Measure Of Autonomy Research Articles

Patterns and predictive factors of loss of the independence trajectory among community-dwelling older adults

BackgroundIndependence is related to the aging process. Loss of independence is defined as the inability to make decisions and participate in activities of daily living (ADLs). Independence is related to physical, psychological, biological, and socioeconomic factors. An enhanced understanding of older people’s independence trajectories and associated risk factors would enable the develop early intervention strategies.MethodsIndependence trajectory analysis was performed on patients identified in the Unité de Prévention de Suivi et d’Analyse du Vieillissement (UPSAV) database. UPSAV cohort is a prospective observational study. Participants were 221 community-dwelling persons aged ≥75 years followed for 24 months between July 2011–November 2013 and benefits from a prevention strategy. Data were collected prospectively using a questionnaire. Independence was assessed using the “Functional Autonomy Measurement System (Système de Mesure de l’Autonomie Fonctionnelle (SMAF))”. Group-based trajectory modeling (GBTM) was performed to identify independence trajectories, and the results were compared with those of k-means and hierarchical ascending classifications. A multinomial logistic regression was performed to identify predictive factors of the independence trajectory.ResultsThree distinct trajectories of independence were identified including a “Stable functional autonomy (SFA) trajectory” (53% of patients), a “Stable then decline functional autonomy decline (SDFA) trajectory” (33% of patients) and a “Constantly functional autonomy decline (CFAD) trajectory” (14% of patients). Not being a member of an association, and previous fall were significantly associated of a SDFA trajectory (P < 0.01). Absence of financial and human assistance, no hobbies, and cognitive disorder were significantly associated with a CFAD trajectory (P < 0.01). Previous occupation and multiple pathologies were predictive factors of both declining trajectories SDFA and CFAD.ConclusionsCommunity-living older persons exhibit distinct independence trajectories and the predictive factors. The evidence from this study suggests that the prevention and screening for the loss of independence of the older adults should be anticipated to maintaining autonomy.

Adapted smart home services based on smart contracts and service level agreements

SummaryIn smart home systems (SHS), devices intercommunicate to create an intelligent environment that can monitor the inhabitant's health state and provide adapted services. However, existing health monitoring systems (HMS) do not provide adapted services to the patient autonomy degree. Furthermore, in these critical systems, the Quality of Service (QoS) aspect is very important; therefore, service level agreements (SLA) are the best solution to define and guarantee the expected QoS levels, nevertheless, existing SLA specification languages lack expressiveness in terms of user preference specification, dynamic service management and pricing. In this work, we propose an elderly health state‐aware SHS to offer adapted services according to the elderly health state, it is based on three main parts: (a) the functional autonomy measurement system (SMAF) for calculating the inhabitant's profile or autonomy degree, (b) domain‐specific language (DSL) for SLA that aims to increase patient‐awareness through the use of preferences, facilitate the SLA management using microservices, and manage the QoS dynamically using multilevel SLA (ML‐SLA) concept, and (c) smart contracts for the provision of adapted services and the verification of SLA terms.

Sub-national Local Autonomy Index in Urugua

Local autonomy and the relationship between levels of government has been an important topic of various disciplines and public policies. The recent application of a local autonomy index in Europe (Ladner, Keuffer and Baldersheim, 2016; Ladner et al., 2019), is an important advance for the measurement of autonomy from a multidimensional perspective, including fiscal, political, legal and organizational aspects. This article expands this research agenda with a perspective that allows us to capture the subnational differences of local autonomy in Uruguay. The patterns of the Provincial Governments in their levels and types of autonomy are analysed, as well as the relevant variables for different dimensions identified, applying exploratory data analysis techniques.

Measuring DAO Autonomy: Lessons From Other Autonomous Systems

Decentralized autonomous organizations (DAOs) have emerged as an interesting new category of software application. Initial applications are disrupting the finance industry, but the technology is not restricted to fintech applications or assets. While other devices or software applications also claim to be autonomous, in many cases there have been levels proposed to scale or categorize the degree of autonomy afforded those applications. This notion of a level of autonomy is particularly important for consumer awareness as these autonomous devices and applications scale out to mass-market services. The societal impact from the operationalization of these technologies can be significant in terms of safety, security, privacy, and the consequences of failures. This article develops a proposed measure of autonomy for DAOs based on the existing legal/financial concept of liabilities.

