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On 26 July 1948, President Harry Truman signed Executive Order 9981, directing the integration of U.S. military forces. Earlier publications on this topic generally covered the origins, proclamation, and implementation of the executive order, and the actions of senior military officers in the Pentagon down to commanders of military installations from mid-1948 to the early 1960s. While these works use specific events at specific installations in specific time frames, none tell the complete story of integration at a specific military installation over time. This article details the actions of installation commanders at Maxwell Air Force Base near Montgomery, Alabama, a central focus of the civil rights movement, from the 1940s to the 1960s. [ABSTRACT FROM AUTHOR]

Despite his infamous legacy, Adolf Hitler remains one of the most significant and well-studied figures of the last century, with well over 120,000 books and articles about him, and including his recorded speeches, writings, letters, memos, and directives, as well as anecdotes about him in publications about other Nazi figures. Yet, there remain tremendous gaps in our understanding of Hitler. This psychohistorical study partially addresses the gap and attempts to obtain a finer grained description of Hitler's progressively narcissistic behaviors and their outcomes. It utilizes historical data, Grapsas' episodic model of narcissist interactions (Grapsas, et. al., 2020), Williamson's (1964) "managerial utility" function, and Chatterjee and Hambrick's (2007) archival/unobtrusive measurement schema as an analytical framework. The authors, who are not clinicians, treat narcissism as a personality trait rather than a clinical diagnosis. Emerging at the right historical moment with a popular message, Hitler relied on his natural oratory skills, studied impression management, and took personal control of party and government funds to facilitate his rise to power. Early successes provided further referent power. Hitler received little of what might be critical feedback from his in-group of unquestioning sycophants, and that little bit was apparently drowned out by the noise of his cult-like following. Rejecting inconvenient evidence, he narcissistically blamed others when failures occurred. [ABSTRACT FROM AUTHOR]

This paper describes the development of a behavioral health and wellness model into the US Army Intelligence and Security Command (INSCOM) to address concerns about suicide within this community. In response to stresses existing within the intelligence community (IC), INSCOM partnered with the Army Public Health Center (APHC) to assess the health and wellbeing of Command personnel. A Community Health Assessment (CHA) survey was conducted (N = 2,704 Soldiers; N = 959 Civilians) that included focus groups across three installations and secondary source data. Six key areas were prioritized: suicide behavior, behavioral health access to care and health promotion, behavioral health stigma and maintaining clearances, workplace environment, sleep health, and overall fitness. Several actions were implemented to address the report's findings and recommendations. A Command Surgeon office was established within INSCOM. An INSCOM Health Assessment and Readiness Team (I-HART) was established. The Deputy Undersecretary of the Army provided support to address suicide within INSCOM by approving 4 highly qualified experts (HQE's) in behavioral health and clinical suicidology to provide research oversight and make recommendations. The Command General approved 8 behavioral health providers. There are planned research efforts within the command focusing on scalable and technology enabled care delivery to improve mental well-being and decrease suicides. [ABSTRACT FROM AUTHOR]

For a half - century, I have been developing a view of free will that is incompatible with determinism and, in the process, attempting to answer the Intelligibility Question about such a free will: Can one make sense of an incompatibilist or libertarian free will without reducing it to mere chance, or mystery, and can such a free will be reconciled with modern views of the cosmos and human beings? In this paper, I discuss recent refinements to my earlier writings on such a view, refinements developed in recent years in response to the large critical literature on my views in the past several decades. My view has usually been designated an event-causal (EC) view of libertarian free will and distinguished from non-causal (NC) and agent-causal (AC) libertarian views. But I was never happy with this designation of my view as “event-causal” and did not use it myself in earlier writings. In this paper, I explain why I now reject it altogether. I have come to believe that to avoid numerous misunderstandings in current debates about free will, we must distinguish four different kinds of libertarian theories, not merely three: in addition to non-causal (NC), agent-causal (AC), and event-causal (EC) theories, we need to add a fourth kind, which might be called an agent-causal/event-causal (AC/EC) theory. My view has always been of this fourth kind. It represents what I call in the title of this paper the “fourth way forward” for making sense of an incompatibilist free will. [ABSTRACT FROM AUTHOR]

We aimed to clarify whether relationships of behavioural activation, avoidance, and response-contingent positive reinforcement with subjective wellbeing components supported a behavioural subjective wellbeing model. We used a correlational, cross-sectional design, and collected data online from a convenience and snowball sample of 224 participants aged 18-72 years using an anonymous survey. We conducted hierarchical multiple regression analyses and structural equation modelling. Behavioural activation positively predicted significant unique variance in (a) positive affect, b = 0.44, 99.2% CI [0.30, 0.58], p < 0.001, ηp2 = 0.27, and (b) satisfaction with life, b = 0.19, 99.2% CI [0.07, 0.31], p < 0.001, ηp2 = 0.08. Behavioural activation negatively predicted significant unique negative affect variance, b = − 0.17, 99.2% CI [− 0.30, − 0.03], p = 0.001, ηp2 = 0.05. Avoidance positively predicted significant negative affect variance, b = 0.45, 99.2% CI [0.31, 0.58], p < 0.001, ηp2 = 0.27. Most other predictors had non-significant effects when behavioural variables were added to our models. Response-contingent positive reinforcement mediated relationships of behavioural activation with positive affect, negative affect, and satisfaction with life. Our results suggest behavioural variables may explain some affect variance often attributed to other predictors. The pattern of relationships we found supports a behavioural subjective wellbeing model focussed on response-contingent positive reinforcement. Our findings suggest these relationships may not be unique to depressed populations. Our results do not indicate causality, but suggest testing causality is warranted in the future. [ABSTRACT FROM AUTHOR]

A literary criticism of the book "Talking to Our Selves: Reflection, Ignorance and Agency" by John Doris is presented. The book reportedly focused on self, agency, and responsibility. Topics include the ignorance of cognitive processes. the characteristics of responsible agency, and the valuation states of the agents.

