on breathing-induced low frequency HRV, while also improving their in-game behavioral performance. Critically, the breathing-based skill learning transferred to subsequent sessions in which biofeedback was not presented. Importantly, all participants remained highly engaged throughout the training. Altogether, our study showed that our VR environment can be used to train breathing regulation in an arousing and active decision-making context. (shrink)

The possibilities for collecting, storing, and processing of data have increased significantly over the last decades. It has been argued that an increasing demand for health data will de...

Background Genuine uncertainty on superiority of one intervention over the other is called equipoise. Physician-investigators in randomized controlled trials need equipoise at least in studies with more than minimal risks. Ideally, this equipoise is also present in patient-participants. In pediatrics, data on equipoise are lacking. We hypothesize that 1) lack of equipoise at enrolment among parents may reduce recruitment; 2) lack of equipoise during participation may reduce retention in patients assigned to a less favoured treatment-strategy. Methods We compared preferences of (...) parents/patients at enrolment, documented by a questionnaire, with preferences developed during follow-up by an interview-study to investigate equipoise of child-participants and parents in the BeSt-for-Kids-study. This trial in new-onset Juvenile Idiopathic Arthritis-patients consists of three strategies. One strategy comprises initial treatment with a biological disease-modifying-antirheumatic-drug, currently not standard-of-care. Semi-structured interviews were conducted with 23 parents and 7 patients, median 11 months after enrolment. Results Initially most parents and children were not in equipoise. Parents/patients who refused participation, regularly declined due to specific preferences. Many participating families preferred the biological-first-strategy. They participated to have a chance for this initial treatment, and would even consider stopping trial-participation when not randomized for it. Their conviction of superiority of the biological-first strategy was based on knowledge from internet and close relations. According to four parents, the physician-investigator preferred the biological-first-strategy, but the majority stated that she had no preferred strategy. In phase 2, preferences tended to change to the treatment actually received. Conclusions Lack of equipoise during enrolment did not reduce study recruitment, mainly due to the fact that preferred treatment was only available within the study. Still, when developing a trial it is important to evaluate whether the physicians’ research question is in line with preferences of the patient-group. By exploring so-called ‘informed patient-group’-equipoise, successful recruitment may be enhanced and bias avoided. In our study, lack of equipoise during trial-participation did not reduce retention in those assigned to a less favoured option. We observed a change for preference towards treatment actually received, possibly explained by comparable outcomes in all three arms. (shrink)

Route memory is frequently assessed in virtual environments. These environments can be presented in a fully controlled manner and are easy to use. Yet they lack the physical involvement that participants have when navigating real environments. For some aspects of route memory this may result in reduced performance in virtual environments. We assessed route memory performance in four different environments: real, virtual, virtual with directional information (compass), and hybrid. In the hybrid environment, participants walked the route outside on an open (...) field, while all route information (i.e., path, landmarks) was shown simultaneously on a handheld tablet computer. Results indicate that performance in the real life environment was better than in the virtual conditions for tasks relying on survey knowledge, like pointing to start and end point, and map drawing. Performance in the hybrid condition however, hardly differed from real life performance. Performance in the virtual environment did not benefit from directional information. Given these findings, the hybrid condition may offer the best of both worlds: the performance level is comparable to that of real life for route memory, yet it offers full control of visual input during route learning. (shrink)

Gerhard Ebeling on faith. Gerhard Ebeling (1912–2001), not only the foremost Luther researcher of the previous century but also one of the most prominent contributors to protestant theology during that period, wrote extensively about faith throughout his long and productive life as a professional theologian. He learnt from Luther that discerning judgement in the differentiation of related matters forms the basis of all sound theology. Applying this insight to his own thought, he reflects on the development of the phenomenon of (...) faith in the Old Testament community and early Christianity and the formalisation of the concept for use in the domain of religious studies. He defends the argument that Christian faith is not only faith in Jesus as the Christ and Lord but also that Jesus, and He only, is the founder and perfecter of faith. The concept of faith is also explored by Ebeling in relation to love, life and reason. The article concludes with a critical evaluation of Ebeling’s contribution in guiding us to witness authentically about our own faith in Jesus Christ within our own situation and against the background of the problems it poses for believing in Christ. (shrink)

