Third, the diagnosis of CTE goes someway to normalizing the behaviour of Hernandez, rendering his behaviours comprehensible. I conclude by considering how the specific narrative of CTE-as-acquired-dementia shapes depictions of Hernandez's subjectivity and discuss how this case troubles existing literatures on the neurologization of selfhood.This paper examines the entanglement of medicine, brain injury, and subjectivity within newspaper discourse and through the case of ex-American footballer Aaron Hernandez. In 2017, two years after being found guilty of murder and five years after scoring in the Super Bowl, Aaron Hernandez died by suicide in his prison cell. Hernandez was posthumously diagnosed with Chronic Traumatic Encephalopathy (CTE), a neurodegenerative disease associated with violence, depression, and dementia-like symptoms. I examine newspaper coverage of the Hernandez case, focusing upon the murder, arrests, conviction, suicide, and diagnosis of CTE in order to examine understandings of Hernandez's subjectivity. I make three conclusions: First, the disease is not mentioned prior to diagnosis with family instability, friendship groups, individual psychology, and the entitlement of celebrity foregrounded. Second, CTE  •CTE is a neurodegenerative disease popularly associated with contact sport.•Aaron Hernandez was convicted of murder, died by suicide, and diagnosed with CTE.•Through media analysis, I ask if Hernandez's actions were seen as shaped by CTE.•CTE is not mentioned prior to suicide and rarely prior to formal diagnosis.•After diagnosis CTE is used to explain and normalize much of Hernandez's behaviour. Hernandez's death came just two years after a conviction for first-degree murder and five years since he scored a touchdown in the 2012 Superbowl for the New England Patriots. If Hernandez's path from sporting glory, to celebrity, to violence, and finally self-inflicted death was believed by many to be a profoundly American story e.g. , what hanot discuss the possibility of CTE prior to Hernandez's posthumous diagnosis. Second, diagnosis itself did significantly affect media depictions of Hernandez, his crimes, and death by, third, rendering Hernandez as less monstrous. Hernandez was no longer depicted as totally Other but was instead brought into contact with others who play football or experience other forms of dementia.This article is about that enmeshment. I use the Hernandez case to examine the ways in which neuroscience in general, and CTE in particular, shape articulations of subjectivity within the contemporary news media. From this analysis I draw three conclusions. First, and contrary to prominent theses which suggest that medicine and neuroscience have been centralized within contemporary discourse, media outlets largely did 22.1Chronic Traumatic Encephalopathy, or CTE, is a neurodegenerative disease‘ … clinically associated with symptoms of irritability, impulsivity, aggression, depression, short-term memory loss and heightened suicidality … With advancing disease, more severe neurological changes develop that include dementia, gait and speech abnormalities and parkinsonism.’ . Ventresca has examined the ‘multiple becomings’ of CTE within media discourse, arguing that CTE variously refers to ‘a medical diagnosis, an object of scientific study, a cultural phenomenon, and a lived experience’ . Ventresca argues, as does Furness, that many former athletes form an identity around the possibility and fear of CTE but also, and significantly, that the uncertainties associated with CTE as a medical diagnosis have been strategically used to undercut any possibility of action based upon such fears. Analyses conducted by Adam Anderson and Kian, for example, argue that increased awareness of CTE, combined with a more widespread softening of masculine ideals, has opened a ‘crack in the hegemonic system’ which is allowing space for non-hegemonic forms of masculinity to be expressed in sport , p. 58. It is the claim advanced within this emerging body of literature – that CTE has become central to understandings of sporting cultures and sporting subjects – which is my concern here. In particular, I consider how the media depict sporting subjects when they are brought into the purview of a medical and neuroscientific gaze. In examining this topic, I draw upon, and contribute to, broader considerations of the ways in which biomedical knowledge affects understandings of ourselves, others, and society.2.2‘[N]euroscience is increasingly visible in the popular press’ , p. 257 facts play a key role in how we experience our selves, our bodies, and others’ . Dumit calls this process ‘objective self-fashioning’  are believed to have root in one's brain and biology, and therefore lie outside of one's control, then an individual may cease to be understood as morally culpable for their status or actions . Simultabilities .‘On the one hand there are fantasies of security, imagined communities where normal individuals and families can live an untroubled life of freedom. And, as its inescapable reciprocal, there is a constant fear of predatory monsters  … A monstrous individual is an anomaly, an exception. This is not merely one who diverges from a norm, but one who is of a radically different nature, implacably pathological, evil.’ . These studies are crucial in understanding neuroscience as a practice and the brain as a particular object. If, however, the intention is to examine the diffusion of medicine/neuroscience/the brain through society, the approach risks ‘chasing its own tail, offering up its own agendas and categories and getting those same agendas and categories back in a refined or filtered or inverted form’ , p. 293.as a diagnosis and have aptly demonstrated that particular individuals have been interpellated by a discourse informed by CTE. These pieces help us to understand the ways in which concussion is understood and reported upon. By preselecting a moment when it is already known that head trauma is relevant, however, these studies do not readily facilitate an examination of concussion/CTE's broader resonance within sport and society for they cannot examine, for example, when or if a discourse related to CTE is absent. Any claim that CTE has permeated culture more broadly, that it provides a general discourse through which to understand players' actions or subjectivities, thus necessitates an additional form of analysis.Such a conclusion is applicable to many studies examining concussion in the media, for many studies focus their analysis upon articles pre-selected because they are known to consider brain injury: either through analyses of how the media responded to a particular high-profile concussion ; or thro2.3The case of Aaron Hernandez allows us to examine if and how concussion and CTE shape understandings of sporting subjectivity more broadly. Hernandez was an All-American athlete throughout high school and college, setting individual records and winning a collegiate national championship while playing for the Florida Gators in 2009 , p. 69. , 2013 a man named Odin Lloyd, who was in a relationship with the sister of Aaron Hernandez's fiancée, was found murdered after suffering multiple gunshot wounds: one week later, on June 26th, Hernandez was arrested for the murder. Just under a year later, on May 15th, 2014 and while in prison, Hernandez was charged with two further ‘drive-by’ murders, those of Safiro Fertado and Daniel de Abreu. On April 15th, 2015, Hernandez was convicted of the murder of Lloyd and sentenced to life imprisonment without the possibility of parole.The current analysis, however, is centred on the following events. On June 17th, 2017 Hernandez was found not guilty of the murders of Fertado and de Abreu. On April 19th, Hernandez was found dead having apparently hanged himself in his cell. His family promptly sent his brain to Boston University to be studied for signs of CTE. Several months later, on September 21st, 2017, a press release from Boston University confirmed Hernandez was suffering from a severe case of CTE.In April 2017 came a series of events in quick succession: On April 14thafter the events in question had received significant media attention. These developments mean that finally, third, we have the opportunity to examine if and how CTE enters media discourse prior to his diagnosis and thus see just how deeply the discourse runs through contemporary media discourse.What is methodologically useful about the above is the following. First, all the incidents – from the murder of Odin Lloyd to the posthumous diagnosis of CTE – happen in the “post-Webster era”, well into the time of “CTE as cultural phenomenon”. Second, given Hernandez's posthumous diagnosis, we know that the media will ultimately deem neurodegenerative disease as relevant to understanding Hernandez and his actions. Crucially, however, Hernandez's diagnosis of CTE arrives 33.1The Boston Globe (BG), The New York Post (NYP), The New York Times (NYT), USA Today (USAT), The Wall Street Journal (WSJ), and The Washington Post (WP).I gathered articles from a cross section of US newspapers with a sample size significant enough to allow for meaningful patterns to be made evident. Outlets were considered which had a large circulation in the US and, in toto, were geographically dispersed. Ultimately, six outlets were selected for inclusion: Factiva; NYP, NYT, USAT, and WP were searched through Nexis; and WSJ was searched through ProQuest.Nexis was searched on the “moderate” and Factiva on the “similar” duplicate setting. Any additional complete or near-complete duplicate articles which escaped filters and became apparent during analysis were also removed. The decision was made to focus exclusively upon print editions for the sake of completion and consistency. No additional selection criteria needed to be met in order for an article to be considered.Content from these outlets was collected via the use of various searchable databases. The BG was searched through 3.2•The murder of Odin Lloyd.•The arrest of Aaron Hernandez for the murder of Lloyd.•The arrest of Hernandez for the murder of Daniel de Abreu and Safiro Furtado.•The conviction of Hernandez for the murder of Lloyd.•The suicide of Hernandez.