Clinical Spectrum- Cognition, Stages, Functionality among Elderly with Dementia: A Cross-Sectional Study

Introduction: Although cognitive and functional impairment are the hallmark features of Dementia but it is often undetected and neglected as a normal part of aging. So we conducted this study on clinical profile of dementia patients. Aims: The aim of this study is to evaluate the Patient’s cognitive impairment, functional capacities, and stages of severity of dementia. Methods: A descriptive cross sectional study was conducted among 50 patients aged 60 years and above, of both sexes with the diagnosis of Dementia, admitted in Medicine ward of Nepalgunj Medical College, Nepalgunj, Nepal. The screening of dementia was done using Mini-Mental State Examination tool and the diagnosis of Dementia was confirmed using the International Classification of Disease-10 Diagnostic Criteria for Research. Cognition, functionality and stages of severity of dementia were assessed using Hierarchic Dementia Scale, Functional Autonomy Measurement System, Functional Assessment Staging Test tools respectively. Results: Among a total of 50 dementia patients, the mean and standard deviation of age was 82.4±6.1 years, majority of cases 60 % were in the age group ≥85 years and most patients were female 56%. The mean Mini-Mental State Examination score was 9.6±3.0, and 50 % had severe impairment of cognition on Hierarchic Dementia Scale. Stage 7 dementia 32 % was most prevalent stage on Functional Assessment Staging and severe deterioration in the functional autonomy was seen in 54% dementia patients (score ≥41 on Functional Autonomy Measurement System). Conclusion: This study concludes that significant number of elderly patients attending tertiary care hospital suffers from dementia with severe impairment in cognition and functionality in various stages of dementia in the elderly patients.

Contra Instrumentalism: A Translation Polemic

Contra Instrumentalism: A Translation Polemic

Toward a personality integration perspective on creativity: between- and within-persons associations among autonomy, vitality, and everyday creativity

ABSTRACT Rooted in self-determination theory and guided by its organismic theorizing on personality integration, the present research examined the association between autonomy and everyday creativity at the levels of individual differences in personality and daily fluctuations in motivation, and whether vitality explains this association. In Studies 1a (N = 203) and 1b (N = 68), participants completed measures of trait autonomy, trait vitality, and everyday creativity via self-ratings and responses to a behavior checklist, respectively. In Study 2 (N = 152), undergraduates completed daily measures of autonomous motivation, state vitality, ‘little-c’ creativity (self-reported and independently rated), and ‘mini-c’ creativity. Results of Studies 1a and 1b revealed indirect effects (between-persons) of autonomy on everyday creativity through vitality. Results of Study 2 revealed indirect effects (within-persons) of autonomous motivation on ‘little-c’ creativity and ‘mini-c’ creativity through state vitality. This complementary set of findings offers a more refined perspective on personality integration and the development of creativity in daily life.

Wellbeing, Developmental Crisis and Residential Status in the Year After Graduating from Higher Education: A 12-Month Longitudinal Study

Graduating from higher education is characterized by a complex set of changes, including the transition into employment as well as residential changes and identity shifts. We explored how wellbeing and depressive symptoms are associated with retrospective appraisals of developmental crisis in the year after leaving university, and the impact of living with parents following graduation. Data were collected from graduates based in the UK over the course of the 12 months following completing an undergraduate degree, via a 3-phase longitudinal design. One-third of the sample reported experiencing a developmental crisis within the year following university. Those who reported a crisis scored significantly lower on measures of environmental mastery across all time points and higher on measures of depression. Those living with parents scored significantly lower on measures of self-acceptance and autonomy and higher on measures of depression. In light of these findings, we conclude that interventions and targeted support to help students manage the psychological challenges of life after university should be developed and implemented.