Objective: To investigate knowledge, attitudes, and practices of oncologists towards physical activity (PA) in cancer survivors, and the association between oncologists' own PA behavior and PA promotion.Methods: Oncologists (n = 123) completed a survey based on the Theory of Planned Behavior (TPB). Participants reported PA promotion behavior, PA involvement, attitudes, intentions, social norm, perceived behavioral control (PBC), and confidence and knowledge of exercise prescription. Structural equation modeling (SEM) evaluated these associations.Results: Less than half of oncologists reported regularly promoting PA to patients (46%), with 20% providing written information and 23% referrals. Only 26% were physically active. TPB SEM pathways explained 54.6% of the variance in PA promotion (comparative fit index (CFI) = 0.905, standardized root mean square residual (SRMR) = 0.040). Social norm was not only the significant pathway to intention but also a significant indirect pathway to PA promotion (p = 0.007). Confidence to promote PA, PBC, and intentions were direct significant pathways to PA promotion (p < 0.05). Exploratory SEM pathways explained 19.6% of the variance of PA behavior, which in turn explained 13.1% social norm, 10.7% attitude, 10.0% confidence to recommend, and 17.8% PA promotion behavior (CFI = 0.921, SRMR = 0.076). Instrumental attitude was a direct significant pathway to PA behavior (p = 0.001). PA behavior was a direct significant pathway to social norms, attitude, confidence to recommend, and PA promotion (p < 0.05).Conclusions: Oncologists reported a modest ability to promote PA, low PA promotion rates, and limited knowledge of exercise prescription. Patient physical activity promotion may be improved through strategies that increase oncologists' PBC, confidence, and their own personal PA participation. [ABSTRACT FROM AUTHOR]

Objectives: To determine whether degree of implementation of the Interventions to Reduce Acute Care Transfers (INTERACT) program is associated with number of hospitalizations and emergency department (ED) visits of skilled nursing facility (SNF) residents. Design: Secondary analysis from a randomized controlled trial. Setting: SNFs from across the United States (N=264). Participants: Two hundred of the SNFs from the randomized trial that provided baseline and intervention data on INTERACT use. Interventions: During a 12‐month period, intervention SNFs received remote training and support for INTERACT implementation; control SNFs did not, although most control facilities were using various components of the INTERACT program before and during the trial on their own. Measurements: INTERACT use data were based on monthly self‐reports for SNFs randomized to the intervention group and pre‐ and postintervention surveys for control SNFs. Primary outcomes were rates of all‐cause hospitalizations, potentially avoidable hospitalizations (PAHs), ED visits without admission, and 30‐day hospital readmissions. Results: The 65 SNFs (32 intervention, 33 control) that reported increases in INTERACT use had reductions in all‐cause hospitalizations (0.427 per 1,000 resident‐days; 11.2% relative reduction from baseline, p<.001) and PAHs (0.221 per 1,000 resident‐days; 18.9% relative reduction, p<.001). The 34 SNFs (12 intervention, 22 control) that reported consistently low or moderate INTERACT use had statistically insignificant changes in hospitalizations and ED visit rates. Conclusion: Increased reported use of core INTERACT tools was associated with significantly greater reductions in all‐cause hospitalizations and PAHs in both intervention and control SNFs, suggesting that motivation and incentives to reduce hospitalizations were more important than the training and support provided in the trial in improving outcomes. Further research is needed to better understand the most effective strategies to motivate SNFs to implement and sustain quality improvement programs such as INTERACT. [ABSTRACT FROM AUTHOR]

We advance discussion of structural inequality by operationalizing “concentrated” disadvantage in terms of highly disadvantaged communities located at the spatial core of contiguous areas of high disadvantage, and by testing the extent to which such location achieves an independent effect on violence. Using exploratory spatial data analysis and count modeling, we show that highly disadvantaged communities located at the center of a contiguous ghetto have significantly higher rates of violence than other highly disadvantaged communities, but that this relationship is moderated by structural disadvantage. In addition to finding a significant interaction between these “deserts” of disadvantage and structural disadvantage, as they relate to violent crime, we also observe that in desert communities, disadvantage has a diminishing effect on violence. [ABSTRACT FROM AUTHOR]

Background: Children with a developmental disability are three to four times more likely than their typically developing peers of developing significant emotional and behavioural problems. There is strong evidence to suggest that individual biological and psychological factors interact with family functioning to precipitate and perpetuate these problems.Aims: This study examined the psychometric properties of a brief measure, the Parent and Family Adjustment Scales (PAFAS) for use with parents of children with a developmental disability.Methods: A sample of 914 parents of children (M=6.27years) with a developmental disability participated in the study. Disabilities included Autism Spectrum Disorder and Intellectual Disability RESULTS: A confirmatory factor analysis supported a 16-item, four factor model of PAFAS Parenting, and an 11-item, three factor model of PAFAS Family Adjustment. The Parenting Scale measures parental consistency, coercive practices, use of encouragement and the quality of parent-child relationship. The Family Adjustment Scale measures parental emotional adjustment and partner and family support in parenting.Conclusions: The current study indicated that the PAFAS demonstrates promise as a brief measure of multiple domains of family functioning important for families who have a child with a developmental disability. [ABSTRACT FROM AUTHOR]

Due to their nature as tissue composites, skeletal joints pose an additional challenge in terms of evaluating the functional significance of morphological variation in their bony and cartilaginous components in response to altered loading conditions. Arguably, this complexity requires more direct means of investigating joint plasticity and performance than typically employed to analyze macro- and micro-anatomical phenomena. To address a significant gap in our understanding of the plasticity of the mammalian temporomandibular joint (TMJ), we investigated the histology and mechanical properties of condylar articular cartilage in rabbits subjected to long-term variation in diet-induced masticatory stresses, specifically cyclical loading. Three cohorts of male weanlings were raised for six months on different diets until adulthood. Following euthanasia, the TMJ condyles on one side were dissected away, fixed, decalcified, dehydrated, embedded and sectioned. Safranin O staining was employed to identify variation in proteoglycan content, which in turn was used to predict patterns of articular cartilage stiffness in contralateral condylar specimens for each treatment group. Hematoxylin and eosin staining was used to quantify diet-induced changes in chondrocyte hypertrophy and cellularity. Mechanical tests document significant decreases in articular cartilage stiffness corresponding to patterns of extracellular matrix relative protein abundance in rabbits subjected to greater cyclical loading. This indicates that TMJs routinely subjected to higher masticatory stresses due to a challenging diet eventually develop postnatal decreases in the ability to counter compressive loads during postcanine biting and chewing. These findings provide novel information regarding TMJ performance, with broader implications about the costs and benefits of phenotypic plasticity as well as implications for how such biological processes affect connective tissue mechanobiology and pathobiology. [ABSTRACT FROM AUTHOR]