•The announcement that Hernandez had CTE.Six key events were initially identified for analysis:All articles published within two weeks of each event3.3I focus in particular on the construction of Hernandez as a subject within media discourse. There is a particular attentiveness to questions of causality (why did what happened happen?), culpability (who or what is responsible for what happened?), and kinship (who is Hernandez like?). Answering these questions involved interweaving two forms of analysis. First, a general inductive analysis  aimed atThe aforementioned combination of thematic and Foucauldian discourse analysis is well placed to examine questions of causality, culpability, and kinship in the case of Hernandez by allowing an inquiry into which topics are raised when  and, once that has happened, how key subjects and objects are constructed . To be clear, I am not analyzing the accuracy of media discourse. It is not my concern here whether Aaron Hernandez really killed Daniel de Abreu and Safiro Furtado or whether CTE explains his actions. These are self-evidently important questions, but they will not be addressed here.44.1NYT, June 21, 2013) and that Hernandez, as a high-profile athlete caught up in a criminal investigation, ‘has a lot of company’ . “Company,” in this case refers exclusively to other NFL players who have been investigated by the police . Discussed in this context is OJ Simpson although in the case of Simpson it is both criminal and aesthetic similarities which capture the attention. The ‘media swarm’ around Hernandez's house and the ‘mundane pursuit’ of Hernandez as he drove a white SUV to the New England Patriots' stadium – while being filmed via helicopters – are both taken to evoke Simpson's famous police chase which occurred, almost to the day, 19 years prior .In the week between the murder of Odin Lloyd and the arrest of Aaron Hernandez a prominent theme was that this story was a familiar one  and there are ‘red flags’ and ‘worrying signs’ in his past, a failed drug test being a prime example . There are also suggestions of ‘possible gang ties’ ; questions over ‘the company he keeps’ ; and possible involvement in another shooting . While it is noted that Hernandez has never been suspended ; is subject to misinformation ; and has not been declared a suspect , his actions still cause a significant degree of suspicion and the loss of endorsements and associated finances is noted . Even prior to Hernandez's arrest, therefore, certain themes begin to emerge: his psychology, his friendship group, and his kinship with other  criminals in the NFL all draw attention.Hernandez himself is described as ‘hot-tempered’ ; muscled-up or ‘action hero’ arms ; and finally his tattoos – which prove a cause of continual fascination .Straight after Hernandez's arrest, a number of themes begin to emerge. First, there is the question of his precedent. Into this category can be found numerous, lengthy descriptions of a bar fight Hernandez was involved in while at The University of Florida. The fact that Hernandez was in this bar with Tim Tebow – the ‘mild-mannered’  and ‘God fearing’  quarterback who was already ‘a fully-fledged phenomenon’ ‘beloved’ for his ‘strong faith’ and ‘motivating personality’  and who clearly stands in contra-distinction to Hernandez – gives the story extra purchase. As was the case prior to his arrest, there are also discussions regarding the possibility that Hernandez previously shot a friend . The murders of Fertado and de Abreu, which are being linked to Hernandez for the first time, are also discussed .Second there is the question of psychology. Hernandez is repeatedly described as ‘emotionless’  or as displaying ‘little’ or ‘no emotion’ while in court . Hernandez is variously ‘agitated’ , ‘angry’ , ‘furious’ , ‘immature’ , and has ‘low self-esteem’ . He is described as has having killed in a ‘cold-blooded fashion’  – perhaps even being the NFL's first ‘serial killer’ . In addition, there is a discussion in both the BG  and the WSJ  of personality tests undertaken prior to the NFL draft which show his ‘low social maturity’ and that he ‘enjoys living on the edge’.Third, there is the matter of causation or explanation there are two dominant threads. The first might be referred to as “psychosocial” factors which pertain to the ‘rocky life’  of Hernandez, particularly while growing up in his home town of Bristol, Connecticut. It is repeatedly noted that Hernandez's father died when he was a teenager  and that this had a profound impact upon him. Sometimes woven into the same narrative is a discussion of the ‘rough-and-tumble’  crowds Hernandez hung out with in ‘hardscrabble’ Bristol . This sometimes leads to questions about ‘thug associates’ , ‘sordid characters’ , and ‘hanging around with gangbangers’ . Celebrity is sometimes seen to play into this matter, as in the suggestion in USAT that Hernandez was part of a ‘rich jock culture’ .When it comes to theories of NYP blames ‘culture’ for Hernandez's acts before bemoaning the fact that ‘those in the highest places, those who could make the biggest differences — starting with our first black president - choose to pass on addressing such elephant-in-the-room matters’ . It is important to note, however, that much of the vocabulary used to describe Hernandez has been critiqued by media studies scholars. “Thug,” for example is as ‘ … a term that carries powerful negative connotations for African American males and is considered by many to be a code for the N-word’  and who are discussed within the media at this time . Given that the coverage of Hernandez occurred in the context of a media ecology in which the talk  – this high number of arrests came despite a local law firm providing pro bono work for players , thus ensuring that Hernandez was able to get ‘off the hook’ . A piece in the NYP argues, ‘[Urban] Meyer [Hernandez's coach in Florida] clearly didn't give a rat's rectum about safety when he spent five years inviting and indulging dangerous, criminally inclined players to the campus of the University of Florida … ’ . The Patriots, meanwhile, repeatedly ‘took a chance’ on players like Hernandez  and were left in a ‘pile of rubble’ . The NFL have ‘been here before’  and appear to have ‘zero impact on [a player's] moral compass' .The second theme relating to causation might be called ‘institutional enablement’. Here the lens falls upon NFL, the New England Patriots, and the University of Florida, with the television broadcaster ESPN also coming under occasional criticism. This institutional collective is sometimes referred to as ‘Football Inc.’: Those individuals and organizations who ‘looked the other way’ or actively subverted attempts to intervene in a life ‘spiralling out of control’ . The FloIn light of the suggestion that there has been a “cultural awakening” to CTE it is worthy of note that, across the 98 articles published after Hernandez's arrest, there was no mention of Hernandez's brain or neurodegenerative disease. Instead, Hernandez's individual psychosocial background, affiliates (who are understood in raced terms), and the institutional indulgence of powerful organizations are all foregrounded. This is strong evidence to suggest that, while CTE may well be a “cultural phenomenon” in the second decade of the twenty-first century, subjects are less readily interpellated into its discourse than they are for other, existing, explanations of behaviour.4.3USAT, entitled ‘Hernandez profile fits as gangster, not serial killer’ , discusses the possibility that Hernandez has ‘gang ties’. It is argued in this article that Hernandez acts like an ‘old school mobster’, adheres to a ‘street code’, and is not a ‘serial killer’: This is a judgement reached by a forensic psychiatrist on the basis that Hernandez has friends, emotions , and a ‘personality structure’. These, it is argued, are not characteristics associated with serial killers. A similar theme is discussed in the WP  wherein it is asked if Hernandez is ‘a spree killer? A gang killer?’. Of greater concern within this piece in the WP is the argument that Hernandez is not like others in the NFL (contra one of the themes identified above). The explanation for Hernandez's acts lies ‘buried deep in him’, ‘a dramatic failure of an internal mechanism’. Hernandez is described in this article as ‘an extreme anomaly’ and ‘profoundly unnatural’ – this is evidenced by the fact that ‘even piranhas don't turn their teeth on each other’. While the sample is small, the formal linking of Hernandez to multiple deaths seems to distance Hernandez from others in the NFL who have committed criminal acts. Through this distancing, it is psychosocial causes “within” Hernandez which are emphasized, rather than CTE or another diagnosis.While the arrest of Hernandez for the double-murder of Safiro Fertado and Daniel de Abreu did not radically change the media discourse, there are some novel concerns within this corpus. The first concerns how Hernandez should be labelled now that he has been formally linked to multiple deaths. An article in 4.4BG, 16 April, 2015#1) whilst, in court, being ‘impassive’  and showing little emotion . Indeed, an article in the BG formalises these traits and diagnoses Hernandez as a ‘sociopath’ . Explanations for this psychology once again emphasize the death of Hernandez's father  and Hernandez's upbringing in the ‘hardscrabble’ town of Bristol – described as ‘flagging’ and ‘prowled by petty criminals’ in the NYT . Hernandez ‘never fully separated’  himself from this upbringing.The media coverage following the conviction of Hernandez for the murder of Odin Lloyd is largely continuous with that after his arrest. There is a continued focus upon Hernandez's psychology – he remains ‘prone to anger’ , ‘not held accountable’ , and treated with ‘wonderment’ and ‘reverence’ because of his athletic talents . This argument is made most clearly in the below quote:USAT, 16 April, 2015#3)‘But it's even more important [to remember that athletes need to ‘live within the law’] for the coaches, agents, hangers-on and, yes, even fans who feed these athletes' egos, enabling their boorish behavior. They might not have pulled the trigger, but they all had a hand in making Hernandez believe he could.’  published a reasonably lengthy piece noting that CTE was linked with aggression. That article also noted that several players who had previously played in the NFL had died by suicide and were then found to have CTE. The NYP  noted in passing that Hernandez's brain had been released and the BG reprinted the district attorney statements which included information about the brain . There is next to nothing, however, which works this discussion of CTE explicitly through Hernandez's behaviour or subjectivity.Nonetheless, reporting on CTE remained sparse: the BG, 25 April, 2017#2) concerning Hernandez's sexuality. It is claimed that bisexuality was Hernandez's ‘most guarded secret’  and there is some discussion of a ‘prison beau’ who may have been an intended recipient of a suicide note . The BG in particular also understands Hernandez in the context of prison suicides in Massachusetts, discussing at length the long-term failings of the state's prison system . Beyond these additions, the narrative stays largely the same: there are the same discussions about Hernandez's ego; his father's death; the ‘ne'er-do-wells’ ; and the fall which ‘started on the streets of Bristol’ .Instead of a decisive turn to the brain, two other topics are discussed at reasonable length. Firstly, the ‘swirling rumours’ ; that, because the sample of brains donated to brain banks is ‘small and nonrandom’  there is the possibility of bias ; that drug use is a potentially confounding variable (NYT 25 September 2017) – there is little hesitation in applying CTE to football , violence, suicide , and Aaron Hernandez as an individual. It is a ‘natural presumption’  that CTE leads to murder-suicide and ‘may explain his prison suicide’ . As one op-ed in the NYT states:‘C.T.E. deprives such players of the ability to handle disputes rationally. Indeed, being afflicted with C.T.E. may well equate to insanity. That's enough to excuse – at least legally – the potentially criminal, violent actions of former N.F.L. players in many states.Finally, it is necessary to turn to newspaper coverage in the days after Hernandez's posthumous diagnosis with CTE. There are several themes in this coverage which seem worthy of note: First, while there is significant discussion of the uncertainties associated with CTE – the fact that it can only be diagnosed posthumously .USAT, 22 September, 2017). It is widely assumed that the NFL's previous attempts to ‘to distance themselves from the disease and the cause-and-effect of playing contact sports’  is destined to fail in the wake of Hernandez: ‘The NFL is going to own that [Hernandez's death] whether it wants to or not’ . Of note here is that this discussion, in the days after Hernandez's death, seems to differ from the coverage considered by 3This direct link between football, CTE, and violence is assumed to have the potential to cause significant problems for “Football Inc.”