Tilburg University

Aims To describe the co‐creation of the ‘Desired Dementia Care Towards End of Life’ (DEDICATED) approach to improve person‐centred palliative care for individuals with dementia and to describe the experiences of healthcare professionals during the approach's implementation. Methods A needs assessment, comprising both qualitative and quantitative studies, informed palliative care needs of healthcare professionals, family caregivers and individuals with dementia. The approach was co‐created with healthcare and education professionals, guided by the findings. Then, healthcare professionals were trained to implement the approach in their organizations. From April to June 2022, semi‐structured interviews with actively engaged professionals were analysed using Conventional Content Analysis. Results The needs assessment yielded six key themes: (1) raising palliative care awareness, (2) familiarization with a person with dementia, (3) communication about future care preferences, (4) managing pain and responsive behaviour, (5) enhancing interprofessional collaboration in advance care planning and (6) improving interprofessional collaboration during transitions to nursing homes. Interviews with 17 healthcare professionals revealed that active involvement in co‐creating or providing feedback facilitated implementation. Overall, the DEDICATED approach was perceived as a valuable toolkit for optimizing palliative care for people with dementia and their loved ones. Conclusion Co‐creating the DEDICATED approach with healthcare professionals facilitated implementation in daily practice. The approach was considered helpful in enhancing person‐centred palliative dementia care. Impact Statement This study underscores the importance of active involvement of healthcare professionals in the research and development of new interventions or tools for palliative care, which can influence the successful implementation, dissemination and sustained usage of the developed tools. Implications for the Profession and Patient Care The developed approach can improve person‐centred palliative care for individuals with dementia, ultimately improving their quality of life and that of their loved ones. Reporting Method This study used the Consolidated Criteria for Reporting Qualitative Research. Patient of Public Contribution No patient or public contribution.

Background Recent years have seen a growing interest in the use of digital tools for delivering person-centred mental health care. Experience Sampling Methodology (ESM), a structured diary technique for capturing moment-to-moment variation in experience and behaviour in service users’ daily life, reflects a particularly promising avenue for implementing a person-centred approach. While there is evidence on the effectiveness of ESM-based monitoring, uptake in routine mental health care remains limited. The overarching aim of this hybrid effectiveness-implementation study is to investigate, in detail, reach, effectiveness, adoption, implementation, and maintenance as well as contextual factors, processes, and costs of implementing ESM-based monitoring, reporting, and feedback into routine mental health care in four European countries (i.e., Belgium, Germany, Scotland, Slovakia). Methods In this hybrid effectiveness-implementation study, a parallel-group, assessor-blind, multi-centre cluster randomized controlled trial (cRCT) will be conducted, combined with a process and economic evaluation. In the cRCT, 24 clinical units (as the cluster and unit of randomization) at eight sites in four European countries will be randomly allocated using an unbalanced 2:1 ratio to one of two conditions: (a) the experimental condition, in which participants receive a Digital Mobile Mental Health intervention (DMMH) and other implementation strategies in addition to treatment as usual (TAU) or (b) the control condition, in which service users are provided with TAU. Outcome data in service users and clinicians will be collected at four time points: at baseline (t0), 2-month post-baseline (t1), 6-month post-baseline (t2), and 12-month post-baseline (t3). The primary outcome will be patient-reported service engagement assessed with the service attachment questionnaire at 2-month post-baseline. The process and economic evaluation will provide in-depth insights into in-vivo context-mechanism-outcome configurations and economic costs of the DMMH and other implementation strategies in routine care, respectively. Discussion If this trial provides evidence on reach, effectiveness, adoption, implementation and maintenance of implementing ESM-based monitoring, reporting, and feedback, it will form the basis for establishing its public health impact and has significant potential to bridge the research-to-practice gap and contribute to swifter ecological translation of digital innovations to real-world delivery in routine mental health care. Trial registration ISRCTN15109760 (ISRCTN registry, date: 03/08/2022).

Experiments on visually grounded, definite reference production often manipulate simple visual scenes in the form of grids filled with objects, for example, to test how speakers are affected by the number of objects that are visible. Regarding the latter, it was found that speech onset times increase along with domain size, at least when speakers refer to nonsalient target objects that do not pop out of the visual domain. This finding suggests that even in the case of many distractors, speakers perform object‐by‐object scans of the visual scene. The current study investigates whether this systematic processing strategy can be explained by the simplified nature of the scenes that were used, and if different strategies can be identified for photo‐realistic visual scenes. In doing so, we conducted a preregistered experiment that manipulated domain size and saturation; replicated the measures of speech onset times; and recorded eye movements to measure speakers’ viewing strategies more directly. Using controlled photo‐realistic scenes, we find (1) that speech onset times increase linearly as more distractors are present; (2) that larger domains elicit relatively fewer fixation switches back and forth between the target and its distractors, mainly before speech onset; and (3) that speakers fixate the target relatively less often in larger domains, mainly after speech onset. We conclude that careful object‐by‐object scans remain the dominant strategy in our photo‐realistic scenes, to a limited extent combined with low‐level saliency mechanisms. A relevant direction for future research would be to employ less controlled photo‐realistic stimuli that do allow for interpretation based on context.