Nichols' Bound presents interesting new angles on traditional debates about free will and moral responsibility, relating them to the latest empirical research in psychology, social sciences and experimental philosophy. In experimental philosophy, he cites numerous recent studies showing that there are strong incompatibilist strands in folk intuitions about free will and responsibility, taking issue with other recent studies claiming that folk intuitions are predominantly compatibilist. But he also argues that incompatibilist folk intuitions are based on faulty reasoning and cannot be realized. We are left with a choice between an eliminativism about free will and moral responsibility (free will skepticism) or revising ordinary beliefs and practices in a compatibilist direction. Though Nichols sees problems with both these positions, he ultimately opts for the latter. Despite agreeing with Nichols on many points, I argue in this paper that he takes the libertarian view of free will off the table too precipitously, leaving us with too narrow a choice of options. I argue that we can make sense of an incompatibilist view of free will and responsibility without reducing it to mere chance or mystery and that it remains an open scientific question whether we can have such a free will. [ABSTRACT FROM AUTHOR]

Objectives To estimate the cost of dementia and the extra cost of caring for someone with dementia over the cost of caring for someone without dementia. Design We developed an evidence-based mathematical model to simulate disease progression for newly diagnosed individuals with dementia. Data-driven trajectories of cognition, function, and behavioral and psychological symptoms were used to model disease progression and predict costs. Using modeling, we evaluated lifetime and annual costs of individuals with dementia, compared costs of those with and without clinical features of dementia, and evaluated the effect of reducing functional decline or behavioral and psychological symptoms by 10% for 12 months (implemented when Mini-Mental State Examination score ≤21). Setting Mathematical model. Participants Representative simulated U.S. incident dementia cases. Measurements Value of informal care, out-of-pocket expenditures, Medicaid expenditures, and Medicare expenditures. Results From time of diagnosis (mean age 83), discounted total lifetime cost of care for a person with dementia was $321,780 (2015 dollars). Families incurred 70% of the total cost burden ($225,140), Medicaid accounted for 14% ($44,090), and Medicare accounted for 16% ($52,540). Costs for a person with dementia over a lifetime were $184,500 greater (86% incurred by families) than for someone without dementia. Total annual cost peaked at $89,000, and net cost peaked at $72,400. Reducing functional decline or behavioral and psychological symptoms by 10% resulted in $3,880 and $680 lower lifetime costs than natural disease progression. Conclusion Dementia substantially increases lifetime costs of care. Long-lasting, effective interventions are needed to support families because they incur the most dementia cost. [ABSTRACT FROM AUTHOR]

Repetitive negative thinking and perfectionism have both been proposed as processes that are related to depressive symptoms. The purpose of this study was to investigate concurrent and prospective relationships between antenatal and postnatal depression, perfectionism, and repetitive negative thinking. A longitudinal design was used and 71 women were followed from their third trimester of pregnancy to six weeks post birth. A structural equation model was tested with antenatal perfectionism predicting antenatal repetitive negative thinking, perfectionism predicting postnatal depression, and antenatal repetitive negative thinking predicting antenatal and postnatal depression. The final model provided an adequate fit to the data but the pathway from antenatal repetitive negative thinking to postnatal depression was not significant. The findings provide support for the role of perfectionism and repetitive negative thinking in the onset and maintenance of perinatal symptoms of depression. It is suggested that future research investigates the efficacy of targeting repetitive negative thinking and perfectionism in pregnancy to examine if this can reduce perinatal depression. [ABSTRACT FROM AUTHOR]

Objective The current study sought to conduct a preliminary investigation of the effectiveness and feasibility of a novel, self-guided online self-compassion training for reducing psychological distress and increasing self-compassion and happiness among psychology trainees. Method A 6-week online self-compassion cultivation program was developed and delivered to Australian psychology trainees (n = 37), and a pre-experimental repeated-measures design was used to collect change data on self-compassion, happiness, perceived stress, emotion regulation difficulties as well as symptoms of depression, anxiety, and stress. Results Participants reported significant increases in self-compassion and happiness and significant decreases in depression, stress, and emotion regulation difficulties between pretest and posttest, with the majority of changes maintained at 3-month follow up. Conclusion This study provides preliminary evidence supporting the effectiveness and acceptability of online self-compassion training as a positive, integrated, and meaningful way of reducing distress and promoting self-compassion and happiness among trainee psychologists. [ABSTRACT FROM AUTHOR]

Background: Clinical features of dementia (cognition, function, and behavioral/psychological symptoms [BPSD]) may differentially affect Medicare expenditures/health care utilization.Methods: We linked cross-sectional data from the Aging, Demographics, and Memory Study to Medicare data to evaluate the association between dementia clinical features among those with dementia and Medicare expenditures/health care utilization (n = 234). Cognition was evaluated using the Mini-Mental State Examination (MMSE). Function was evaluated as the number of functional limitations (0-10). BPSD was evaluated as the number of symptoms (0-12). Expenditures were estimated with a generalized linear model (log-link and gamma distribution). Number of hospitalizations, institutional outpatient visits, and physician visits were estimated with a negative binomial regression. Medicare covered skilled nursing days were estimated with a zero-inflated negative binomial model.Results: Cognition and BPSD were not associated with expenditures. Among individuals with less than seven functional limitations, one additional limitation was associated with $123 (95% confidence interval: $19-$227) additional monthly Medicare spending. Better cognition and poorer function were associated with more hospitalizations among those with an MMSE less than three and less than six functional limitations, respectively. BPSD had no effect on hospitalizations. Poorer function and fewer BPSD were associated with more skilled nursing among individuals with one to seven functional limitations and more than four symptoms, respectively. Cognition had no effect on skilled nursing care. No clinical feature was associated with institutional outpatient care. Of individuals with an MMSE less than 15, poorer cognition was associated with fewer physician visits. Among those with more than six functional limitations, poorer function was associated with fewer physician visits.Conclusions: Poorer function, not cognition or BPSD, was associated with higher Medicare expenditures. [ABSTRACT FROM AUTHOR]

The article discusses the Doolittle Raid that was an air raid by the U.S. in Japan with the aim to boost American morale. It reflects on the order made by U.S. President Franklin D. Roosevelt after the Japanese attack on Hawaii on December 7, 1941 to strike back at Japan. It notes that the Doolittle Raid was led by Navy captain Francis Low and Lieutenant Colonel Jimmy Doolittle who was a famous pre-ware military test pilot, civilian aviator, and aeronautical engineer.