. With his diagnosis of CTE, ‘Aaron Hernandez just became the most dangerous man in football’  and should come as ‘no surprise’  because there was ‘ample evidence’  of CTE when Hernandez was arrested in 2013 and charged with killing Odin Lloyd. As the below quote demonstrates, it is suggested that questions were asked at the time of Hernandez's acts:NYT, 23 September, 2017#2)‘When Aaron Hernandez, the former New England Patriots tight end, was convicted in 2015 of murdering a friend of his, questions arose: Did his years of butting heads on the football field contribute to his violent behavior off the field? And when he killed himself, in April, new questions were asked: Did football play a role in his suicide?’ . His aggression is also understood in relation to dementia, and ‘uncharacteristic aggression’ is transformed into a trait ‘many caregivers’ can readily relate to . Finally, parents and parental decision making is consistently evoked . Following Hernandez's diagnosis of CTE, ‘parents wonder if they're consigning their kids to a jail cell or the morgue by allowing them to play’ .A third point of interest concerns Hernandez's “kin”, those drawn close to Hernandez within discourse and deemed to be like him. We have seen that, following his arrest, Hernandez was grouped together with other NFL players who had committed crimes: A kinship which “made sense” because of a shared (raced) culture and the institutional enablement of the NFL, amongst other things. Hernandez and his kin were quite evidently Othered in these narratives: Hernandez was a ‘sociopath’; if not a serial killer then a ruthless ‘gangster’, hanging around with ‘gangbangers’ and adhering to a ‘street code’. Following NYT, 25 September, 2017#2) with other forms of dementia. If CTE remains an exceptionally rare diagnosis, dementias in general are not and, furthermore, the ‘dominant perceptions of the ‘disease’ [dementia] are framed primarily around loss of self’  described the case as ‘a true American horror story’, ‘a grim American tale’, and an ‘American tragedy’. James Patterson, one of the world's bestselling authors, has written a book about Hernandez entitled All-American Murder (2018). If it is true that Hernandez's story of sporting glory, celebrity, violence, and finally suicide speaks profoundly to the contemporary American condition, what role does medicine/neurology play?Following Aaron Hernandez's suicide, an article in Numerous scholars e.g.  have argMy examination of the media discourses surrounding the arrest, conviction, suicide, and diagnosis of Aaron Hernandez has only partially supported this thesis. It is certainly true that, following a posthumous diagnosis of CTE, understandings of Hernandez's behaviour change significantly: his culpability  is questioned and diminished; his aggression is no longer unquestioningly monstrous and is brought into contact with the lived-experience of caregivers supporting individuals with dementia. CTE, undoubtedly, became entangled with the story of Aaron Hernandez.specific moment of diagnosis. Despite occurring in a “post-Webster era” when discussion of CTE is, apparently, to the fore, there was no mention of Hernandez's brain or the possibility of neurodegenerative disease during coverage of either his arrests or subsequent conviction. Even Hernandez's suicide and the removal of his brain for diagnostic testing brought little discussion of CTE. Instead, family instability, ‘hanging with the wrong crowd’ , individual psychology, and the entitlement of celebrity aided and abetted by Football Inc. were all found to be general explanations more readily deployed in the media in order to understand Hernandez's behaviour.Nonetheless, this intertwining of sporting subjectivity and neurological state was highly dependent upon a only possible post-mortem. This situation, quite evidently, is very different to that found in depression, schizophrenia, personality disorder, or the vast majority of other conditions considered within biologicalization literature. We are thus reminded that the entanglement of bio/neuroscience with selfhood ‘ … may depend, to some extent, on the specific characteristics of the condition in question’  once he was diagnosed, and diagnosis is uestion’ , p. 1766uestion’ , p. 10 o


Furthermore, it is important to distinguish between Alzheimer's disease prevention and Alzheimer's dementia prevention when using these terms. While prior studies have codified research-based criteria for the progressive stages of AD, there are no clear clinical consensus criteria to guide the use of these terms for physicians in practice. A clear understanding of the implications of each term will help guide clinical practice and clinical research. The authors explore the semantics and appropriate use of the terms “prevention” and “risk reduction” as they relate to AD in clinical practice.The terms “prevention” and “risk reduction” are often used interchangeably in medicine. There is considerable debate, however, over the use of these terms in describing interventions that aim to  Further, it is important to distinguish between Alzheimer's disease prevention and Alzheimer's dementia prevention when using these terms.The terms “prevention” and “risk reduction” often are used interchangeably in medicine when referring to clinical interventions that aim to delay or prevent the onset of a disease. The implications of each term are unique and may also imply differential therapeutic effects of a proposed intervention. There is considerable debate over the use of these terms in describing interventions that aim to There has been growing interest in “preventative” interventions, ranging from pharmacologic approaches targeting disease pathology  to alterations in lifestyle  and treatment of co-morbid medical conditions associated with an increased risk of AD dementia. The interventions aim to provide an evidence-based strategy for patients in an effort to prolong or delay the transition from preclinical (asymptomatic) AD to more advanced stages of the disease. While the end goal may be “prevention,” the means to attain this goal may include a host of “risk reduction” interventions along with a myriad of other techniques .for physicians in practice. In 2013, a panel of over 100 international experts published a letter positing that dementia, including AD, can be prevented  categorizes preventative interventions as primary, secondary, or tertiary prevention. Primary prevention aims to avoid disease or its associated pathology before it occurs, whereas secondary prevention entails screening to recognize disease in its earliest stages, before symptoms occur, to slow or stop its progression. Tertiary prevention involves the treatment of disease to prevent complications and minimize disability  and Tau (T) as well as Neurodegeneration (N), which begin years to decades before any cognitive symptoms of clinical AD become apparent . AccordiIn AD dementia risk assessment, both non-modifiable and modifiable risk factors have been identified . Non-modRecently, there has been an exponential increase in the number of studies investigating the impact of modifiable risk factor reduction on brain health, cognition, and dementia risk. Many of these demonstrate that secondary prevention strategies to reduce modifiable risk factors correlate with a decrease in the rate of progression to MCI and symptomatic AD , 20, sugSimilarly, in a systematic review of a longitudinal study, the “Lifestyle for Brain Health” (LIBRA) score was used to predict cognitive change over a period of up to 16 years. Risk variables included in this model are related to protective factors , and predisposing factors . Researchers found a one-point progression in the LIBRA score correlated with a 9% increased risk for cognitive impairment and 19% increased risk for dementia . These dOther clinical trials have employed various pharmacologic interventions to delay the onset of AD. The ongoing A4 study, which is described as “a secondary prevention trial in older people with amyloid accumulation at high risk for AD dementia,” is currently exploring the efficacy of an anti-amyloid monoclonal antibody, solanezumab, in patients with positive amyloid PET scans . AnotherAlthough clinical trials have demonstrated a decrease in central nervous system amyloid burden, a biomarker of AD, dementia is a complicated clinical and pathophysiological process with a diverse set of symptoms and etiologies. The Systolic Blood Pressure Intervention—Memory and Cognition in Decreased Hypertension (SPRINT-MIND) Trial examined whether treating to the lower systolic blood pressure target (120 mmHg) compared to a higher goal (140 mmHg) would reduce the risk of developing dementia and/or MCI and reduce the total volume of white matter lesions in the brain, as demonstrated by magnetic resonance imaging. Preliminary data showed a 19% lower rate of new cases of MCI and a 15% lower rate of combined MCI plus probable all-cause dementia for the intensive vs. standard treatment group , 27. Thigeneral medical practice is well illustrated through an example of a different medical condition: cancer. An individual could be a non-smoking, active, normal weight person who is conscientious about eating a healthy diet and lives in a non-toxic, safe environment with no family history of cancer, yet he or she could still develop lung cancer despite the paucity of risk factors. If a patient receives the diagnosis of a disease, it is only logical that said disease was in no way “prevented” according to the colloquial definition of the word. To prove that prevention is possible, must researchers and practitioners wait until a patient is deceased to measure the success or failure of the interventions they assigned? At what point has a disease been “prevented,” if ever? In this case, risk reduction does not equate to disease modification or prevention.One potential argument for the use of “risk reduction” as opposed to “prevention” in Another argument against the use of “prevention” in diseases like AD is the lack of complete knowledge about disease-specific pathology and the sequence and timing that said