Research ethics committees (RECs) evaluate whether the risk-benefit ratio of a study is acceptable. Decentralized clinical trials (DCTs) are a novel approach for conducting clinical trials that potentially bring important benefits for research, including several collateral benefits. The position of collateral benefits in risk-benefit assessments is currently unclear. DCTs raise therefore questions about how these benefits should be assessed. This paper aims to reconsider the different types of research benefits, and their position in risk-benefit assessments. We first propose a categorization (...) of research benefits, based on the types of benefits that can be distinguished from the literature and ethical guidelines. Secondly, we will reconsider the position of collateral benefits. We argue that these benefits are not fundamentally different from other benefits of research and can therefore be included in risk-benefit assessments of DCTs. (shrink)

The development of gene expression profiling and next-generation sequencing technologies have steered oncogenomics to the forefront of precision medicine. This created a need for harmonious cooperation between clinicians and researchers to increase access to precision oncology, despite multiple implementation challenges being encountered. The aim is to apply personalised treatment strategies early in cancer management, targeting tumour subtypes and actionable gene variants within the individual’s broader clinical risk profile and wellbeing. A knowledge-generating database linked to the South African Medical Research Council’s (...) Genomic Centre has been created for the application of personalised medicine, using an integrated service and research approach. Insights gained from patient experiences related to tumour heterogeneity, access to targeted therapies and incidental findings of pathogenic germline variants in tumour DNA, provided practice-changing evidence for the implementation of a cost-minimisation pathology-supported genetic testing strategy. Integrating clinical care with genomic research through data sharing advances personalised medicine and maximises precision oncology benefits. (shrink)

Argumentation as the public exchange of reasons is widely thought to enhance deliberative interactions that generate and justify reasonable public policies. Adopting an argumentation-theoretic perspective, we survey the norms that should govern public argumentation and address some of the complexities that scholarly treatments have identified. Our focus is on norms associated with the ideals of correctness and participation as sources of a politically legitimate deliberative outcome. In principle, both ideals are mutually coherent. If the information needed for a correct deliberative (...) outcome is distributed among agents, then maximising participation increases information diversity. But both ideals can also be in tension. If participants lack competence or are prone to biases, a correct deliberative outcome requires limiting participation. The central question for public argumentation, therefore, is how to strike a balance between both ideals. Rather than advocating a preferred normative framework, our main purpose is to illustrate the complexity of this theme. (shrink)

Disputations were a fixture of Martin Luther’s academic career. Luther participated regularly in disputations. It was an important communicative vehicle through which he developed and expressed his theology. The well-known 95 theses are a case in point. Luther’s career as a disputator was impressive. Several of his most influential disputations were explicitly intended for consideration by his academic and ecclesiastical colleagues, but the majority of his disputations took place as a curricular exercise at the University of Wittenberg. The purpose of (...) these disputations was pedagogical and polemical. Luther deployed the same tools for his defence of proper doctrine that were at the centre of the Protestant reformation in the face of objections. The disputatio de homine is a systematic summary of Luther’s anthropology. It incorporates the doctrine of justification as the theological definition of man. It treats the subject within the context of the relationship between theology and philosophy, and reflects upon the new language of theology. The disputatio de homine provides an essential resource for the study of Luther’s anthropology and the doctrine of justification. (shrink)

Individuals make decisions under uncertainty every day. Decisions are based on in- complete information concerning the potential outcome or the predicted likelihood with which events occur. In addition, individuals’ choices often deviate from the rational or mathematically objective solution. Accordingly, the dynamics of human decision making are difficult to capture using conventional, linear mathematical models. Here, we present data from a 2-choice task with variable risk between sure loss and risky loss to illustrate how a simple nonlinear dynamical system can (...) be employed to capture the dynamics of human decision making under uncertainty (i.e., multistability, bifurcations). We test the feasibility of this model quantitatively and demonstrate how the model can account for up to 86% of the observed choice behavior. The implications of using dynamical models for explaining the nonlin- ear complexities of human decision making are discussed as well as the degree to which the theory of nonlinear dynamical systems might offer an alternative framework for understanding human decision making processes. (shrink)

This article provides ethical guidance on using race in health research as a variable or in defining the study population. To this end, a plain, non-exhaustive checklist is provided for researchers and research ethics committees, preceded by a brief introduction on the need for justification when using race as a variable or in defining a study population, the problem of exoticism, that distinctions pertain between race, ethnicity and ancestry, the problematic naming of races, and that race does not serve well (...) as a presumed biological construct in genetic research. (shrink)