Background Previous reports have provided (some) demographics of the cosmetic consumer; however, findings are not unequivocal. This relates to differences in the studies’ categorizations, samples, and contextual factors. Methods Employing a cross-sectional survey design, which was disseminated by 11 cosmetic clinics and consumer platforms in the Netherlands, this study provides a clear overview of a total of 734 Dutch cosmetic consumers’ (a) demographic characteristics; (b) motivations for undergoing a range of specific cosmetic procedures; (c) cosmetic procedure frequency, i.e., how frequently they undergo particular procedures; and (d) frequency of, and motivations for, switching clinics. Relations between cosmetic consumers’ demographics, motivations for cosmetic procedures, and different procedures chosen were also established. Results There is no unequivocal characterization of ‘the’ cosmetic consumer in the Netherlands, although they mostly identified as heterosexual women from Dutch descent with relatively high educational attainment levels and a high income. Some regional differences in terms of cosmetic procedure engagement were observed. Motivations for cosmetic procedure engagement were multifaceted, and responses varied between open- and closed-ended questions. Few relations between predictors and (a selection of) cosmetic procedures proved significant. (Higher) age and high educational attainment positively correlated with undergoing botulinum toxin injections and eyelid corrections. Gender and daily use of highly visual social media positively correlated with undergoing dermal filler injections. Lastly, lower-educated consumers were significantly more likely to have breast enlargements than higher-educated consumers. Conclusions This study provides a comprehensive overview of the demographic characteristics and motivations of a varied sample of cosmetic consumers, and the types and quantities of cosmetic procedures they undergo. In terms of demographics, we can conclude that there is no unequivocal characterization of ‘the’ cosmetic consumer in the Netherlands, although she frequently identifies as a heterosexual female of Dutch descent. Level of Evidence Not gradable

Background Timely detection of stress in people with dementia and people with an intellectual disability (ID) may reduce the occurrence of challenging behavior. However, detecting stress is often challenging as many long-term care (LTC) residents with dementia and residents with ID have communication impairments, limiting their ability to express themselves. Wearables can help detect stress but are not always accepted by users and are uncomfortable to wear for longer periods. Integrating sensors into clothing may be a more acceptable approach for users in LTC. To develop a sensor system for early stress detection that is accepted by LTC residents with dementia and residents with ID, understanding their perceptions and requirements is essential. Objective This study aimed to (1) identify user requirements for a garment-integrated sensor system (wearable) for early stress detection in people with dementia and people with ID, (2) explore the perceptions of the users toward the sensor system, and (3) investigate the implementation requirements in LTC settings. Methods A qualitative design with 18 focus groups and 29 interviews was used. Focus groups and interviews were conducted per setting (dementia, ID) and target group (people with dementia, people with ID, family caregivers, health care professionals). The focus groups were conducted at 3 time points within a 6-month period, where each new focus group built on the findings of previous rounds. The data from each round were used to (further) develop the sensor system. A thematic analysis with an inductive approach was used to analyze the data. Results The study included 44 participants who expressed a positive attitude toward the idea of a garment-integrated sensor system but also identified some potential concerns. In addition to early stress detection, participants recognized other potential purposes or benefits of the sensor system, such as identifying triggers for challenging behavior, evaluating intervention effects, and diagnostic purposes. Participants emphasized the importance of meeting specific system requirements, such as washability and safety, and user requirements, such as customizability and usability, to increase user acceptance. Moreover, some participants were concerned the sensor system could contribute to the replacement of human contact by technology. Important factors for implementation included the cost of the sensor system, added value to resident and health care professionals, and education for all users. Conclusions The idea of a garment-integrated sensor system for early stress detection in LTC for people with dementia and people with ID is perceived as positive and promising by stakeholders. To increase acceptability and implementation success, it is important to develop an easy-to-use, customizable wearable that has a clear and demonstrable added value for health care professionals and LTC residents. The next step involves pilot-testing the developed wearable with LTC residents with dementia and residents with ID in clinical practice.