pathology develops and accumulates. While anti-amyloid drugs may reduce amyloid burden, it is unclear whether they can delay cognitive decline and, thus, whether they can protect against AD . SeveralThe accumulation of amyloid-β is arguably the most commonly-accepted hypothesis for the onset of AD, but other hypotheses include the accumulation of tau, aberrant neuronal cell cycle reentry, demyelination, neuroinflammation, autophagy, metabolic dysfunction, cerebrovascular changes, and more . While aNature or WHO, it is difficult to argue against the use of the term. However, this definition is not yet universally accepted in the medical community. Conversely, AD prevention in clinical practice may not be entirely feasible for a number of reasons beyond the direct control of the treating physician, such as patient noncompliance with prescribed interventions. Further, inconsistencies in translating AD research into clinical practice, the lack of a “one-size-fits-all” approach, and uncertainty about AD pathogenesis also complicate care. In addition, it is unclear whether the risk factors being addressed will be entirely specific to AD rather than another form of dementia. A greater understanding of the evolution of neuropathology and pathophysiology of AD may be necessary before one can definitively argue for the use of the word “prevention” in the clinical setting.The significance of a debate over the use of “prevention” vs. “risk-reduction” is grounded in the necessity for an honest and transparent answer for patients living along the AD spectrum, as well as for their families and caregivers, particularly if these paradigms are going to be applied in clinical practice. Based solely on the example definitions of “prevention” borrowed from Although consensus among experts may not yet be within reach, it is worthwhile to discuss and explore these definitions. To this end, a structured clinical approach of targeted intervention may aim to delay onset (and/or reduce risk) in the area of primary AD prevention, yet for secondary and tertiary prevention, may instead seek to delay onset (and/or possibly prevent) the progression from a prodromal stage to dementia. Whether through the removal of pathological markers, enhancement of cognitive reserve, or other methods of brain resilience, further research is warranted to gain better insight into risk reduction and the feasibility of AD prevention from a practical clinical perspective. Until that time, clinicians and patients may seek ways to reduce the burden of AD and offer a proactive approach toward maintaining their cognitive health based on the mounting evidence demonstrating a direct relationship between modifiable risk factors and future dementia –35.Nature's definition of the term, realistically, outcomes will vary when applied in a clinical setting due to a combination of different factors. Patient compliance, for example, plays a role in the success of prevention strategies. Non-adherence can occur in clinical practice due to a variety of reasons including stigmas and societal pressures, the high cost of medications, and an inability to perceive improvement before and after a treatment intervention . It is important to recognize, however, that clinical research methodology is distinct from the clinical practice of Alzheimer's risk reduction. While the use of medications, supplements, or lifestyle interventions in a clinical trial might “prevent” AD according to rvention . Anotherrvention . ConsequIt will also be important from a clinical research perspective to study approaches geared toward optimizing the health of individuals rather than to solely diagnose and treat a disease state. It will be possible to view divergent preclinical patterns of diseases before they typically present . This is“Can Alzheimer's be prevented?” is a critical question . SeveralBased on the strong association between heart disease and AD, further research must explore the mechanisms by which cardiac risk factors influence the onset of dementia-related illnesses like AD. The majority of past studies have been epidemiological in nature, highlighting associations and not causation. Homologous basic science and clinical research studies are needed to quantitatively show that AD prevention is feasible and/or effective. Please see Box 1 for more information.Box 1There is significant overlap between traditional cardiovascular disease (CVD) risk factors and modifiable risk factors for AD. While the application and interpretation of “prevention” and “risk reduction” remain controversial in AD, preventative cardiology, by contrast, is a well-established field of medical practice. In fact, the preliminary draft of the Guide to the Primary Prevention of Cardiovascular Diseases, which was published in 1997 and used to supplement pre-existing guidelines for heart health put forward by the American College of Cardiology, was one of the first official sets of practice guidelines using the word “prevention” in its title .In 1948, the Framingham Heart Study, a longitudinal investigation based in the greater Boston area, was launched to investigate the epidemiology of cardiac disease and identify modifiable risk factors . This coThe Framingham Study proved the value of a diverse set of risk-targeted interventions in preventing cardiac events and strokes, even among those more susceptible to adverse outcomes due to a family history of heart disease. Cardiac prevention techniques are now commonly utilized by primary care providers. More recently, there has been a growing number of specialized cardiac prevention programs that focus almost exclusively on primary, secondary, and tertiary prevention. The prevention of CVD, which has been an accepted clinical practice for decades now, may serve as a model for preventative care in AD.Globally, there are now a number of centers providing direct clinical care to patients at risk for AD dementia that, at their core, provide services aimed at risk reduction, early detection, and health promotion as components in the overall strategy of primary, secondary and tertiary prevention. In the United States, examples include the Alzheimer's Prevention Clinic at Weill Cornell Medicine and New York-Presbyterian in New York, the Alzheimer's Risk Assessment and Intervention Clinic at the University of Alabama in Birmingham, the Center for Brain Health at NorthShore University HealthSystem in Illinois, the Comprehensive Center for Brain Health Dementia Prevention Initiative at Florida Atlantic University in Florida, the Alzheimer's Prevention Clinic and Research Center in Puerto Rico (in research collaboration with Weill Cornell), and the Brain Health Center at the Pacific Neuroscience Institute, Providence Saint John's Health Center in California , 42–44. Increased collaboration is needed to connect clinicians and researchers who are actively practicing AD risk reduction and/or prevention. This area of research is often viewed as too theoretical to study scientifically, as someone can do everything “right” and still be diagnosed with a spectrum of health problems or do everything “wrong” and live late in life with no or few significant ailments. The hope is that future clinical trials can distinguish more clearly between effective and ineffective interventions currently used to prevent, elongate the asymptomatic period, and/or decrease the risk of AD for those at all stages of the dementia spectrum.Ultimately, use of the terms “prevention” or “risk reduction” in clinical  settings remains the decision of the individual practitioner or clinician-researcher. The choice may also depend on the overall short-term and longer-term goals of the interventions. For example, even in the absence of a known modifiable risk factor, primary prevention interventions may aim to “optimize” brain health (as evidenced by improvements in objective cognitive testing) in the short-term. However, the prevention and/or risk reduction of AD may be a longer-term goal. This choice of terminology may be even more relevant when communicating with the public, as “prevention” may be a more tangible and actionable concept to grasp compared with the term “risk reduction,” which may be a source of ambiguity. Additionally, when “prevention” is defined as the end goal of intervention and reduction of risks is just one of many strategies employed to meet that goal, “risk reduction” may be too narrow a phrase to be truly interchangeable with “prevention.” Regardless, clinicians should be transparent in defining the aims of modifiable risk factor reduction techniques and avoid overpromising the expected effects for those at risk or currently on the pre-dementia spectrum of AD. For symptomatic patients, considering the current state of evidence, caution should be used when using a term such as “reverse” when referring to cognitive decline and/or the pathogenesis of the disease. Rather, aiming for symptomatic benefit, delaying progression or mitigating cognitive decline is more appropriate considering the nature of AD as a progressive neurodegenerative disease. A survey of attitudes toward these terms in a diverse group of healthcare providers and the public at large may yield valuable insights to help inform and even improve messaging further.Overall, a greater understanding of the implications and boundaries of each term has the potential to stimulate dialogue between clinicians, clinician researchers, and the lay public. In doing so, it may facilitate the adoption of emerging strategies within preventative neurology, which may be the only definitive way to find a “cure” for AD—via a rigorous “prevention” and/or “risk reduction” approach.JH, CO, and RI: Conceptualization; JH, CO, JO, PL, JG, NS, SB, AR, YK, HH, TR, AF, SP, DM, SK, JM-C, JM, RK, and RI: Writing original draft, review, and editing. All authors approved of the final version of the manuscript to be published.RI has served as a consultant for Neurotrack. JO has ownership in CardioTabs, a company that sells supplements, including a curcumin product, to support brain health. TR has received research support from Brain Canada, Brain and Behavior Research Foundation, BrightFocus Foundation, Canada Foundation for Innovation, Canada Research Chair, Canadian Institutes of Health Research, Center for Aging and Brain Health Innovation, National Institutes of Health, Ontario Ministry of Health and Long-Term Care, Ontario Ministry of Research and Innovation, and the Weston Brain Institute. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