Individuals make decisions under uncertainty every day based on incomplete information concerning the potential outcome of the choice or chance levels. The choices individuals make often deviate from the rational or mathematically objective solution. Accordingly, the dynamics of human decision-making are difficult to capture using conventional, linear mathematical models. Here, we present data from a two-choice task with variable risk between sure loss and risky loss to illustrate how a simple nonlinear dynamical system can be employed to capture the dynamics (...) of human decision-making under uncertainty (i.e., multi-stability, bifurcations). We test the feasibility of this model quantitatively and demonstrate how the model can account for up to 86% of the observed choice behavior. The implications of using dynamical models for explaining the nonlinear complexities of human decision-making are discussed, as well as the degree to which nonlinear dynamical systems theory might offer an alternative framework for understanding human decision-making processes. (shrink)

Die voortgesette proses van implementering van nuwe materiaal wat gebruik word vir katkisasie in die Nederduitsch Hervormde Kerk van Afrika vertoon 'n besondere trajek. Die proses het, in terme van geloof, begin met die formalisering van sowel die geloofsbegrip as die beskrywing van die inhoud van geloof. Dit is voortgesit deur 'n proses van die objektivering van die inhoud van geloof tot feite wat geleer kan word en is uiteindelik voltrek deur die implementering van 'n pragmatiese opvoedkundige doelwit waarin geloof (...) bloot 'n middel tot 'n doel geword het. Die trajek kan kortliks soos volg beskryf word: • Die Heidelbergse Kategismus Geloof is die aanneming van die beloftes van God wat vertroue in die lewende God skep. • 'Kortbegrip': Geloof is sekere kennis van God en sy beloftes en 'n hartlike vertroue dat al my sondes om Christus ontwil vergewe is. • Die belydenis van die Hervormers: Ek glo in God beteken dat ek al my vertroue op God stel en Hom op sy woord neem. • Geloofsleer: Geloof is kennis van die Woord van God en vertroue in die God van die Woord. • Geloof en Lewe 11: Geloof is die toe-eiening van kenbare geloofoorleweringe wat in die Bybel opgeneem is. Die kerk kan daarom kinders deur 'n proses van kategese begelei tot geloofsvolwassenheid. Vandag is die uitgangspunt van katkisasie en die motivering daarvoor in die Nederduitsch Hervormde Kerk van Afrika die oortuiging dat die kerk kinders deur 'n proses van kategese tot godsdienstige volwassenheid kan lei. Van Selms se kategismus pas nie in die trajek wat hier beskryf word nie. Die Nederduitsch Hervormde Kerk van Afrika sou vandag heeltemal anders gelyk het as meer as een generasie van die lidmate van die Kerk aan hierdie kategeseboek blootgestel was. (shrink)

Rudolf Bultmann was one of the leading thinkers within an influential theological direction that arose in Europe after the First World War, known as dialectical theology. Comprehensive introductions to the life and work of Bultmann in the South African theological journals, written in Afrikaans, either does not exist, or are difficult to trace for the Afrikaans readership. This article on Bultmann aims to fill the gap by offering a lexicographical contribution on the life and work of Bultmann. The focus of (...) this article is on Bultmann as a Lutheran thinker. The theme of the New Testament and systematic theology is essentially the same, namely to explain the concept of Christian self-understanding as an eschatological event in which faith is expressed for the sake of faith in God and only in God. Bultmann explained the same theological concepts with his theology as those that were explained by the church reformers of the 16th century, but under radically new circumstances. The so-called modern and postmodern people of our time not only broke ties with the past, but in the process they also lost their ability for using historical-critical patterns of thought that tries to bridge historical distances, and therefore sacrificed all efforts to think systematically on the altar of relativism. We can learn from Bultmann what systematic reformed theology really is. (shrink)

