Assessing capacity in the setting of self-neglect: development of a novel screening tool for decision-making capacity

Compared with older adults with disabilities and those who autonomously choose to live in squalor, self-neglect syndrome arises from a predicate state of vulnerability in frail older adults. This state of vulnerability is characteristically associated with a decline in decision-making capacity regarding the ability to care for and protect oneself. We developed the COMP Screen to evaluate vulnerable older adults to identify potential gaps in decision-making capacity using a screening tool. A total of 182 older adults were evaluated and consistent declines in cognitive ability and decision-making processes were present in this population. However, there were no significant differences between elders referred for self-neglect and matched older adults. These findings suggest that declines in decision-making processes are not uncommon in vulnerable older adults but traditional conceptualizations of decision-making capacity may be inadequate for differentiating the capacity for self-care and protection in elders who self-neglect.     

Shelf Space Management When Demand Depends on the Inventory Level

Two factors that their influence on the demand has been investigated in many papers are (i) the shelf space allocated to a product and to its complement or supplement products and (ii) the instantaneous inventory level seen by customers. Here we analyze the joint shelf space allocation and inventory decisions for multiple items with demand that depends on both factors. The traditional approach to solve inventory models with a state‐dependent demand rate uses a time domain approach. However, this approach often does not lead to closed‐form expressions for the profit rate with both dependencies. We analyze the problem in the inventory domain via level crossing theory. This approach leads to closed‐form expressions for a large set of demand rate functions exhibiting both dependencies. These closed‐form expressions substantially simplify the search for optimal solutions; thus we use them to solve the joint inventory control and shelf space allocation problem. We consider examples with two products to investigate the significance of capturing both demand dependencies. We show that in some settings it is important to capture both dependencies. We consider two heuristics, each one of them ignores one of the two dependencies. Using these heuristics it seems that ignoring the dependency on the shelf space might be less harmful than ignoring the dependency on the inventory level, which, based on computational results, can lead to profit losses of more than 6%. We demonstrate that retailers should use their operational control, e.g., reorder point, to promote higher demand products.     

“That Model is Sooooo Last Millennium!” Residential Long-Term Care as a System,Not a Place

The current quandary with the design of existing long-term care settings results from focus on structures (“institutions”) instead of on a system of supports and services that transcends physical and traditional boundaries across settings, including nursing homes, assisted living residences, and the home. Supported by analyses of the commonalities, socio-historical and political contexts, core values, and fallacies of social and medical models in existing and emerging long-term care options, a holistic model is proposed based on new core values that facilitate community and family integration and that asserts dignity and personhood as universal attributes in an array of settings.     

Sexual behavior among HIV-positive men who have sex with men: what's in a label?

Relatively little attention has been paid to the use and importance of labels used by men who have sex with men to describe insertive or receptive sexual behavior during intercourse. This study examines sexual self-labels, sexual behavior, HIV transmission risk, and psychological functioning among 205 HIV-seropositive men who have sex with men. The majority of participants (88%) identified as a top, a bottom, or versatile. Tops were more likely to engage in insertive anal intercourse than bottoms, and bottoms were more likely to engage in receptive anal intercourse than tops, with versatiles reporting intermediate rates of both behaviors. Although the results suggest preliminary evidence regarding the predictive utility of self-labels, sexual behaviors of self-label groups were greatly overlapping. Differences were found among self-label groups in gay self-identification, internalized homophobia, sexual sensation seeking, and anxiety. Results suggest an added value in assessing self-labels in addition to asking about sexual behavior.     

Hazardous Materials Releases in the Northridge Earthquake: Implications for Seismic Risk Assessment

In recent years, increasing attention has been given to the problem of earthquake-initiated hazardous materials releases (EIHRs). While the evidence indicates that EHIRs are an important part of the earthquake hazard profile, little attention has been given to documenting them in a way that could form the basis for more systematic estimates of their probability and consequences. Data from the January 17, 1994 Northridge earthquake document the range and nature of hazardous materials events in the impact area, including those at fixed-site facilities and in transportation systems. Proportional estimates of hazmat incidence are provided, and the implications of these data for developing risk assessments and earthquake hazard management are discussed.     