This article examines the phenomenon of heroic metamorphosis: what it is, how it unfolds, and why it is important. First, we describe six types of transformation of the hero: mental, moral, emotional, spiritual, physical, and motivational. We then argue that these metamorphoses serve five functions: they foster developmental growth, promote healing, cultivate social unity, advance society, and deepen cosmic understanding. Internal and external sources of transformation are discussed, with emphasis on the importance of mentorship in producing metamorphic growth. Next we describe the three arcs of heroic transformation: egocentricity to sociocentricity, dependence to autonomy, and stagnation to growth. We then discuss three activities that promote heroic metamorphosis as well as those that hinder it. Implications for research on human growth and development are discussed. One of the most revered deities in Hinduism is Ganesha, a god symbolizing great wisdom and enlightenment. Ganesha’s most striking attribute is his unusual appearance. In images throughout India and southeast Asia, he is shown to be a man with an ordinary human body and the head of an elephant. According to legend, when Ganesha was a boy, he behaved foolishly in preventing his father Shiva from entering his own home. Shiva realized that his son needed an entirely new way of thinking, a fresh way of seeing the world. To achieve this aim, Shiva cut off Ganesha’s human head and replaced it with that of an elephant, an animal representing unmatched wisdom, intelligence, reflection, and listening. Ganesha was transformed from a naïve boy operating with little conscious awareness into a strong, wise, and fully awakened individual.This article is about how people undergo dramatic, positive change. We focus on heroic metamorphosis – what it is, how it comes about, and why it’s important. Unlike Ganesha, one need not undergo dramatic physical change to experience heroic transformation. One must engage in any of three types of activities that we describe in this article: (1) training regimens, (2) spiritual practices, and (3) the hero’s journey. Anyone who transforms as a result of these activities emerges a brand-new person, a much-improved version of one’s previous self. Metamorphosis and transformation are both defined as “changing form,” a process that precisely describes the massive alteration undergone by Ganesha. Having undergone the hero’s journey as the pathway to transformation, Ganesha sees the world with greater clarity and insight. The hero’s journey inevitably involves setback, suffering, and a death of some type. What dies is usually the former self, the untransformed version of oneself that sees the world “through a glass darkly” . Ganeshatrans-universal scale. Biological cells grow, mutate, and die, and on a much grander scale the galaxies of the universe are in a constant state of flux. Darwinian theory portrays all of life as engaged in an inescapable struggle to survive in response to ever-changing circumstances. Life presents an ultimatum to all organisms: change as all phenomena in the universe must change, or fall.Metamorphic change pervades the natural world, from the changing of the seasons to biological growth and decay . The uniThe Varieties of Religious Experience. These conversion experiences bear a striking similarity to descriptions of the hero’s transformation as reported by famed mythologist Heroic transformation appears to be a prized and universal phenomenon that is cherished and encouraged in all human societies ,b. SurprThree Essays on the Theory of Sexuality described life-altering transformative stages in childhood involving oral, anal, phallic, and latent developmental patterns. None of these changes were particularly “heroic” but they did underscore Freud’s belief in the inevitability of immense psychological change. Although Freud suggested that people tend to resist change in adulthood, several subsequent schools of psychological thought have since proposed mechanisms for transformative change throughout the human lifespan. Humanistic theories, in particular, have embraced the idea that humans are capable of a long-term transformation into self-actualized individuals .The purpose of the hero’s journey is to provide a context or blueprint for human metamorphosis. Why do we need such life-changing growth? post-traumatic growth demonstrates that people can overcome severe trauma and even use it to transform themselves into stronger, healthier persons than they were before the trauma  description of the religiously converted individual.liminal space  is that our consumption of heroic tales takes place within an interactive system that is energetically in motion, and drawing us toward rising heroes and repelling us from falling ones. The HLD framework proposes two transformative functions of hero stories: an epistemic function and an energizing function. Hero narratives supply epistemic growth by offering mental schemas that describe prosocial action, reveal basic truths about human existence, unpack life paradoxes, and cultivate emotional intelligence. The epistemic value of hero tales is revealed in A third external source of transformation is the vast hero literature and mythology to which we are exposed throughout our lives. The fourth external source of transformation is the social environment of the hero. In hero narratives and classic mythology, the hero’s journey is populated by numerous friends, companions, lovers, parent figures, and mentors who assist the hero on her quest . The herCampbell also described the hero’s brush with lovers and temptresses, who can either assist, distract, or do harm to the hero. Most people who are asked to identify their heroes describe a mentor or coach who exerted a transformative effect on them , 2014.generative individuals, having been given so much early in life, are now in a position to give back to younger people.The hero’s journey offers a transformative experience toward wisdom that can be shared later with others. In short, the journey prepares people for leadership roles. According to Other theories also point to the transformative effect of mentoring and leadership.For Hollander, “a major component of the leader–follower relationship is the leader’s perception of his or herself relative to followers, and how they in turn perceive the leader” (p. 55). autonomy. “There are the ‘strong’ people,” wrote Maslow, “who can easily weather disagreement or opposition, who can swim against the stream of public opinion and who can stand up for the truth at great personal cost” (p. 379). Fulfillment of the lower needs in the pyramid is essential for autonomy to develop in individuals. “People who have been made secure and strong in the earliest years tend to remain secure and strong thereafter in the face of whatever threatens” (p. 380). A person’s willingness to deviate from the dominant cultural pattern is essential for heroic transformation. Heroes do the right thing, and do what they must do, regardless of authority, tradition, and consequence. One can be autonomous but not necessarily growing and stretching toward realizing one’s full potential. The pre-transformed hero naturally resists change, and thus severe setbacks may be her only impetus to budge. Without a prod, she will remain comfortable in her stagnation, oblivious to the idea that anything needs changing. The hero’s journey marks the death of pretense and inauthenticity, and the birth of the person one is meant to be. Can anything be done to promote heroic transformation? We noted earlier that one cannot be in charge of one’s own heroic transformation. According to In examining the characteristics of people who risked their lives to save others, Second, existential courage, consisting of people’s identity aspirations and strivings for their lives to feel meaningful and consequential. Kramer’s technique involves fostering people’s willingness to take psychological and social risks in the pursuit of desired but challenging future identities. His “identity lab” is a setting where students work individually and collaboratively to (1) identify and research their desired future identities, (2) develop an inventory or assessment of identity- relevant attributes that support the realization of those desired future identities, (3) design behavioral experiments to explore and further develop those self-selected identity attributes, and, finally, (4) consolidate their learnings from their experiments through reflection and assessment. Kramer’s results show that his participants feel significantly more “powerful,” “transformative,” “impactful,” and “effective” in pursuing their identity aspirations. They also report increased self-efficacy and resilience.In a similar vein, Another example of training practices can be found in initial rituals and rites of passages found in many cultures throughout the world. Although modern Western cultures have eliminated the majority of these practices, most cultures throughout history did deem it necessary to require adolescents, particularly boys, to undergo rituals that signaled their transformation into maturity and adulthood . In manyChild-rearing can serve as another type of transformative training practice. A striking example can be seen in Rescuers reported that their family unit engendered traits of independence, potency, risk-taking, decisiveness, and tolerance. Bystanders, in contrast, recalled a lack of familial closeness that engendered impotence, indecisiveness, and passivity. Rescuers’ parents were less likely than bystanders’ parents to express negative Jewish stereotypes such as “dishonest,” “untrustworthy,” and “too powerful.” Overall, rescuers were raised to practice involvement in community, commitment to others’ welfare, and responsibility for the greater good. In contrast, bystanders’ parents assigned demonic qualities to Jews and promoted the idea that Jews deserved their fate.For millennia, spiritual gurus have extolled the benefits of engaging in a variety of spiritual practices aimed at improving one’s mental and emotional states. Recent research findings in cognitive neuroscience and positive psychology are now beginning to corroborate these benefits. Mindfulness in particular has attracted widespread popularity as well as considerable research about its implications for mental health. The key component of mindfulness as a mental state is its emphasis on focusing one’s awareness solely on the present moment. People who practice mindful meditation show significant decreases in stress, better coping skills, less depression, improved emotional regulation, and higher levels of resilience . Mindfulright thinking , the Grinch (in How the Grinch Stole Christmas), Phil Connors (in Groundhog Day), and George Banks (in Mary Poppins).Finally, we turn to the complex emotion of love as a transformative agent. In addition to starring in Man’s Search for Meaning, In heroism-guided purpose.We opened this article by noting that the only way most of us undergo transformation is to embark on the hero’s journey. While we have complete control over whether we receive training that can facilitate a heroic metamorphosis, and over whether we engage in spiritual practices, we have far less control over our participation in the classic hero’s journey. We can only remain open and receptive to the ride that awaits us. As we have noted, our departure on the journey can be jarring – we often experience an accident, illness, transgression, death, divorce, or disaster. The best we can do is fasten our seatbelts and trust that the darkness of our lot will eventually transform into lightness. But we cannot remain passive. During the journey we must be diligent in doing our part to secure allies and mentors, and to take actions that cultivate strengths such as