Background Enhancing Local Control (LC) of brain metastases is pivotal for improving overall survival, which makes the prediction of local treatment failure a crucial aspect of treatment planning. Understanding the factors that influence LC of brain metastases is imperative for optimizing treatment strategies and subsequently extending overall survival. Machine learning algorithms may help to identify factors that predict outcomes. Methods This paper systematically reviews these factors associated with LC to select candidate predictor features for a practical application of predictive modeling. A systematic literature search was conducted to identify studies in which the LC of brain metastases is assessed for adult patients. EMBASE, PubMed, Web-of-Science, and the Cochrane Database were searched up to December 24, 2020. All studies investigating the LC of brain metastases as one of the endpoints were included, regardless of primary tumor type or treatment type. We first grouped studies based on primary tumor types resulting in lung, breast, and melanoma groups. Studies that did not focus on a specific primary cancer type were grouped based on treatment types resulting in surgery, SRT, and whole-brain radiotherapy groups. For each group, significant factors associated with LC were identified and discussed. As a second project, we assessed the practical importance of selected features in predicting LC after Stereotactic Radiotherapy (SRT) with a Random Forest machine learning model. Accuracy and Area Under the Curve (AUC) of the Random Forest model, trained with the list of factors that were found to be associated with LC for the SRT treatment group, were reported. Results The systematic literature search identified 6270 unique records. After screening titles and abstracts, 410 full texts were considered, and ultimately 159 studies were included for review. Most of the studies focused on the LC of the brain metastases for a specific primary tumor type or after a specific treatment type. Higher SRT radiation dose was found to be associated with better LC in lung cancer, breast cancer, and melanoma groups. Also, a higher dose was associated with better LC in the SRT group, while higher tumor volume was associated with worse LC in this group. The Random Forest model predicted the LC of brain metastases with an accuracy of 80% and an AUC of 0.84. Conclusion This paper thoroughly examines factors associated with LC in brain metastases and highlights the translational value of our findings for selecting variables to predict LC in a sample of patients who underwent SRT. The prediction model holds great promise for clinicians, offering a valuable tool to predict personalized treatment outcomes and foresee the impact of changes in treatment characteristics such as radiation dose.

We use disaggregated U.S. data and a border discontinuity design to show that more generous unemployment insurance (UI) policies lower bank deposits. We test several channels that could explain this decline and find evidence consistent with households lowering their deposit holdings due to reduced precautionary savings. Because deposits are the largest and most stable source of funding for banks, the decrease in deposits affects bank lending. Banks that raise deposits in states with generous UI policies reduce their loan supply to small businesses. Furthermore, counties that are served by these banks experience a higher unemployment rate and lower wage growth. This paper was accepted by Lukas Schmid, finance. Funding: G. Kabas acknowledges financial support from the European Research Council [ERC ADG 2016-GA 740272 lending]. Supplemental Material: The online appendix and data files are available at https://doi.org/10.1287/mnsc.2022.03217 .

Cognitive functioning is increasingly considered when making treatment decisions for patients with a brain tumor in view of a personalized onco-functional balance. Ideally, one can predict cognitive functioning of individual patients to make treatment decisions considering this balance. To make accurate predictions, an informative representation of tumor location is pivotal, yet comparisons of representations are lacking. Therefore, this study compares brain atlases and principal component analysis (PCA) to represent voxel-wise tumor location. Pre-operative cognitive functioning was predicted for 246 patients with a high-grade glioma across eight cognitive tests while using different representations of voxel-wise tumor location as predictors. Voxel-wise tumor location was represented using 13 different frequently-used population average atlases, 13 randomly generated atlases, and 13 representations based on PCA. ElasticNet predictions were compared between representations and against a model solely using tumor volume. Preoperative cognitive functioning could only partly be predicted from tumor location. Performances of different representations were largely similar. Population average atlases did not result in better predictions compared to random atlases. PCA-based representation did not clearly outperform other representations, although summary metrics indicated that PCA-based representations performed somewhat better in our sample. Representations with more regions or components resulted in less accurate predictions. Population average atlases possibly cannot distinguish between functionally distinct areas when applied to patients with a glioma. This stresses the need to develop and validate methods for individual parcellations in the presence of lesions. Future studies may test if the observed small advantage of PCA-based representations generalizes to other data.