Pain assessment of elderly with neurocognitive disorders in long-term care: an occupational lens

Abstract Background Occupational performance of older adults living in long-term care facilities is influenced by environmental possibilities and service provision. Pain among older adults with neurocognitive disorders might be a factor mitigating functional status. However, pain evaluation during daily routine through advanced stages of the disorder is scarce. Objective Identify pain-related behaviors of older adults with neurocognitive disorders during their morning routine in long-term care facilities. Methods A multiple-case study based on an embedded concurrent mixed methods design (quan-QUAL) was conducted in Quebec (Canada) in three long-term care units. Older adults with a neurocognitive disorder were observed (from 7:00 to 12:00 AM) and evaluated through the accomplishment of their morning routine. Through inter- and intra-case analyses, pain assessment scales (PACSLAC-II, Algoplus and DS-DAT) and morning routine assessment (occupational therapist's observations of the person, occupations and environment, functional autonomy measure, field notes) were integrated in mixed methods matrixes. Results Sixteen (n = 16) participants (average age: 76 years old [59, 93]) with various but advanced functional declines and pain symptoms were included. Participants' significant occupations all related to basic activities of daily living. Hygiene care and getting dressed were occupations for which an alteration of occupational performance was identified. Conclusions During their morning routine, older adults with a neurocognitive disorder living in long-term care facilities are facing pain symptoms and occupational deprivation, limiting the fulfilment of their needs and their engagement in occupations. Accordingly, older adults' occupations in relation to their environment should also be considered in future studies investigating pain. Key messages Occupational performance of older adults with a neurocognitive disorder living in long term care facilities is limited to basic activities of daily living. Assessment of pain of patients with a neurocognitive disorder in long-term care units should include the identification of environmental and occupational factors contributing to this pain.

LEGAL IMPEDIMENTS TO SUB-NATIONAL INFRASTRUCTURE DEVELOPMENT IN NIGERIA: DEPLOYING INSTITUTIONAL BYPASSES TO CIRCUMVENT REGULATORY INEFFICIENCIES

Nigeria's poor infrastructure development has long been an inhibiting factor to unlocking Africa's largest economy. In this paper, I argue that Nigeria's Constitution is complicit in occasioning this infrastructural quagmire, owing to the fact that it unduly hinders sub-nationals in Nigeria from driving their own infrastructural development and that in a federalist state such as Nigeria, some measure of sub-national autonomy is required to achieve any meaningful infrastructural advancement. Further, at the sub-national level I examine how legal impediments (such as fiscal dependency & regulatory inefficiency) continue to sabotage the much-needed infrastructure revolution in Nigeria. Finally, deploying the institutional bypass theory, I attempt to proffer implementable solutions to remedy some of the challenges that constrain sub-national infrastructure development in Nigeria.

Putting the Team in the Driver’s Seat: A Meta-Analysis on Team Autonomy and Team Effectiveness

Autonomy is a ubiquitous team design feature, as it is purported to relate positively to team effectiveness. However, the theoretical link between team autonomy and team effectiveness is not well understood, and previous studies have found inconsistent relationships between team autonomy and various indicators of team effectiveness. To resolve the incomplete understanding of the effects of team autonomy and illuminate the “black box” by which it affects team effectiveness, we drew from the input-mediator-outcome framework to investigate task- and relationship-focused team functioning as mediators, while also testing the moderating effects of task interdependence, task complexity, and the autonomy measurement’s referent. We also expanded the construct of team effectiveness beyond team performance to include behavioral and attitudinal team effectiveness outcomes. Our meta-analyses, based on 291 effect sizes from 58 studies conducted on 4,130 teams, revealed significant positive effects of team autonomy on team effectiveness and task- and relationship-focused team functioning. We found significant indirect effects of team autonomy on team effectiveness via both task-focused team functioning and relationship-focused team functioning. Task interdependence strengthened the relationship between team autonomy and team effectiveness, whereas task complexity weakened the relationship between team autonomy and task-focused functioning. Team autonomy was also shown to relate differentially to the effectiveness outcomes, and its relationship to team functioning was strongly influenced by the autonomy measurement’s referent.