resilience, courage, and resourcefulness . After bSeveral unexplored issues involving heroic transformation deserve more thorough treatment than we can devote to them here. These issues focus on education, religion, gender, inclusive transcendence, and barriers to transformation. We give brief attention to these topics below.On July 16, 2003, legendary President of South Africa Nelson Mandela delivered a speech in support of the Mindset Network, a non-profit organization designed to improve educational opportunities for children of all ages. “Education,” he said, “is the most powerful weapon which you can use to change the world.” This statement attracted widespread media attention and remains a highly recurring internet meme today. A Google search of “education can change the world” yields thousands of hits echoing Mandela’s claim and extending the idea to include education being the key “to success,” “to happiness,” “to freedom,” “to the world,” and “to the future.” Summing up our supreme collective confidence in education, United Nations Emergency Relief Coordinator Mark Lowcock declared that “Education is the key to everything” .th terrorist attacks and their collaborators, as identified by the 9/11 commission, attended universities. The lead pilot, Mohamed Atta, was college-educated, and the operational planner, Khalid Sheikh Mohammed, studied engineering in North Carolina. The chilling masked figure on many ISIS beheading videos was Mohammed Emwazi, who had a college degree in computer programming. In the same vein, Are these claims true? We believe it is a mistake and perhaps even dangerous to equate education with transformation. Consider, for example, the link between education and crime. Some studies suggest that education mitigates crime  while otWe do not wish to undersell education’s positive consequences for individuals and societies. Improving educational opportunities for citizens no doubt helps people satisfy needs in As noted earlier, In his studies of initiation rituals worldwide, If, as we have argued, transformation involves promoting unity and adopting a sociocentric mindset, then women may be agents of transformation. Throughout history, men have built things, fixed things, and defended us from things  – all inCan you play the role of woman?Understanding and being open to all things…Giving birth and nourishing,Bearing but not possessing,Working yet not taking credit,Leading yet not dominating,This is the Primal Virtue.transcend and include .A major source of arrested development is the problem of self-ignorance. A recurring theme in psychological research is that people are unaware of much of their own psychological functioning . This laA second barrier is found in impoverished environments that deny people opportunities for transformation. A fourth barrier to transformation is people’s strong tendency to self-identify as victims.Individuals who have been harmed and who derive their entire personal identity from being wronged by someone else, or by society, may find it difficult to grow and transcend their victimhood. We are not making the claim that there are no legitimate victims; there most certainly are people who have been harmed and have real grievances. Our argument is that adopting a strong and permanent victim identity is a sure way of avoiding growth and moving beyond the pain of having been harmed. A highly unfortunate consequence of harboring a victim mindset is the need to scapegoat. People tend to reason that if someone has harmed them, then that perpetrator must be punished. There is no doubt that scapegoating others has been the primary cause of most violence and warfare throughout human history. Until people learn to take individual responsibility for their lives and for their anger, the deadly duo of victimhood and scapegoating will continue to work in concert to thwart heroic transformation.dark mentors to describe these damaging guides who not only undermine people’s ability to walk the heroic path; they encourage us down the wrong path.Another barrier to transformation lies in the absence of good mentorship. Social sources of wisdom, inspiration, and change are critical elements of the hero monomyth as described by Severe mental and physical illness can also impede people’s ability to undergo heroic transformation. Most individuals facing severe mental or physical disability are unable to reap the benefits of the hero’s journey because they are preoccupied with managing their condition. Related to this problem is the prevalence of narcissism. Psychologists believe that roughly 6% of US adults are afflicted with narcissistic personality disorder , which mFinally, people may avoid heroic transformation because they lack psychological flexibility, defined as an individual’s ability to adapt to fluctuating situational demands. Those classified as low in psychological flexibility have been shown to experience less growth and development . To helpwonder at it, as a transformation” (This article has reviewed the functions, processes, and consequences of the hero’s transformation. William James once observed, “Whenever one aim grows so stable as to expel definitively its previous rivals from an individual’s life, we tend to speak of the phenomenon, and even The transformed hero exemplifies the zenith of human development. Psychologists have called this state self-actualization , the conAll authors contributed equally to the development and expression of the ideas in this article.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


User and Item Similarity Model with Trust in Diverse Kinds (UISTD), to enhance the personalization of social sensing while reducing users’ privacy concerns. UISTD utilizes user-to-user similarities and item-to-item similarities to generate multiple kinds of personalized items with common tags. UISTD also applies a modified k-means clustering algorithm to select the core users among trust relationships, and the core users’ preferences and disclosure behaviors will be regarded as the predicted disclosure pattern. The experimental results on three real-world data sets demonstrate that target users are more likely to: (1) follow the core users’ interests on diverse kinds of items and disclosure behaviors, thereby outperforming the compared methods; and (2) disclose more information with lower intrusion awareness and privacy concern.Privacy intrusion has become a major bottleneck for current trust-aware social sensing, since online social media allows anybody to largely disclose their personal information due to the proliferation of the Internet of Things (IoT). State-of-the-art social sensing still suffers from severe privacy threats since it collects users’ personal data and disclosure behaviors, which could raise user privacy concerns due to data integration for personalization. In this paper, we propose a trust-aware model, called the  N item recommendation, which involves suggesting a list of items that best fit users’ “like” trends , ViewHistory, Kinds )User Item  with the removed items is recommend.UISTD is equipped with a personalization algorithm that calculates the recommended items in three steps: First, the algorithm determines the friends and computes their similarities on real-time decisions . Specifik-means clustering approach has been modified as follows to cluster the users.UISTD will inform users about what their friends are doing on all sites and generate personalization for items by calculating the possibility that a user may like each item. UISTD investigates whether target users will follow core users’ disclosure behaviors when the target users come upon a site with which they are not familiar. The privacy disclosure solution for a target user is valid only when: (1) they disclose their privacy at the same level as the core users; and (2) they accept the predicted top-ranking items from UISTD. Before applying the privacy disclosure solution, UISTD clusters the users such that all users will be suggested to follow the closest core user. The m entities, which are denoted as . Each entity xE is expressed as xE , where xjR  stands for a recorded rating from user x on item j. The entities are divided into clusters according to their rating records, and each cluster regards a core user as its center. An entity is included in a cluster if it has properties that are most similar to those of its core user, over the core users of all clusters. The entities have trust relationships with each other, and the relationships are represented by m − 1 edges; hence, the total number of edges is m is the total number of entities and the routine  stands for the rating differences between iE and jE:k is the kind that item i  belongs to. Users apply the same tag to items of the same Kind. An entity xE is regarded as abnormal if routine  > D/T, because this indicates that their ratings are too far away from those of other users.Suppose that the whole group of users is a set of k. For m users, k = 1 when all users are in the same cluster and k = m when each user belongs to their own cluster. Hence, the value of k varies from 1 to m. Another parameter, namely, the minimum distance variance in n folds, which is denoted as nMDV, is introduced. Users’ data sets are randomly divided into 10 folds, which are numbered from 1 to 10. For each turn, one fold is regarded as a testing set, while the remaining nine folds are applied as a training set and n is the fold number:k is the total number of clusters, x is the user set in cluster jC, and m is the core user. Each time the value of k changes, nMDV is computed accordingly. The minimum value of nMDV is recorded and the corresponding value of k is recorded as nk, which is regarded as the number of clusters. The corresponding value of nk is the final value.We denote the number of clusters by u has an edge connection with another user v, they will form a trust relationship, which indicates the possibility of information disclosure. Trust relationships can be divided into three levels depending on how many times disclosures have occurred and the total amount of information that has been disclosed. As shown in When target users are confronted with privacy threats, e.g., intrusion detection, it is assumed that they will not only tend to accept the core users’ like trends on items but also follow the core users’ disclosure decisions. This was confirmed in our previous work . We exteHere, we formally define Trust and Disclosure:u Trust from user u maintains a trust list that specifies who can be a disclosure receiver. This contains a set uU’ of all users, such as u’, that have a trust relationship with u. A cluster represents the level of friendship with u’, e.g., high, normal, or low. The strength score indicates the level of proximity to user u’ in the same group, where a higher score represents a closer relationship with user u, to whom these users may disclose more privacy. When the sensitivities of two disclosures i and i’ are the same, they can be placed into the same cluster. When a user u can disclose content i, u may also disclose content i’ if i and i’ belong to the same cluster. Our implemented definition of Disclosure is as