Background One of the objectives of medicine is to relieve patients' suffering. As a consequence, it is important to understand patients' perspectives of suffering and their ability to cope. However, there is poor insight into what determines their suffering and their ability to bear it. Purpose To explore the constituent elements of suffering of patients who explicitly request euthanasia or physician-assisted suicide (EAS) and to better understand unbearable suffering from the patients' perspective. Patients and methods A qualitative study using in-depth (...) face-to-face interviews was conducted with 31 patients who had requested EAS. The grounded theory approach was used to analyse the data. Results Medical, psycho-emotional, socio-environmental and existential themes contributed to suffering. Especially fatigue, pain, decline, negative feelings, loss of self, fear of future suffering, dependency, loss of autonomy, being worn out, being a burden, loneliness, loss of all that makes life worth living, hopelessness, pointlessness and being tired of living were constituent elements of unbearable suffering. Only patients with a psychiatric (co)diagnosis suffered unbearably all the time. Conclusions Unbearable suffering is the outcome of an intensive process that originates in the symptoms of illness and/or ageing. According to patients, hopelessness is an essential element of unbearable suffering. Medical and social elements may cause suffering, but especially when accompanied by psycho-emotional and existential problems suffering will become ‘unbearable’. Personality characteristics and biographical aspects greatly influence the burden of suffering. Unbearable suffering can only be understood in the continuum of the patients' perspectives of the past, the present and expectations of the future. (shrink)

The Remmelink Committee published its report on medical decisions at the end of life in the Netherlands in September 1991. As a result, the Dutch debate about physician aid‐in‐dying has been broadened to include life‐terminating acts that have not been explicitly requested by the patient.

The gospel is not a new law. A clear distinction must be made between law and gospel, so that the gospel is not mistakenly understood as a new law, but as the gospel. The relationship between law and gospel must be considered carefully. Two prominent theologians, Martin Luther and Karl Barth, did just that, but in opposition to one another. This article describes and compares their respective views. Barth defends a political use of the gospel. The gospel provides believers with (...) action instructions for the civilian life. Barth argues in terms of analogical thinking and, according to him, believers’ understanding of reality is determined by their understanding of Christ. Luther, on the other hand, believes that the preaching of Christ and the life experience are in contrast. Faith and life are not identical. He understands the believer as the hearer of the gospel – as passive recipient of the grace of God. The passivity here, however, is a highly creative one. The relevance for us of the theological position defended regarding law and gospel is evident from the document ‘Association of the World Communion of Reformed Churches with the Joint Declaration on the Doctrine of Justification’. The spirit of the document is clearly Barthian. Fundamental theological differences are on the table with the Lutheran position and there is no question of real consensus. Intensive study and frank ecumenical conversation is required to seek real consensus for the sake of a clear Christian testimony in the world. (shrink)

In our society, where interest in Buddhist meditation is expanding enormously, numerous scientific studies are now conducted on the neurophysiological effects of meditation practices and on the neural correlates of meditative states. However, very few studies have been conducted on the experience associated with contemplative practice: what it is like to meditate -- from moment to moment, at different stages of practice -- remains almost invisible in contemporary contemplative science. Recently, 'micro-phenomenological' interview methods have been developed to help us become (...) aware of lived experience and describe it with rigour and precision. The present article presents the results of a pilot project1 aimed at applying these methods to the description of meditative experience. The first part of the article describes these methods and their adjustment for the investigation of meditative experience. The second part provides micro- phenomenological descriptions of two processes of which meditation practice enables the practitioner to become aware: the process of losing contact with the current situation and generation of virtual ones in 'mind-wandering' episodes, and the process of emergence of a thought. The third part of the article highlights the interest such descriptions may have for practitioners and for teachers of meditation, defines the status of these results, and outlines directions for further research. (shrink)

Patient competence, defined as the ability to reason, appreciate, understand, and express a choice is rarely discussed in patients with obsessive compulsive disorder, and coercive measures are seldom used. Nevertheless, a psychiatrist of psychologist may doubt whether OCD patients who refuse treatment understand their disease and the consequences of not being treated, which could result in tension between respecting the patient’s autonomy and beneficence. The purpose of this article is to develop a notion of competence that is grounded in clinical (...) practice and corresponds with the experiences of patients with obsessions and/or compulsions. We present a naturalistic case study giving both the patient’s and the therapist’s perspective based on in-depth interviews and a narrative analysis. The case study shows that competence is not merely an assessment by a therapist, but also a co-constructed reality shaped by the experiences and stories of patient and therapist. The patient, a medical student, initially told her story in a restitution narrative, focusing on cognitive rationality. Reconstructing the history of her disease, her story changed into a quest narrative where there was room for emotions, values and moral learning. This fitted well with the therapist’s approach, who used motivational interventions with a view to appealing to the patient’s responsibility to deal with her condition. We conclude that in practice both the patient and therapist used a quest narrative, approaching competence as the potential for practical reasoning to incorporate values and emotions. (shrink)