Sharing Matters of the Heart: The Importance of Emotional Disclosure for Cardiac Patients and their Spouses

Previous research has suggested that emotional expression is important for psychological adjustment to disease (e.g., Stanton et al., 2000). Indeed, experimentally prescribed emotional disclosure (traditionally, expressive writing) in the context of illness has been shown to provide benefits for mental and physical health (Pennebaker, 1993). However, the experimentally prescribed disclosure in previous research has typically been asocial, akin to writing in a diary. In contrast, the present research, by experimentally manipulating the intended audience of one’s disclosure, examined the effect of addressing one’s emotional disclosure to specific types of listener, namely a therapist or one’s spouse. Cardiac couples in which one partner had a recent cardiac event took part in the current study. First, partners completed pre-study characteristics questionnaires. Next, in a lab session, partners (in separate rooms) were randomly assigned to one of three conditions: (1) they disclosed their thoughts and feelings about the cardiac event as though speaking to their partner; (2) they disclosed their thoughts and feelings about the event as though speaking to a therapist; or (3) in a non-disclosure, control condition, they spoke about a neutral topic. Partners then engaged in a dyadic discussion about each partner’s experiences, thoughts and feelings about the cardiac event. Finally, a one-month follow-up measure assessed their relational outcomes since participation. It was hypothesized that the partner-oriented condition would lead to better outcomes than the therapist-oriented condition, and that disclosing overall would be more beneficial than non-disclosure. The study also examined the influence of pre-study characteristics on in-lab and follow-up outcomes, with the hypothesis being that participants doing less well initially (i.e., higher on psychological distress, Type D personality, emotional suppression, and lower on mindfulness, cognitive reappraisal, relationship satisfaction, and perceived social support) would experience relatively more benefits from participation than those initially doing well. In addition, the study investigated whether type of event (unexpected and sudden vs. planned and more gradual) would differentially influence measures throughout the study, with the hypothesis being that couples who experienced a sudden event (MI) would be more distressed and therefore benefit more from participation than those who went through a planned procedure. Hypotheses were partially supported. Although the manipulation of disclosing to one’s partner vs. a therapist did not elicit many differences, one important and novel finding emerged regarding the orientation of disclosures: partner-disclosures yielded a more communal orientation whereas therapist-disclosures yielded a more self-focused orientation. The importance of patients’ disclosure orientation (me vs. we) was revealed when it emerged that greater communal focus led to better outcomes for both partners, but greater self-focus led to less positive outcomes for spouses. Compared to non-disclosure, disclosure generally was found to provide greater benefits for relational communication as well as marital satisfaction at follow-up. Consistent with predictions, participants who seemed most in need at pre-study (i.e., greater distress, Type D personality, emotional suppression, and less marital satisfaction and perceived support) experienced better outcomes than those who were initially well. Finally, couples who went through a sudden event were found to be more in need and benefited more than those whose event was planned, and this was especially pronounced in the effects on the spouses. Directions for future research and implications for clinical practice were discussed. For example, in addition to highlighting the value of emotional disclosure in the context of serious illness, the findings identified characteristics of cardiac couples who may be more in need of communication interventions and drew attention to important, relatively unmet needs in the patients’ spouses

Structural sensitivity of chaotic dynamics in Hastings-Powell's model

The classical Hastings-Powell model is well known to exhibit chaotic dynamics in a three-species food chain. Chaotic dynamics appear through period-doubling bifurcation of stable coexistence limit cycle around an unstable interior equilibrium point. A specific choice of parameter value leads to a situation where the chaotic attractor disappears through a collision with an unstable limit cycle. As a result, the top predator goes to extinction. Here we explore the structural sensitivity of this phenomenon by replacing the Holling type II functional responses with Ivlev functional responses. Here we prove the existence of two Hopf-bifurcation thresholds and numerically detect the existence of an unstable limit cycle. The model with Ivlev functional responses does not indicate any possibility of extinction of the top predator. Further, the choice of functional responses depicts a significantly different picture of the coexistence of the three species involved with the model

The Beatific Vision and the Heavenly Mediation of Christ

This article argues that Thomas Aquinas is to be interpreted as holding that the beatific vision of the saints is causally dependent on the glorified humanity of Christ. It opposes the view that, for Aquinas, Christ’s humanity has causal significance only for those who are being brought to the beatific vision by grace, and not for those who have attained this vision, such that there is a Christological deficit in Aquinas’s eschatology. The argument proceeds somewhat in the manner of an article of Aquinas’s Summa Theologiae. Having briefly outlined the recent debate, especially the contribution of Hans Boersma, two objections are put against my position. A sed contra is formulated on the basis of quotations from the Summa. The responsio is based on Aquinas’s extensive use of a philosophical ‘principle of the maximum’ and its particular application by Aquinas to grace. After replies to the objections, based on the method and structure of the Summa, I locate Aquinas’s position in the debate on Christ’s heavenly mediation between that of John Calvin and that of John Owen and Jonathan Edwards