follows:Each user Disclosured d, similar items can be determined, such as d’, according to their clusters. The sensitivity score quantifies the similarity between Disclosures d and d’, where a higher score indicates that the users are less likely to disclose information. The disclosure pattern will be predicted based on the Disclosures {D} and privacy receivers {U} whose clusters contain the same levels of Trust and Disclosure. For example, we found that a core user cu disclosed content d of Trust type normal and predict that another user u’ (u’ and u are in a same cluster c) will also disclose d’ . In the experiment section, we will evaluate the accuracy of the predicted disclosure pattern.For each Disclosure Three real-world data sets are used in this section, including Epinions and Ciao, which are comprised of users’ reviews and numerical ratings of a variety of products. The third data set comes from our previous work, in which we hired users who had at least five accounts on social sensing websites, through a crowdsourcing platform, namely, Sojump, which is a website that provides online survey services and connects more than two million individuals and businesses to coordinate the use of human intelligence. Previously supported data “DLPDS” were used to support this study and are available at relevant place within the text as reference . All thrnMDV over 10 execution results is reported as the final performance. We adopted two popular ranking metrics to evaluate personalization performance, namely, precision and F1-measure at N (P@N and F1@N), where the cutoff N is chosen in {5, 10}, which represents the number of recommended items:u, U’ is the set of users in the testing set, and R@N denotes the measurement of recall at N. The F1-measure represents a trade-off between ranking precision and recall. Higher values of P@N and F1@N demonstrate better top-N item performance. As suggested by Guibing et al.  in Equation (1). Parameter The 10-fold cross-validation approach was adopted; for each iteration, nine subsets were used as the training set and the remaining subset was used as the testing set. The lowest g et al. , we tuner et al. .The most basic non-personalized approach, namely, MostPop, by Zhao et al. , is regaWe have also added more comments of the data set results. MostPop provides most basic personalized items which computed from the popular items of users’ interests, so we believe it can be regarded as the baseline method. FISM has added item similarity in computing the personalized items. The performance of FISM outperforms that of MostPop. Furthermore, FSM extends FISM by computing both item similarity and user similarity of active users on the trust network. As a result, the precision  and F1-measures  are generally higher with FSM than FISM. Social trust is noted to impose important influence on the ranking performance, and users are more likely to accept the personalized items from active users’ preferences, e.g., herding effect. Finally, UISTD aggregates the knowledge trained from the item similarity and user similarity across multiple item kinds, and the overlapping interests of the users on joint domain has made up for the sparsity problem from single type of items. Meanwhile, the DLPDS data set has more dense data with more trust relationships; therefore, UISTD performed best on this data set. This demonstrates that by gaining enough trust connections from all user networks we can better identify the users’ interests and enhance the prediction accuracy. All tests were run on a server with 32 Genuine Intel(R) CPUs (2.6 GHz) and 2 GB memory. For each execution, the average time for UISTD on DLPDS, Ciao, and Epinions was approximately 7, 23, and 53 min, respectively.k-means clustering algorithm, we assume that all target users follow the disclosure behaviors of their core users, who belong to the same cluster. In this part, we only consider the performance of UISTD on DLPDS, where 717 participants from Sojump with unique IP addresses responded to our study, 693 of whom were qualified for further analysis; the others were disqualified since they provide false information. Each user was randomly assigned to one of two scenarios: In Scenario 1 (n = 351), users were informed of what the core users had disclosed and what was being “liked” by the core users, to facilitate personalization. In Scenario 2 (n = 342), users were only informed of what was being liked by the core users. We mainly examined the tension between the disclosure volume and the prediction accuracy. The privacy disclosure includes personal information requests  and online information requests .Since predicted items in UISTD are generated via a modified The process was run for 60 h. As shown in P and N, are initialized to 0 to record the numbers of positive and negative comments. Whenever a positive comment is identified, the counter P.counter is incremented by 1, and whenever a negative comment is identified, the counter N.counter is incremented by 1. We regard the negative comments as users’ awareness of potential risks. As shown in We require the users to forward their comments during their participation in the experiment in both scenarios. The comments can be positive, e.g., “I believe the privacy requesting strategy is good”, or negative, e.g., “The information requesting is terrible and offensive”. We use natural language-processing techniques to semantically determine whether each comment is positive, negative, or neutral. Two counters, which are denoted as k-means clustering algorithm to select the core users, and their disclosure behaviors and like trends can lead the target users to be more likely to accept the personalization and disclose more information, via the trust relationships between the target users and the core users. We conducted experiments on three real-world data sets, and demonstrated that our UISTD model outperformed its counterparts in terms of prediction accuracy of personalization and disclosure volume, as it not only applies the trust relationships and tags of various kinds of items but also reduces the users’ awareness of privacy intrusion. This statement is supported by semantic evaluation of users’ comments on potential risk vs. benefits, and the UISTD model performs best. This paper considered users’ privacy concerns regarding data collection in the personalization of social sensing; however, it did not analyze how users’ features will affect how much they feel intruded upon. In future work, we plan to incorporate users’ features into a personalized privacy collection strategy and investigate the motivations behind users’ privacy disclosure intentions related to social sensing. Hopefully, additional interesting phenomena will be identified.This article proposed a model, namely, UISTD, that incorporates trust relationships for the top-ranking of diverse item personalization in social sensing infrastructure. Both item-to-item similarity and user-to-user similarity were applied in a matrix factorization algorithm, and diverse kinds of items were also considered. UISTD utilizes a modified


This article outlines the historical evolution and precursors of modern music therapy in Vienna from c. 1820 to 1960. The first section describes early attempts to purposefully integrate music into Viennese psychiatry and highlights the groundbreaking work of Bruno Goergen (1777–1842), who around the year 1820 deliberately incorporated music into psychiatric institutions based on his dedication to the ideals of “moral treatment” and “no-restraint” psychiatry. Shortly thereafter, the first medical dissertations on the therapeutic effect of music began to be published in Vienna. Around 1850, the emergence of an “active” form of “music therapy” (in the broadest sense) is recognizable; during the same time period, physicians began taking their patients’ musical preferences, education, and disposition into account. However, as university medicine became firmly rooted in the standards of experimental science, physicians increasingly lost their interest in music. The second section gives an overview of several cultural movements that emerged in the first half of the twentieth century and inspired the pioneers of music therapy in Vienna, paving the way for the foundation of modern Viennese music therapy in 1958. Among these were the life reform movement, the curative rhythm and dance movement, and anthroposophy, as well as psychotherapy and progressive music-educational concepts. At the conclusion of this article, the main traits of the history of music therapy in Vienna and some of the pervading premises of Viennese music therapy are summarized. The entire secret is to be found in music, from which we want to construct a completely different therapeutic system.Nicolaus Lenau (1802–1850), as quoted by his biographer Frankl , p. 117Wiener Schule der Musiktherapie)1The term “Wiener-Schule der Musiktherapie” appeared as early as 1960 . The definition given here was taken from the Austrian Music Therapy Act and is not specific to the Viennese music therapy training course.See the curriculum for the study of Music Therapy at the University for Music and the Performing Arts, Vienna, p. 2, URL:  This approach includes the deliberate therapeutic use of music’s functional effects (classified as activating or relaxing) as well as an awareness of the inherent relational potential of music and its ability to initiate social-communicative processes. Essentially, the Vienna school of music therapy is based on a tradition of teaching and practice that has been developed from clinical experience  and guided by humanistic and psychodynamic ideas  on 26 November 1958  and others , organized an international symposium on Music in Medicine, in Velden in the province of Carinthia  emphasized that music was “rightfully praised as a means of psychic healing” , published in Vienna in 1807, demonstrates how older paradigms overlapped with new musico-medical theories around the turn of the century. For instance, Lichtenthal equally draws on the baroque doctrine of the affects, as well as the concept of predefined forms of expression in specific musical modes  book res non naturales): Music was believed to light up the soul (Gemüth) and to distract the mind from morbid thoughts. Particularly in private psychiatric institutions, such as Vienna’s Private Sanatorium for the Mentally Ill , the privileged classes expected their cultivated lifestyle to continue for example through music lessons, literary readings, dance events, and other entertainments (see below). The Lower Austrian Provincial Institution for the Cure and Care of Mental and Nervous Diseases at Steinhof , established between 1904 and 1907 , also featured a music salon in the wing reserved for private patients. However, such early approaches were not defined as distinct music therapeutic methods. Not until the foundation of music therapy in 1957–1958, with a training course at the Vienna Academy of Music and Performing Arts, would it be possible for this particular therapeutic field to develop into a scholarly discipline that includes research and teaching.Attempts to integrate music definitively into nineteenth-century