Nurse Practitioner Autonomy and Complexity of Care in Rural Primary Care.

The growing ranks of nurse practitioners (NPs) in rural areas of the United States have the potential to help alleviate existing primary care shortages. This study uses a nationwide source of claims- and EHR-data from 2017 to construct measures of NP clinical autonomy and complexity of care. Comparisons between rural and urban primary care practices reveal greater clinical autonomy for rural NPs, who were more likely to have an independent patient panel, to practice with less physician supervision, and to prescribe Schedule II controlled substances. In contrast, rural and urban NPs provided care of similar complexity. These findings provide the first claims- and EHR-based evidence for the commonly held perception that NPs practice more autonomously in rural areas than in urban areas.

Are the psychological benefits of choral singing unique to choirs? A comparison of six activity groups

This study compared the psychological well-being of choral singers to those who took part in five other activities: solo singers, band/orchestra members, solo musicians, team sport players, and solo sport players. These comparison groups were chosen because they each share (or lack) three key features of choral singing: (a) singing, (b) the production of music, and (c) membership of a social group or team. A total of 194 participants completed an online questionnaire to assess their well-being and the extent to which their chosen activity satisfies their psychological needs for autonomy, competence, and relatedness. Analysis indicated that participants who sang in a choir reported similar levels of psychological well-being, happiness, anxiety, depression, and self-esteem to those who took part in the other five leisure activities. Significant differences were found on measures of autonomy and relatedness, but participants in all six groups also reported experiencing similar levels of competence when engaged in their chosen leisure activity. These findings suggest choral singing may not be uniquely beneficial, and any leisure activity that offers opportunities for improvement, mastery of a new skill, or a sense of accomplishment might have a positive effect on our psychological well-being.

Self-Leadership Among Healthcare Workers: A Mediator for the Effects of Job Autonomy on Work Engagement and Health

Due to the high workload, working within the healthcare industry can be quite demanding. This often results in high rates of absenteeism, unfulfilled vacancies, and voluntary turnover among healthcare workers. We expect that job autonomy is an important resource for work engagement and health of healthcare workers because it satisfies the basic need for autonomy. However, we propose that this relationship between job autonomy and work engagement and health can be explained by self-leadership. Self-leading individuals take initiative and responsibility and are assumed to use self-influencing strategies (e.g., goal setting, self-observation, creating natural rewards) as a way to improve motivation and general well-being. Employees from two healthcare organizations (N = 224 and N = 113) completed a questionnaire containing measures of job autonomy, work engagement, general health, and self-leadership. The hypothesized model was tested using a series of regressions, and the results confirmed the indirect relationships between job autonomy and work engagement and general health, respectively, through natural rewards strategies. The behavior-focused and cognitive self-leadership strategies were, as mediator, marginally significant: positively for work engagement and negatively for general health. Self-leadership behavior was not related with work engagement and general health. Implications of the findings for theory and practice on healthy healthcare workers are discussed.

PAIN AND AUTONOMY LEVEL OF THE ELDERLY WITH KNEE OSTEOARTHRITIS IN CENTRAL ANATOLIA

Purpose: The aim of this study was to determine the pain and autonomy levels of the elderly with knee osteoarthritis. Materials and Methods: The descriptive study was conducted with 147 patients who consulted the Physiotherapy and Rehabilitation-Orthopedics Clinic of a Research and Application Hospital in a city center The data were obtained by using information form, visual analog scale and functional autonomy measurement system. Results: A significant, moderate negative relationship was observed between the age variable, the sub-dimension of the scale and the Functional Autonomy Measurement System. When the autonomy level of the patients with knee osteoarthritis was evaluated, it was seen that the participants in the 65-74 age group had 1.28 times better autonomy levels compared to those in the 75 and above age group. The study revealed a significant, weak negative relationship between the duration of the illness and daily activities, mental functions and functional autonomy measurement system score averages. Conclusion: It was found that the elderly with knee osteoarthritis have lower levels of autonomy and being single, low education level, advanced age, and increased duration of illness affecting the level of autonomy.