We cannot view the future of healthcare but we can sense that big changes are afoot. Many revolve around the plans to 'repeal and replace' the Affordable Care Act. We speculate on some potential areas of change in the context of a set of tenets about what care for older persons should address. [ABSTRACT FROM AUTHOR]

Background There is a general belief that the markers of nursing home quality do not aggregate easily. Identifying consistent and coherent dimensions of quality that usefully summarize the multiplicity of nursing home quality measures is an important goal. It would simplify interpretation and help consumers, their families and advocates to choose nursing facilities. Objectives This study uses quality indicators ( QIs) from a state nursing home report card to explore the dimensionality of quality in nursing homes and to determine whether aggregation at the resident versus facility level yields the same underlying dimensions. Design Cross-sectional study. Setting 382 Medicare- and/or Medicaid-certified nursing homes in Minnesota. Participants Residents admitted to the nursing homes during 2011-2012. Measurements 16 QIs obtained from the Minimum Data Set 3.0 assessment instrument between 2011 and 2012 were used in the exploratory factor analysis. Results Factor analysis results suggest four main factors or dimensions to characterize facility performance: continence care (including 4 QIs), restraints and behavioral symptoms (including 3 QIs), care for specific conditions (including 6 QIs), and physical functioning (including 3 QIs). The resident-level and facility-level results generally agreed for 11 QIs. Conclusion Nursing home quality of care can be captured in summary measures, which can be used by consumers, providers and researchers. Reporting at the resident or facility level will depend on the purpose. These summary measures can be used by policy-makers to identify and reward high-performing facilities and by families to choose nursing facilities for care. [ABSTRACT FROM AUTHOR]

In his influential paper, 'Freedom and Resentment,' P. F. Strawson argued that our ordinary practices of holding persons morally responsible and related reactive attitudes (such as blame, resentment, indignation, and moral approval) were wholly 'internal' to the practices themselves and could be insulated from traditional philosophical and metaphysical concerns, including concerns about free will and determinism. This 'insulation thesis' is a controversial feature of Strawson's influential paper; and it has had numerous critics. The first purpose of this paper is to explain my own reasons for thinking that our practices of holding responsible cannot be entirely insulated from incompatibilist concerns about freedom and determinism. The second purpose is to argue that these incompatibilist concerns are in fact legitimate concerns: There are sound reasons to believe that our ordinary practices of holding persons morally responsible do require at least sometimes in our lives that we must be capable of acting freely in a manner that is not determined. I defend this thesis by spelling out why I believe various compatibilist strategies attempting to show that moral responsibility is compatible with determinism fail to show this. In the course of this critique, a general theme will emerge: In order to do full justice to our ordinary practices of holding persons responsible and the freedoms thus involved, one must distinguish between different types of freedom, and in particular, between freedom of action and freedom of will. [ABSTRACT FROM AUTHOR]

Perfectionism is a risk and maintaining factor across psychopathology and has been proposed to be a transdiagnostic process. The aim of this study was to examine the reliability and validity of the Clinical Perfectionism Questionnaire (CPQ) in 32 adults (75% female, M age = 35.54 years, SD = 9.71) with a range of psychological disorders, presenting for treatment of clinical perfectionism. There was evidence that the CPQ was correlated with established measures of perfectionism and theoretically related constructs including self-criticism and dichotomous thinking. The CPQ was also able to predict treatment outcome. The internal consistency was not adequate in the current study; however, the sample size was small. Future studies should examine the psychometric properties of the CPQ in a larger sample of individuals with a range of psychological disorders. [ABSTRACT FROM AUTHOR]

In this study, six colors (vivid red, vivid blue, vivid yellow, pale red, pale blue, and pale yellow†) were manipulated in a simulated study environment to determine their effects on university students' learning performance, emotions, and heart rate. It was hypothesized that learning, physiological and emotional states would be affected by different colors in private study spaces. A total of 24 undergraduate and postgraduate students participated in this study. The dependent variables were reading task performance, emotional responses, and changes in heart rate. The results showed that, although participants assessed the situation as relaxed, calm, and pleasant in the pale color conditions, reading scores were significantly higher in the vivid color conditions. Heart rates were significantly affected by hue; they increased in the red and yellow conditions. In addition, the results suggested that, regardless of the degree of whiteness, the hue had a significant impact on participants' emotions; blue increased relaxation and calmness feelings of participants compared to the other colors. Implications of these findings and suggestions for further research are discussed. © 2015 Wiley Periodicals, Inc. Col Res Appl, 41, 196-205, 2016 [ABSTRACT FROM AUTHOR]

In a recent paper in this journal, “How should libertarians conceive of the location and role of indeterminism?” Christopher Evan Franklin critically examines my libertarian view of free will and attempts to improve upon it. He says that while Kane's influential [view] offers many important advances in the development of a defensible libertarian theory of free will and moral responsibility … [he made] “two crucial mistakes in formulating libertarianism” – one about the location of indeterminism, the other about its role – “both of which have helped fan the flame of the luck argument”. In this paper, I respond to Franklin's criticisms, arguing that, so far from making it significantly more difficult to answer objections about luck and control, as he claims, giving indeterminism the location and role I do makes it possible to answer such objections and many other related objections to libertarian free will. A central theme of this paper will emerge in my responses: In order to make sense of freedom of will in general and to do justice to the complex historical debates about it, one must distinguish different kinds of control agents may have over events and correspondingly different kinds of freedom they may possess. [ABSTRACT FROM AUTHOR]