Functional specificity in discussion networks: The influence of general and problem-specific networks on health outcomes

Though commonly used in social science research to measure the influence of social networks, the link between discussing “important matters” within networks and the achievement of instrumental ends is frequently unspecified or untested. To address this gap, we explore the consequences of using the general “important matters” approach versus one in which the substance of discussions is directly linked to the outcomes of interest. The egocentric social networks of people experiencing an acute health crisis are examined. We identify the characteristics of and the degree of membership overlap between “important matters” and “health matters” discussants, and explore their relative power in explaining a wide range of health and health services-related outcomes. We find no evidence for the influence of “important matters” networks, while characteristics of “health matters” networks demonstrate a significant effect across all models.     

Not Practicing What You Preach: Religion and Incongruence Between Pornography Beliefs and Usage

Religious Americans, and conservative Protestants in particular, have historically been the most ardent opponents of pornography’s production, dissemination, and use. Yet while religiously committed and theologically conservative Americans are generally less likely to view pornography than others, the difference is often not as great or consistent as one might suppose given their strong moral stance. Drawing on insights from religious incongruence theory, this study considered whether religious commitment and theological conservatism predicted a greater incongruence between what Americans say they believe about pornography morally and whether they actually watch it. Data are taken from the nationally representative 2006 Portraits of American Life Study (N = 2,279). Analyses show that greater religious service attendance and prayer frequency are predictive of American men (not women) affirming that viewing pornography is “always morally wrong” while still viewing it in the previous year. Evangelicalism and other sectarian Protestantism are also the religious traditions most likely to believe pornography is always morally wrong while also viewing it. Findings ultimately suggest that religious commitment and affiliation with theological conservatism may influence Americans (primarily men) to oppose pornography more strongly in principle than reflected in actual practice. Data limitations and implications for future research are discussed.     

Unbuckling the Bible Belt: A State-Level Analysis of Religious Factors and Google Searches for Porn

While the link between individual religious characteristics and pornography consumption is well established, relatively little research has considered how the wider religious context may influence pornography use. Exceptions in the literature to date have relied on relatively broad, subjective measures of religious commitment, largely ignoring issues of religious belonging, belief, or practice. This study moves the conversation forward by examining how a variety of state-level religious factors predict Google searches for the term porn, net of relevant sociodemog raphic and ideological controls. Our multivariate findings indicate that higher percentages of Evangelical Protestants, theists, and biblical literalists in a state predict higher frequencies of searching for porn, as do higher church attendance rates. Conversely, higher percentages of religiously unaffiliated persons in a state predict lower frequencies of searching for porn. Higher percentages of total religious adherents, Catholics, or mainline Protestants in a state are unrelated to searching for porn with controls in place. Contrary to recent research, our analyses also show that higher percentages of political conservatives in a state predicted lower frequencies of porn searches. Our findings support theories that more salient, traditional religious influences in a state may influence residents—whether religious or not—toward more covert sexual experiences.     

Moral Incongruence and Pornography Use: A Critical Review and Integration

Internet pornography use (IPU) remains a controversial topic within sexual behavior research fields. Whereas some people report feeling dysregulated in their use of pornography, mental health and medical communities are divided as to whether IPU can be addictive. The present review sought to examine this issue more closely, with a focus on how variables other than pornography use, such as moral disapproval and moral incongruence (i.e., feeling as if one’s behaviors and one’s values about those behaviors are misaligned), might specifically contribute to self-perceived problems around pornography use. Through an examination of recent literature, the present work reviews evidence that moral incongruence about IPU is a common phenomenon and that it is associated with outcomes relevant to current debates about pornography addiction. Specifically, moral incongruence regarding IPU appears to be associated with greater distress about IPU, greater psychological distress in general, greater reports of problems related to IPU, and greater reports of perceived addiction to IPU. The implications of this body of evidence for both clinical and research communities are discussed, and future directions for research are considered.