In the Hands of Women: Conditional Cash Transfers and Household Dynamics

AbstractObjectiveThis study examines the effect of welfare payments provided to women on intra‐household decision‐making, female autonomy, and perceptions of responsibility for housework, by exploiting the case of Mexico's Progresa conditional cash transfer program.BackgroundAlthough past scholarship has extensively studied the relationship between wives' labor market earnings and household dynamics, fewer studies have analyzed the causal impact of women's welfare payments on these outcomes. These resources have become increasingly important as policy initiatives, especially in developing countries, have focused on implementing targeted programs promoting women's economic empowerment.MethodA sample of married and cohabiting couples participating in Progresa was constructed using the National Survey of Household Characteristics (N = 9,751 unions). Random assignment to the program allowed to estimate the causal effects of Progresa payments after 1.5 years, controlling for unobserved factors.ResultsProgresa cash transfers had a positive effect on attitudinal measures of housework and female autonomy, while they did not change household decision‐making. Progresa payments did not generate a gender backlash response among treated families—such as pushing women further into unpaid labor, as some critics expected.ConclusionIn the short‐run, Progresa cash transfers improved women's position in the household. These findings are consistent with both resource‐based and time constraints perspectives.ImplicationsThis study illustrates how can we exploit field experiments to answer sociological questions concerning the family.

Physicians' perceptions of autonomy support during transition to value-based reimbursement: A multi-center psychometric evaluation of six-item and three-item measures.

BackgroundSuccessive health system reforms have steadily eroded physician autonomy. Escalating accountability demands placed on physicians concurrent with diminishing autonomy plus widespread “cost cutting” endanger clinical work-life quality and, in turn, threaten patient-care quality, safety, and continuity. This has engendered a renewed emphasis on bettering physician work-life to safeguard patient care. Research indicates that autonomy support could be an effective intervention point in this dynamic, and that improving healthcare practitioners’ experience of autonomy can promote better patient outcomes. New measures of autonomy support towards physicians during systemic/organizational transformation are thus needed.ObjectiveWe investigated the validity and reliability of two versions of a brief measure of physicians’ perceptions of autonomy support.DesignPsychometric evaluation of practitioners’ responses to a theory-based, pilot-tested, multi-center, cross-sectional survey-questionnaire.ParticipantsPhysicians serving in California, Massachusetts, or upstate New York clinical practices implementing pay-for-performance incentives were eligible. We obtained responses from 1,534 (35.14%) of 4,365 physicians surveyed.AnalysisWe randomly partitioned the study sample equitably into derivation and validation subsamples. We conducted parallel analysis, inter-item/point-biserial correlations, and item-response-theory-based graded response modeling on six autonomy support items. Three items with the highest (a) point-biserial correlations, (b) item-level discrimination and (c) information capture were used to construct a short-form (3-item) version of the full (6-item) autonomy scale. We utilized exploratory structural equation modeling and confirmatory factor analysis to establish the factor structure and construct validity of the full-length and short-form scales before comparing their factor invariance, reliability and interrater agreement across physician subgroups.FindingsAll six autonomy support items loaded highly onto one factor accounting for the majority of variance and demonstrating good data fit. The three most discriminating and informative items loaded equally well onto a single factor with similar goodness-of-fit to the data. The three-item scale correlated highly with its six-item parent, showing equally high sensitivity and specificity in discriminating high autonomy support. Variability in scores nested predominantly at within- rather than between-subgroup levels.Conclusions and implicationsOur data supported the factor structure, construct validity, internal consistency, and reliability of six- and three-item autonomy support scales. These brief tools are easily incorporated into multi-dimensional questionnaires at relatively low cost.