Research Summary This study reports findings from a randomized controlled trial that examined the effects of the TASER® (a conducted energy weapon sold by TASER International, Scottsdale, Arizona) on several dimensions of cognitive functioning. The research demonstrated that in a sample of healthy human volunteer participants, TASER exposure led to significant and substantial reductions in (a) short-term auditory recall and (b) abilities to assimilate new information through auditory processes. The effects lasted up to 1 hour for most subjects, almost all of whom returned to baseline 60 minutes postexposure. Policy Implications The study applies the findings of reduced cognitive functioning among healthy participants in a laboratory setting to criminal suspects in field settings and questions the abilities of 'average' suspects to waive their Miranda rights knowingly, intelligently, and voluntarily within 60 minutes of a TASER exposure. The study poses the question: What would it cost police to wait 60 minutes after a TASER deployment before engaging suspects in custodial interrogations? [ABSTRACT FROM AUTHOR]

Background: Cerebrospinal fluid (CSF) biomarkers can distinguish Alzheimer's disease (AD) patients from normal controls; however, their interpretation and potential for use in patients with mild cognitive impairment (MCI) remains unclear.Objective: To examine whether biomarker levels allow for risk stratification among MCI patients who are at increased risk to develop AD, thus allowing for improved targeting of early interventions for those whose risk are higher.Methods: We analyzed data from the Alzheimer's Disease Neuroimaging Initiative on MCI patients (n = 195) to estimate their risk of developing AD for up to 6 years on the basis of baseline CSF biomarkers. We used time-dependent receiver operating characteristic analysis to identify the best combination of biomarkers to discriminate those who converted to AD from those who remained stable. We used these data to construct a multi-biomarker score and estimated the risk of progression to AD for each quintile of the multi-biomarker score.Results: We found that Aβ(1-42) and P-tau(181p) were the best combination among CSF biomarkers to predict the overall risk of developing AD among MCI patients (area under the curve = 0.77). The hazard ratio of developing AD among MCI patients with high-risk (3rd-5th quintiles) biomarker levels was about 4 times greater than MCI patients with low-risk (1st quintile) levels (95% confidence interval, 1.93-7.26).Conclusion: Our study identifies MCI patients at increased risk of developing AD by applying a multi-biomarker score using CSF biomarker results. Our findings may be of value to MCI patients and their clinicians for planning purposes and early intervention as well as for future clinical trials. [ABSTRACT FROM AUTHOR]

The article explores the history of long-term care (LTC) in the U.S. and around the world. Particular focus is given to how this relates to elder care. Additional topics discussed include the payment of services for LTC, the foundation of the Great Society Programs in the U.S. in 1965 and the Nursing Home Reform Act of 1987.

Background: Various researchers have theorized that bereaved adults who report non-secure attachment are at higher risk of pathological grief. Yet past findings on avoidant attachment representations and grief have yielded limited and contradictory outcomes. Little research has been conducted with older adults to identify the psychological processes that mediate between self-reported attachment representations and the patterns of grief. Objective: To examine the impacts of avoidant attachment and anxious attachment dimensions on emotion and non-acceptance, in response to the loss of a conjugal partner, and the mediating effect of yearning thoughts. Design: Men (N = 21) and women (N = 68) aged 60 years and above who had lost a partner within the last 12 to 72 months were invited to participate. Participants rated their levels of yearning thoughts about the deceased, emotions and non-acceptance on the Texas Revised Inventory of Grief (TRIG-Present), and their type and level of general romantic attachment on the Experiences In Close Relationship questionnaire (ECR). Results: Structural equation modelling (SEM) indicated that individuals who reported higher levels of avoidant attachment reported less emotional responses and less non-acceptance. SEM also showed that individuals who reported higher levels of anxious attachment reported greater emotional responses and greater non-acceptance. SEM further indicated that these relationships were mediated by yearning thoughts. Conclusion: People adopt different grief coping patterns according to their self-reported attachment representations, with the nature of their yearning thoughts influencing the process. Grief therapy may be organized according to individual differences in attachment representations. [ABSTRACT FROM AUTHOR]

Animal Fun was designed to enhance motor and social development in young children. Its efficacy in improving motor skills was presented previously using a randomised controlled trial and a multivariate nested cohort design. Based on the Environmental Stress Hypothesis, it was argued that the program would also result in positive mental health outcomes, investigated in the current study. Pre-intervention scores were recorded for 511 children aged 4.83-6.17 years (M=5.42, SD=.30). Intervention and control groups were compared 6 months following intervention, and again in their first school year. Changes in teacher-rated prosocial behaviour and total difficulties were assessed using the Strengths and Difficulties Questionnaire, and data analysed using Generalised Linear Mixed Models. There was a significant improvement in prosocial behaviour of children in the intervention group six months after initial testing, which remained at 18-month follow-up. Total difficulties decreased at 6 months for the intervention group, with no change at 18 months. This effect was present only for the hyperactivity/inattention subscale. The only significant change for the control group was an increase in hyperactivity/inattention scores from pre-intervention to 18-month follow-up. The Animal Fun program appears to be effective in improving social and behavioural outcomes. [ABSTRACT FROM AUTHOR]

The article explores comprehensive chronic disease care and multimorbidity. Particular focus is given to how this relates to the health and care of elders and seniors. Additional topics discussed include instances of depression and dementia, commercial disease management programs and evidence-based approaches.

Background: Measurement of clinical outcomes is necessary to define best practice. It requires a validated tool that can be easily applied as part of clinical practice. We present the preliminary validation of a brief self-reported Review of Musculoskeletal System (ROMS) questionnaire that captures functional limitations due to musculoskeletal problems and other medical and emotional conditions. Methods: Data were derived from a clinical outcomes database (Orthopaedic Minimal Data Set [OrthoMiDaS]) that combines patient-reported data collected as part of routine care and secondary data extracted from electronic medical records. The study utilized 82,873 encounters collected from 24,116 consecutive patients with problems in the upper and lower extremities. In addition to the ROMS, the study used version 2 of the Short Form-12 (SF-12v2), the Penn Shoulder Score (PSS), the Hip disability and Osteoarthritis Outcome Score (HOOS), and the Knee injury and Osteoarthritis Outcome Score (KOOS) questionnaires. Fifteen cross-sectional samples were used to evaluate the floor and ceiling effects as well as the construct and content validity. Five longitudinal cohorts were used to measure test-retest reliability and responsiveness. Standard statistical tests were applied. Results: The floor and ceiling effects of the ROMS questionnaire in patients with shoulder, hip, and knee problems ranged from 1.3% to 8.5%. Construct-validity tests confirmed convergent and divergent validity of the ROMS. The tests also justified its additional value when the ROMS was used with joint-specific tools. When measuring test-retest reliability of the ROMS scales, intraclass correlation ranged from 0.80 to 0.90 at approximately one week and from 0.71 to 0.87 at approximately four weeks. Responsiveness of the ROMS was greater than that of the SF-12 and less than that of the jointspecific questionnaires. Conclusions: The ROMS is compatible with routine clinical process and has good psychometric properties in patients with shoulder, hip, and knee disorders. It can be used as a primary outcome tool for large observational studies and can supplement more specific tools in controlled studies. Clinical Relevance: The ROMS was developed as a tool to measure and monitor the clinical status of the musculoskeletal system in a population of patients during and after treatment as well as over time. [ABSTRACT FROM AUTHOR]