Objectives Workplace stigmatisation and discrimination are significant barriers to accessing employment opportunities, reintegration and promotion in the workforce for people with mental illnesses in comparison to other disabilities. This paper presents qualitative evidence of anticipated and experienced workplace stigma and discrimination among individuals with major depressive disorder (MDD) in 35 countries, and how these experiences differ across countries based on their Human Development Index (HDI) level. Design Mixed-method cross-sectional survey. Participants, setting and measures The qualitative data were gathered as part of the combined European Union Anti-Stigma Programme European Network and global International Study of Discrimination and Stigma Outcomes for Depression studies examining stigma and discrimination among individuals with MDD across 35 countries. Anticipated and experienced stigma and discrimination were assessed using the Discrimination and Stigma Scale version 12 (DISC-12). This study used responses to the open-ended DISC-12 questions related to employment. Data were analysed using the framework analysis method. Results The framework analysis of qualitative data of 141 participants identified 6 key ‘frames’ exploring (1) participants reported experiences of workplace stigma and discrimination; (2) impact of experienced workplace stigma and discrimination; (3) anticipated workplace stigma and discrimination; (4) ways of coping; (5) positive work experiences and (6) contextualisation of workplace stigma and discrimination. In general, participants from very high HDI countries reported higher levels of anticipated and experienced discrimination than other HDI groups (eg, less understanding and support, being more avoided/shunned, stopping themselves from looking for work because of expectation and fear of discrimination). Furthermore, participants from medium/low HDI countries were more likely to report positive workplace experiences. Conclusions This study makes a significant contribution towards workplace stigma and discrimination among individuals with MDD, still an under-researched mental health diagnosis. These findings illuminate important relationships that may exist between countries/contexts and stigma and discrimination, identifying that individuals from very high HDI countries were more likely to report anticipated and experienced workplace discrimination.

This paper analyses the phenomenology and epistemology of chatbots such as ChatGPT and Bard. The computational architecture underpinning these chatbots are large language models (LLMs), which are generative artificial intelligence (AI) systems trained on a massive dataset of text extracted from the Web. We conceptualise these LLMs as multifunctional computational cognitive artifacts, used for various cognitive tasks such as translating, summarizing, answering questions, information-seeking, and much more. Phenomenologically, LLMs can be experienced as a “quasi-other”; when that happens, users anthropomorphise them. For most users, current LLMs are black boxes, i.e., for the most part, they lack data transparency and algorithmic transparency. They can, however, be phenomenologically and informationally transparent, in which case there is an interactional flow. Anthropomorphising and interactional flow can, in some users, create an attitude of (unwarranted) trust towards the output LLMs generate. We conclude this paper by drawing on the epistemology of trust and testimony to examine the epistemic implications of these dimensions. Whilst LLMs generally generate accurate responses, we observe two epistemic pitfalls. Ideally, users should be able to match the level of trust that they place in LLMs to the degree that LLMs are trustworthy. However, both their data and algorithmic opacity and their phenomenological and informational transparency can make it difficult for users to calibrate their trust correctly. The effects of these limitations are twofold: users may adopt unwarranted attitudes of trust towards the outputs of LLMs (which is particularly problematic when LLMs hallucinate), and the trustworthiness of LLMs may be undermined.

Neurofeedback, a non-invasive intervention, has been increasingly used as a potential treatment for major depressive disorders. However, the effectiveness of neurofeedback in alleviating depressive symptoms remains uncertain. To address this gap, we conducted a comprehensive meta-analysis to evaluate the efficacy of neurofeedback as a treatment for major depressive disorders. We conducted a comprehensive meta-analysis of 22 studies investigating the effects of neurofeedback interventions on depression symptoms, neurophysiological outcomes, and neuropsychological function. Our analysis included the calculation of Hedges’ g effect sizes and explored various moderators like intervention settings, study designs, and demographics. Our findings revealed that neurofeedback intervention had a significant impact on depression symptoms (Hedges’ g = −0.600) and neurophysiological outcomes (Hedges’ g = −0.726). We also observed a moderate effect size for neurofeedback intervention on neuropsychological function (Hedges’ g = −0.418). As expected, we observed that longer intervention length was associated with better outcomes for depressive symptoms (β = −4.36, P < 0.001) and neuropsychological function (β = −2.89, P = 0.003). Surprisingly, we found that shorter neurofeedback sessions were associated with improvements in neurophysiological outcomes (β = 3.34, P < 0.001). Our meta-analysis provides compelling evidence that neurofeedback holds promising potential as a non-pharmacological intervention option for effectively improving depressive symptoms, neurophysiological outcomes, and neuropsychological function in individuals with major depressive disorders.

The grandparent role has been often described as one of the most fulfilling aspects of older age. Yet, no longitudinal studies investigated the effect of the transition to grandparenthood on older adults’ sense of purpose and meaning in life. In this pre-registered study, we investigated the effect of becoming a first-time grandparent and a first-time caregiving grandparent on changes in sense of purpose and meaning in life. We used data from the Health and Retirement Study (HRS) and English Longitudinal Study of Ageing (ELSA), covering up to 12 years around the transition ( N HRS = 843, N ELSA = 587). To disentangle potential grandparenthood effects from age-related developmental changes, we used propensity score matching to compare grandparents to matched non-grandparents. Using latent change score models, we only found increases in sense of purpose in the years leading up to the transition, but not afterwards. No consistent findings of mean-level changes were observed in the control groups. Thus, our findings suggest that becoming a (caregiving) grandparent does not necessarily contribute to higher meaning and sense of purpose in life than before or compared to non-grandparents.