Viennese psychiatric institutions were often based on dietetic principles  at Neutor close to Salzgries. Occasionally, they were housed in the Bürgerspital  founded in 1257, and although kept in a separate ward, they were still confined in cages (Narrenkotter). The Austrian physician Leopold Wittelshöfer (1818–1889) noted that the mentally ill were treated like beasts rather than human beings  – later infamously known as “Fools’ Tower” (Narrenthurm) – was erected as part of Vienna’s General Hospital. The establishment of such lunatic asylums by royal mandate in Austria should be seen in a broader international context, particularly with regard to the emergence of enlightened “modern psychiatry” and reform movements in France, Germany, and England. Vienna’s k. k. Irren-Anstalt was constructed as a circular building comprising 139 barred cells on 5 floors. However, the conditions in this asylum, considered to be Europe’s first institution exclusively for the mentally ill, were for the most part still inhumane , who dedicated himself to these ideals according to his own variation of enlightened absolutism, the k. k. Irren-Anstalt as its chief physician (from c. 1805 to 1808). In 1819, Goergen founded the first private sanatorium specifically for Gemüthskranke  at house no. 173 in Gumpendorf, a well-to-do Viennese suburb at that time. In Goergen’s writings, the term Gemüthskrankheit  was generally used with a varying range of meanings and signified a broad spectrum of mental illnesses, including “delusions” .7Gemüth and Gemüthskrankheit in their nineteenth-century context are detailed in Korenjak (The terms Korenjak .One of the most important advocates of the use of music in psychiatric institutions was Bruno Goergen (Görgen) (1777–1842), a native of Trier, who received his medical doctorate in Vienna in 1800  were regarded as means to restore the balance of the mind and the Gemüth. In order to amuse his patients, Bruno Goergen would sometimes arrange small festive occasions with food, music, and dance. In this context, music and dance were not only believed to have a beneficial influence on the soul (Gemüth), they were also provided as a reward for patients’ “good behavior.” In cases of misconduct, however, Goergen excluded patients from these events, according to the principles of moral therapy. According to Georgen, physicians and caretakers had to act as “shining examples.” Georgen lived with his family in the sanatorium and used to share meals with his patients in order to teach them good manners.The ideal state of the soul, the mind, and the emotions was generally seen as a “calmness of the mind and the soul ,” and Aleks Pontvik’s (1909–1979)12Pontvik’s year of birth is uncertain. According to Wikipedia, he was born in 1909. “psycho-rhythmy [Psychorhythmie]”  and Emilie Flöge (1874–1952) shows both of them in flowing garments symbolizing the contemporary idea of the “emancipation and liberation of bodily movement.” The so-called life reform movement  Scheiblauer (1861–1968), who introduced music and eurhythmics to curative-educational programs for handicapped and deaf–blind persons by working for example with the patients’ sensation of vibration  founded eurhythmics, an “elemental” music-motoric educational theory focusing on the physical experience of musical emotions expressed through movement , Sutermeister published an anthology of his poems in 1901. A short passage from his poem Wie der taube Dichter hört (How the Deaf Poet Hears) illustrates Sutermeister’s perception of sound and music:[…] what feelings of pleasure slowly come over me,/I am carried and cradled by the tide in play, though never did I swim – /Surrendered to the waters and the winds in sweet rapture,/This is my inner awareness of hearing, this is my perception of sound. , who had lost his hearing as a consequence of contracting meningitis at the age of four.The concept of eurhythmy, introduced by Rudolf Steiner and Marie Steiner, neé Sievers, also had an inspirational influence on early modern music therapy in Vienna. The pioneers of music therapy in Vienna, such as Editha Koffer-Ullrich (1904–1990), Alfred Schmölz (1921–1995), and Ilse Castelliz (1914–2012), were familiar with Steiner’s anthroposophical system of thought. The musical instruments Steiner preferred, including pentatonic flutes and lyres, as well as the use of specific intervals, had a lasting effect on Viennese music therapy, which was founded several decades after the introduction of Steiner’s theories  was based on the idea of “healthy movements” that would beneficially affect the “unsound organism”  together with Margarethe Eckinger (1908–1993) established a According to Steiner, the human soul should not only find expression though the voice, but even more so through the Steiner,  and a “vSteiner, , 1927b. In the same year, the first Austrian Montessori school was also established in Vienna. According to Maria Montessori (1870–1952), one of the most important pedagogical endeavors is giving children an understanding of music. Montessori observed that small children would respond to music primarily through movement. Furthermore, she was convinced that music is not reserved for a chosen few. Everyone should be enabled to “enjoy this universal language of humankind and the expression of all the feelings of the soul as well”  (erdnah), natural, and physical; as always bound up with movement, dance, and language. According to Orff, music can be learned and enjoyed by anyone and has to be practiced actively, not only by listening, but also by participating in the performance  was published between 1932 and 1935.The first edition of his In the famous Berlin Dada manifesto tal Art) , art wastal Art) , p. 67 aOrff-Schulwerk aims to support individual creativity and was conceived as a source for improvisation: “The Schulwerk, in each of its phases, was [always] intended to provide impulse to [further] self-initiated creations; thus, it will never be completed but will always be in progress, in a state of flux” , music, language, movement, and dance are interrelated through rhythm Orff, , p. 17. Schulwerk was integrated into remedial educational curricula, for example by Karl Hofmarksrichter (1900–1976), head of the Straubing School for the Deaf-Mute in Germany , one of Carl Orff’s pupils and later his second wife, created the so-called Orff Music Therapy, combining the Orff-Schulwerk with a therapeutic approach geared particularly to the needs of handicapped and autistic children , also known as the Günther-Schule in Munich. Based on the beliefs of Emile Jaques-Dalcroze, Rudolf von Laban, and Elisabeth (“Bess”) Mensendieck (1864–1960), Günther’s concept comprised not only dance, musical-rhythmic physical education, and medical gymnastics but also singing, breathing, and voice exercises. One of Günther’s main ideals was the overcoming of repressed expression and creativity , Carl Orff founded the Union for Applied and Free Movement  and self-expression through music (Aus-dem-Eigenen-Schöpfen) were key ideas of his teaching principles , in his book  Jacoby, , p. 39. Üben ohne Übung) activate the potential for (self-)expression that may have become atrophied or obstructed in an individual, even if such recovery is only possible within the “developmental limits of the disability” . Nevertheless, psychoanalytic considerations of music and the unconscious appear in many writings by Freud’s followers , Sigmund Freud 1856–1939) noted he was “almost unable to enjoy music” Freud, , p. 197. noted heThe theoretical development of modern Viennese music therapy has often drawn from depth psychology, incorporating ideas such as the existence of an unconscious that could be expressed and “revealed” through musical activity. Moreover, the music therapeutic relationship between the client/patient and the therapist has frequently been designated in psychoanalytical terms. Karin Mössler points out that the psychotherapeutic approach  has been the “leading paradigm” , whose merits were extolled by Elena Fitzthum in her edited book Harmonik) create “harmony” is crucial for well-being and health. According to Plato, the muses bestowed upon humans a harmony containing “movements,” which are related to the “movements of the soul” Plato, , p. 73.  Pontvik was convinced that “well-structured” and harmonious “impulses”  would have a salutary effect on the soul. Pontvik called his approach Psychorhythmie  notion of archetypes and, more importantly, by Hans Kayser’s (1891–1964) “doctrine of harmonics” (k) Jung, , p. 181.k) Jung, , 1955. SPontvik, , 1962. HPontvik, , p. 28. Pontvik, , p. 17, In 1952, Hans Sittner became acquainted with music therapy while in the USA, and after his return, he contacted Hans Hoff (1897–1969), head of the Psychiatric-Neurologic University Clinic in Vienna Schmölz, . Later, In the early stages, Viennese music therapy was based on an interdisciplinary collaboration of physicians, psychologists, musicians, pedagogues, and scientists , and in particular by the Austrian neurologist and psychiatrist Heinrich Obersteiner Junior (1847–1922). It is important to realize, however, that early attempts to integrate music into psychiatry did not rely on a “therapeutic process,” or on the idea of the therapeutic expression of the self through music. Music was primarily seen as a means of distraction (e.g. from fixed ideas), or of education (in the form of music lessons) and entertainment (by means of asylum concerts and chamber music). Accordingly, the Viennese psychiatrist Alexander Pilcz (1871–1954) concluded in 1905:Even though by 1960 Vienna was able to look back upon a long tradition of the use of music in psychiatry, the very early fundament of the modern Vienna school of music therapy was built on anthroposophy, harmonics, and progressive education Mössler, . HoweverThe impulses derived from twentieth-century reform movements, including progressive music education (self-expression and improvisation), had a stronger influence on modern therapeutic concepts than nineteenth-century Viennese psychiatry. Unlike nineteenth-century practice, the therapeutic relationship was discovered to be a crucial part of the therapeutic triad (patient–music–therapist) and the “musical dialogue.” From today’s perspective, clinical insight, the humanistic approach, and inspiration from psychotherapy are considered to be the main influences on Viennese music therapy training establish social interactions and relationships, and to further insights into the self beyond any mental or physical illness. Based on research and teaching, Viennese music therapy encompasses the prevention, treatment, and rehabilitation of acute and chronic illnesses, as well as the advancement of social competence.20http://www.mdw.ac.at/I113/html/mth/?PageId=3192.See In summary, the foundations of the Vienna school of music therapy are multifaceted and to a great degree interdisciplinary. Emerging from an environment shaped by several mid-twentieth-century reform movements , modern Viennese music therapy operates according to the basic understanding that music is a creative expression of the self, which can be enjoyed by anyone, irrespective of and