This article argues for a fresh look at how we provide long-term care (LTC) for older persons. Essentially, LTC offers a compensatory service that responds to frailty. Policy debate around LTC centers on costs, but we are paying for something we really don't want. Building societal enthusiasm (or even support) for LTC will require re-inventing and re-branding. LTC has three basic components: personal care, housing, and health care (primarily chronic disease management).They can be delivered in a variety of settings. It is rare to find all three done well simultaneously. Personal care (PC) needs to be both competent and compassionate. Housing must provide at least minimal amenities and foster autonomy; when travel time for PC raises costs dramatically, some form of clustered housing may be needed. Health care must be proactive, aimed at preventing exacerbations of chronic disease and resultant hospitalizations. Enhancing preferences means allowing taking informed risks. Payment incentives should reward both quality of care and quality of life, but positive outcomes must be defined as slowing decline. Paying for services but not for housing under Medicaid would automatically level the playing field between nursing homes (NH) and community-based services. Regulations should achieve greater parity between NH and community care and include both positive and negative feedback. Providing post-acute care should be separate from LTC. Using the tripartite LTC framework, we can create innovative flexible approaches to providing needed services for frail older persons in formats that are both desirable and affordable. Such care will be more socially desirable and hence worth paying for. [ABSTRACT FROM AUTHOR]

There are a limited number of dominant discourses available to frame drug use within Australia. These dominant discourses play an important role in policy debate and development, and also drug use behaviour. We describe the development of a psychometric instrument that is hypothesised to measure the degree to which individuals internalise dominant drug discourses. Sixty items were developed to reflect six dominant discourses of drug use. A substantive validity analysis was conducted. The highest loading items were included in a 27-item measure that was administered to 370 people seeking substance use treatment in Perth, Western Australia. In addition, participants completed the Locus of Control of Behaviour Scale. Confirmatory Factor Analysis tested the fit of a predicted six factor model, in addition to three other plausible models. The best fitting model was the predicted model. Internal locus of control was correlated with medical and legal discourse. The Dominant Drug Discourses Scale appears to measure internalisation of six dominant discourses. The tool has utility in research examining policy development and drug use behaviours. To establish the construct validity of the tool and better understand the constructs being measured, further research is required. [ABSTRACT FROM AUTHOR]

The selection of valid and reliable instruments for research and clinical purposes is needed to increase our understanding of the role that expectations of motherhood have in early identification and treatment of perinatal mental health difficulties. We aimed to identify and assess the psychometric properties of self-report measures of expectations of motherhood. A systematic review was conducted and articles describing the development or validation of quantitative self-report measures of expectations of motherhood were included. The developmental quality (risk of bias) and psychometric properties of each measure were assessed according to the 2018 COSMIN guidelines. Twenty-five articles describing 16 measures were identified and included. Eleven measures were designed to assess a broad range of expectations, while the remaining measures mainly assessed expectations of childbirth. The quality of measure development was mostly poor and rated as adequate or better for only three measures. The most suitable measures with the strongest evidence of good psychometric properties are the Slade-Pais Expectations About Childbirth Scale and the Rigidity of Maternal Beliefs Scale. This systematic review of measures of expectations has identified relatively few measures with adequate psychometric properties. Further development of existing measures is needed for use in both research and clinical settings. KEY POINTS What is already known about this topic: Maternal mental health difficulties can have significant and long-term adverse consequences on mothers, their children, and families. Previous evidence suggests that holding unrealistic maternal expectations may contribute to postpartum mental health difficulties. Early identification of the potentially modifiable risk factor of maternal expectations may contribute to improving postpartum mental health outcomes. What this topic adds: This is the first systematic review to assess the developmental quality and psychometric properties of 16 measures of expectations of motherhood. The Slade-Pais Expectations About Childbirth Scale had the strongest evidence for good psychometric properties. For the majority of the measures, adequate methods for ensuring good content validity during measure development and validation were not used. [ABSTRACT FROM AUTHOR]

An editorial is presented which addresses America's physician (clinician) payment system and information reporting in relation to the U.S. Medicare Access and CHIP Reauthorization Act (MACRA). A fee-for-service (FFS) payment system is addressed, along with a sustainable growth rate formula and the U.S. Centers for Medicare and Medicaid Services' ability to implement MACRA. Electronic health records, an Alternative Payment Model, and a Merit-based Incentive Payment System (MIPS) are assessed.

The aging network has the opportunity to grow by aligning itself with emerging integrated medical institutions. But such an alliance comes at a cost. Can the network retain its core values as part of such an enterprise? Aging has now been administratively merged with disability. The aging network faces several options. It can essentially continue business as usual. It can develop a product line for facilitating transitional care. It can look for opportunities to combine social and medical care, but such programs have been hard to sustain and justify. It could develop a horizontally integrated program to offer LTSS across a variety of venues and sell it to healthcare. [ABSTRACT FROM AUTHOR]

Objective To compare the probability of experiencing a potentially preventable hospitalization ( PPH) between older dual eligible Medicaid home and community-based service ( HCBS) users and nursing home residents. Data Sources Three years of Medicaid and Medicare claims data (2003-2005) from seven states, linked to area characteristics from the Area Resource File. Study Design A primary diagnosis of an ambulatory care sensitive condition on the inpatient hospital claim was used to identify PPHs. We used inverse probability of treatment weighting to mitigate the potential selection of HCBS versus nursing home use. Principal Findings The most frequent conditions accounting for PPHs were the same among the HCBS users and nursing home residents and included congestive heart failure, pneumonia, chronic obstructive pulmonary disease, urinary tract infection, and dehydration. Compared to nursing home residents, elderly HCBS users had an increased probability of experiencing both a PPH and a non- PPH. Conclusions HCBS users' increased probability for potentially and non- PPHs suggests a need for more proactive integration of medical and long-term care. [ABSTRACT FROM AUTHOR]

The author discusses aspects of free will as an open scientific problem highlighted in the book of philosopher Mark Balaguer. He mentions his agreement with Balaguer on the libertarian theory of free will along with the involvement of indeterminism in choices and process of deliberation. An overview of his comment on the centered event casual theory of colleague Randy Clarke is also presented.