Fault Injection on Embedded Neural Networks: Impact of a Single Instruction Skip

With the large-scale integration and use of neural network models, especially in critical embedded systems, their security assessment to guarantee their reliability is becoming an urgent need. More particularly, models deployed in embedded platforms, such as 32-bit microcontrollers, are physically accessible by adversaries and therefore vulnerable to hardware disturbances. We present the first set of experiments on the use of two fault injection means, electromagnetic and laser injections, applied on neural networks models embedded on a Cortex M4 32-bit microcontroller platform. Contrary to most of state-of-the-art works dedicated to the alteration of the internal parameters or input values, our goal is to simulate and experimentally demonstrate the impact of a specific fault model that is instruction skip. For that purpose, we assessed several modification attacks on the control flow of a neural network inference. We reveal integrity threats by targeting several steps in the inference program of typical convolutional neural network models, which may be exploited by an attacker to alter the predictions of the target models with different adversarial goals.Comment: Accepted at DSD 2023 for AHSA Special Sessio

Thomas Aquinas, the Beatific Vision and the Role of Christ: A Reply to Hans Boersma

This article continues a conversation with Hans Boersma on the role of Jesus Christ in the beatific vision enjoyed by the saints. In his book Seeing God, Boersma maintained that there is a Christological deficit in Thomas Aquinas’s account of the beatific vision. In response I suggested that Aquinas held that Christ’s beatific vision is forever the cause of that of the saints. In his reply to me, Boersma more or less accepted my conclusion, but claimed there was still a Christological deficit because Aquinas mentions the thesis only rarely. He then drew attention to a second, more important factor in the alleged deficit, namely, Aquinas’s identification of the divine essence rather than Christ as the vision’s object. The present article responds to both elements of the alleged deficit, arguing against Boersma on the basis of the Summa Theologiae’s structure that there is no such deficit in Aquinas. While Boersma, after finding against Aquinas, moves in conclusion “towards a theophanic view of the beatific vision,” in my own conclusion I sketch out an alternative, Thomist account of the relationship between the beatific vision and heavenly theophany

The need to move from 6-minute walk distance to outcome trials in pulmonary arterial hypertension

Assessment of change in exercise capacity using the 6-min walk distance (6MWD) test has been the primary end-point in the majority of pulmonary arterial hypertension (PAH) clinical trials. The 6MWD has some advantages as an end-point in such studies. It is simple and inexpensive to perform, reproducible and validated. In short-term studies with small patient numbers, as is typical in a rare disease like PAH, using change from baseline in 6MWD as the primary outcome measure demonstrated statistically significant differences between placebo and study drugs, leading to their approval. However, there have been increasing calls for clinical trials to employ primary end-points that reflect long-term disease progression and morbidity. While the 6MWD was initially considered to be a potentially reliable surrogate for disease progression in PAH, there is increasing evidence that this is not necessarily the case. Given this, there is a need to re-examine the role of 6MWD in PAH trials, and to evaluate the evidence supporting whether there is a need to move from 6MWD to more robust measures of clinical outcomes, such as morbidity and mortality. However, in the clinic the 6MWD test, alongside symptoms, haemodynamics and biomarkers, remains a useful tool in the assessment and management of PAH patients

emPHasis-10: development of a health-related quality of life measure in pulmonary hypertension.

The aim of this study was to develop a measure of the impact of pulmonary hypertension (PH) on health-related quality of life (HRQoL) as there is a need for a short, validated instrument that can be used in routine clinical practice. Interviews were conducted with 30 PH patients to derive 32 statements, which were presented as a semantic differential six-point scale (0–5), with contrasting adjectives at each end. This item list was completed by patients attending PH clinics across the UK and Ireland. Rasch analysis was applied to identify items fitting a uni-dimensional model. 226 patients (mean age 55.6±14 years; 70% female) with PH (82% had pulmonary arterial hypertension) completed the study questionnaires. 10 of the 32 items demonstrated fit to the Rasch model (Chi-squared 16; p>0.05) and generated the emPHasis-10 questionnaire. Test–retest (intraclass correlation coefficient 0.95, n=33) and internal consistency (Chronbach’s α=0.9) were strong. emPHasis-10 scores correlated consistently with other relevant measures and discriminated subgroups of patients stratified by World Health Organization functional class (ANOVA F=1.73; p<0.001). The emPHasis-10 is a short questionnaire for assessing HRQoL in pulmonary arterial hypertension. It has excellent measurement properties and is sensitive to differences in relevant clinical parameters. It is freely available for clinical and academic use