Over the past five decades, I have been developing a distinctive view of free will according to which it requires that agents be to some degree ultimately responsible for the formation of their own wills (characters, motives and purposes). To act 'of one's own free will' in this sense is to act 'from a will' that is to some extent 'of one's own free making'. A free will of this ultimate kind (often called 'incompatibilist' or 'libertarian') has been under attack in the modern era as obscure and unintelligible. In this paper, I discuss the arguments for such a view and compare it to other contemporary views of free will and action. I then address criticisms that such a non-determinist free will cannot be made intelligible or reconciled with modern science, does not allow sufficient agent control, reduces to mere chance or luck or randomness, leads to various regresses, or fails to account for moral responsibility, among other criticisms. [ABSTRACT FROM AUTHOR]

Objectives To compare hospitalizations of dually eligible older adults who had an extended Medicaid nursing home ( NH) stay and transitioned out to receive Medicaid home- and community-based services ( HCBS) with hospitalizations of those who remained in the NH. Design Retrospective matched cohort study using Medicaid and Medicare claims and NH assessment data. Setting Community (receiving Medicaid HCBS) or NH. Participants Dually eligible fee-for-service beneficiaries aged 65 and older in Arkansas, Florida, Minnesota, New Mexico, Texas, Vermont, and Washington from 2003 to 2005. Individuals who had a Medicaid NH stay of at least 90 days and transitioned to Medicaid HCBS (N = 1,169) were matched to individuals who had a Medicaid NH stay of at least 90 days and remained in the NH (N = 1,169). Measurements Potentially preventable hospitalizations (defined according to ambulatory-care-sensitive conditions) and all hospitalizations were examined. Results Cox proportional hazards models were used to compare the risk of hospitalization between the groups, accounting for the differing time at risk and censoring. Being a NH transitioner increased the hazard of experiencing a potentially preventable hospitalization by 40% (95% confidence interval ( CI) = 1.01-1.93) over remaining in the NH. NH transitioners had a 58% (95% CI = 1.32-1.91) greater risk of experiencing any type of hospitalization than NH stayers. Conclusion Individuals who transitioned from the NH to HCBS had a greater risk of hospitalization. Most of the attention in long-term care transition programs has been focused on NH readmission, but programs encouraging NH transition should recognize that individuals may be at greater risk for hospitalization after returning to the community. Planning for the medical needs of individuals who transition from an extended NH stay may improve their posttransition outcomes. [ABSTRACT FROM AUTHOR]

This article provides preliminary evaluation for a new and easy to use parental sensitivity scale, which is rated from a short videotaped play session with the parental figure. The five Tuned- In Parent Rating Scales ( TIP-RS) have been developed for use with identified dyadic problems in infant-parent relationships and provide a window on the micro-behaviours that may contribute to the dyadic disjunctions. A sample of 88 mothers who contacted a community early parenting unit was filmed in interaction with their infants and completed surveys including the Depression Anxiety and Stress Scale ( DASS) and the Edinburgh Postnatal Depression Scale ( EPDS). Six trained coders rated the videos. Confirmatory factor analysis supported the unidimensionality of the TIP-RS. The TIP-RS total score was negatively correlated with both the EPDS ( r[ N = 42] = −.34, p = .024) and the DASS ( r[ N = 42] = −.43, p = .029), providing evidence for its concurrent validity. Inter-rater reliability across the six raters for each of the TIP-RS sub-scales and total score ranged from .68 to .83. The present results warrant continued investigation of the psychometric properties of the TIP-RS as a tool for intervention with targeted parent-child relationships. [ABSTRACT FROM AUTHOR]

The study examined the minority group-threat hypothesis across a metropolitan setting to test whether (1) increases in black and Latino representation in communities were associated with increased misdemeanor arrests and (2) if increases in minority groups in historically white communities were associated with increased police arrests. The study argued that threat trigger variables should be measured in terms of difference scores and weighted by initial dominant group representation. The latter argument is informed by the defended neighborhood perspective and assesses the threat hypotheses in historically white communities. Using negative binomial regression modeling that adjusted for spatial autocorrelation, the study found that net of theoretical controls, increases in percent black population were associated with increased black misdemeanor arrests, but only in historically white census tracts. Increases in Latino representation were associated with increased minority misdemeanor arrests both across all tracts generally, as well as in historically majority white tracts. [ABSTRACT FROM PUBLISHER]

Objectives: Prior evidence suggests geographic disparities in the effect of maternal education on child nutritional status between countries, between regions and between urban and rural areas. We postulated its effect would also vary by micro-geographic locations (indicated by mountain areas, plain areas and the edge areas) in a Chinese minority area. Methods: A cross-sectional study was conducted with a multistage random sample of 1474 school children aged 5-12 years in Guyuan, China. Child nutritional status was measured by height-for-age z scores (HAZ). Linear mixed models were used to examine its association with place of residence and maternal education. Results: Micro-geographic disparities in child nutritional status and the level of socioeconomic composition were found. Children living in mountain areas had poorer nutritional status, even after adjusting for demographic (plain versus mountain, β = 0.16, P = 0.033; edge versus mountain, β = 0.29, P = 0.002) and socioeconomic factors (plain versus mountain, β = 0.12, P = 0.137; edge versus mountain, β = 0.25, P = 0.009). The disparities significantly widened with increasing years of mothers’ schooling (maternal education*plain versus mountain: β = 0.06, P = 0.007; maternal education*edge versus mountain: β = 0.07, P = 0.005). Moreover, the association between maternal education and child nutrition was negative (β = -0.03, P = 0.056) in mountain areas but positive in plain areas (β = 0.02, P = 0.094) or in the edge areas (β = 0.04, P = 0.055). Conclusions: Micro-geographic disparities in child nutritional status increase with increasing level of maternal education and the effect of maternal education varies by micro-geographic locations, which exacerbates child health inequity. Educating rural girls alone is not sufficient; improving unfavorable conditions in mountain areas might make such investments more effective in promoting child health. Nutrition programs targeting to the least educated groups in plain and in edge areas would be critical to their cost-effectiveness. [ABSTRACT FROM AUTHOR]

Key features of bone tissue structure and composition are capable of directing cellular behavior toward the generation of new bone tissue. Bone tissue, as well as materials derived from bone, have a long and successful history of use as bone grafting materials. Recent developments in design and processing of synthetic scaffolding systems has allowed the replication of the bone's desirable biological activity in easy to fabricate polymeric materials with nano-scale features exposed on the surface. The biological response to these new tissue-engineering scaffold materials oftentimes exceeds that seen on scaffolds produced using biological materials. [ABSTRACT FROM AUTHOR]

The authors conducted a systematic literature review of preventive pharmacological treatments for episodic childhood migraines searching several databases through May 20, 2012. Episodic migraine prevention was examined in 24 publications of randomized controlled trials that enrolled 1578 children in 16 nonrandomized studies. Single randomized controlled trials provided low-strength evidence that propranolol would result in complete cessation of migraine attacks in 713 per 1000 children treated (95% confidence interval, 452-974); trazodone and nimodipine decreased migraine days, while topiramate, divalproex, and clonidine were no more effective than placebo in preventing migraines. Migraine prevention with multidisciplinary drug management was not sustained at 6 months. Divalproex resulted in treatment discontinuation due to adverse effects, and topiramate increased the risk of paresthesia, upper respiratory tract infection, and weight loss. Long-term preventive benefits and improvement in disability and quality of life are unknown. No studies examined quality of life or provided evidence for individualized treatment decisions. [ABSTRACT FROM PUBLISHER]

Abstract: The association between nursing home (NH) characteristics and residents’ quality of life (QOL) has not been systematically reviewed. This study synthesizes published evidence about the association between NH ownership, affiliation, location, chain membership, percentage of private rooms, facility size, and staffing with residents’ QOL. We searched Medline, Web of Science, CINAHL, and Scirus for primary studies published between 1960 and March 31, 2012. We critically appraised risk of bias according to study design, QOL measurements, and adjustment for residents’ characteristics. We analyzed the statistical and clinical significance, direction and magnitude of the association. From 1117 citations retrieved, we found one longitudinal quasi-experimental and 10 cross-sectional eligible studies. Variability in the NH characteristics reported and QOL measurements precluded meta-analysis. Studies with low and medium risk of bias (ROB) suggested that nonprofit NHs resulted in better QOL for residents. The low ROB study indicated that in certain QOL domains, rural facilities and facilities with a higher percentage of private rooms were associated with better self-reported resident QOL. All low and medium ROB studies found that RN, LVN/LPN and total nursing staff had no significant relationship with QOL. One longitudinal quasi-experimental study indicated that the Green House with individualized care had better QOL than conventional NHs. The available evidence does not permit strong conclusions about the association between NH characteristics and residents’ QOL. The evidence does, however, raise questions about whether NH structure alone can improve residents’ QOL and how residents’ QOL should be measured and improved. [Copyright &y& Elsevier]

The present study examined the relationships between order maintenance arrests and violent crime across and within communities in a major metropolitan setting. Integrating the macro-deterrence and systemic model perspectives, the research tested the direct effects of vigorous disorder arrests on robbery and assault with a deadly weapon (i.e., violent street crime), as well as the interactive effects of Disorder Arrests × Residential Integration (mobility and owner-occupied dwelling) on violent crime. The research found no direct relationship between disorder arrests and violent crime, but it found that disorder arrests in conjunction with decreased residential integration was associated with violent crime reductions. The results suggest that police disorder arrests may produce the strongest violence reduction results in areas of decreased residential attachment; however, as residential integration increases, the effects of order maintenance arrests on violent crime diminish. The study discusses the implications for shared social control agency in communities, as well as future research directions. [ABSTRACT FROM AUTHOR]

Objectives To evaluate the effect of urinary incontinence ( UI) on elderly nursing home ( NH) residents' self-reported quality of life ( QOL), especially on the specific QOL domains most closely associated with UI. Design Retrospective cross-sectional study using the Minimum Data Set ( MDS) and Minnesota Nursing Home Report Card data in 2010 to compare overall QOL and its domains of residents with and without UI using propensity scores and inverse probability weighting ( IPW) adjustments to reduce selection bias. Setting All Medicare- or Medicaid-licensed NHs in Minnesota. Participants All residents aged 65 and older except those with conditions that could readily overwhelm the effect of UI on QOL, such as coma and cerebral palsy. Measurements Urinary incontinence ( UI) was defined as leakage two or more times a week (score ≥2 on MDS 5-point scale), and continence was defined as continent or usually continent (score 0 or 1 on MDS 5-point scale). QOL was assessed using a self-reported QOL questionnaire that measured general QOL, not QOL specific to UI symptoms. Results Urinary incontinence ( UI) prevalence was 65.8% in 10,683 older NH residents. Self-reported QOL was good (>0.7 on a scale from 0 to 1) in 8,620 eligible residents in 371 NHs. Mood and meaningful activity domains had lower scores; dignity had the highest score. UI was associated with being older and female, ADL dependence, impaired cognitive ability, Alzheimer's disease, non- Alzheimer's dementia, bowel incontinence, diabetes mellitus, and long-term NH stay. Bivariate analysis found that residents with UI had lower QOL than those without. Using IPW to reduce selection bias, it was found that, although UI was not associated with overall QOL, it decreased the QOL domains of dignity, autonomy, and mood. Conclusion To improve the QOL of residents with UI, attention should be paid to dignity, autonomy, and mood. [ABSTRACT FROM AUTHOR]