Emotional autonomy and adjustment among emerging adults: The moderating role of family relationships

Emerging adults build their personal maturity within the family context; however, few studies focus on the role of emotional autonomy during this stage. The aim of this study was to analyze the relationship between emotional autonomy and adjustment during emerging adulthood, bearing in mind the possible moderating role of parental support in this relationship. Data were collected from 1,502 Spanish undergraduate students (903 women) aged between 18 and 29. Participants completed measures of emotional autonomy (EAS, Steinberg & Silverberg, 1986), family social support (MSPSS; Zimet, Dahlem, Zimet & Farley, 1988), psychological well-being (PWBS; Ryff, Lee, Essex & Schmutte, 1995) and psychological distress (DASS-21; Lovibond & Lovibond, 1995). The results indicate that emotional autonomy correlates negatively with family support and psychological well-being and positively with psychological distress. However, only when young people perceive a family context with low social support is gaining emotional distance from their parents associated with an increase in their psychological well-being. Our findings highlight the crucial role that the family environment plays in well-being during young adulthood, and reveal that the effect of emotional distancing from parents on adjustment depends on the quality of the family climate. Future research should seek to gain greater insight into emotional autonomy during emerging adulthood, taking into account cross-cultural diversity.

Dynamic distribution decomposition for single-cell snapshot time series identifies subpopulations and trajectories during iPSC reprogramming.

Recent high-dimensional single-cell technologies such as mass cytometry are enabling time series experiments to monitor the temporal evolution of cell state distributions and to identify dynamically important cell states, such as fate decision states in differentiation. However, these technologies are destructive, and require analysis approaches that temporally map between cell state distributions across time points. Current approaches to approximate the single-cell time series as a dynamical system suffer from too restrictive assumptions about the type of kinetics, or link together pairs of sequential measurements in a discontinuous fashion. We propose Dynamic Distribution Decomposition (DDD), an operator approximation approach to infer a continuous distribution map between time points. On the basis of single-cell snapshot time series data, DDD approximates the continuous time Perron-Frobenius operator by means of a finite set of basis functions. This procedure can be interpreted as a continuous time Markov chain over a continuum of states. By only assuming a memoryless Markov (autonomous) process, the types of dynamics represented are more general than those represented by other common models, e.g., chemical reaction networks, stochastic differential equations. Furthermore, we can a posteriori check whether the autonomy assumptions are valid by calculation of prediction error—which we show gives a measure of autonomy within the studied system. The continuity and autonomy assumptions ensure that the same dynamical system maps between all time points, not arbitrarily changing at each time point. We demonstrate the ability of DDD to reconstruct dynamically important cell states and their transitions both on synthetic data, as well as on mass cytometry time series of iPSC reprogramming of a fibroblast system. We use DDD to find previously identified subpopulations of cells and to visualise differentiation trajectories. Dynamic Distribution Decomposition allows interpretation of high-dimensional snapshot time series data as a low-dimensional Markov process, thereby enabling an interpretable dynamics analysis for a variety of biological processes by means of identifying their dynamically important cell states.

Financial Autonomy Among Emerging Adults in Australia

This paper investigates how financial autonomy develops in young adults and under what circumstances that development process is hastened or hindered. The paper uses longitudinal data from the Household, Income, and Labour Dynamics in Australia (HILDA) survey for persons aged 15-25, thus following young people from the time they are adolescents and into adulthood. We develop a novel measure of financial autonomy based on an individual’s degree of responsibility for household decision-making related to (a) managing day-to-day spending, (b) making large household purchases, and (c) savings and investments. Measuring financial autonomy allows us to observe a period of “emerging adulthood” as opposed to merely delaying nest-leaving due to cost-constraints (i.e. costs of living). If emerging adulthood plays an important role in young adults’ development, we would expect to see steadily increasing levels of financial autonomy while the young adults are still at home. If on the other hand, delayed nest-leaving is only due to costs-constraints, we would not expect to observe such a period of systematic preparation for independent living. We estimate a correlated random-effects model for the latent financial autonomy construct, specifying a range of covariates related to individual demographic and resource characteristics, household characteristics, and regional factors. For men, there is a significant and positive age gradient associated with financial autonomy. There is no evidence of an age profile for young women whose level of financial autonomy is mostly explained by their household- and regional characteristics. This suggests that the phase of “emerging adulthood”, in which financial autonomy is learned over time at home, plays an important role for young men but not for young women. This systematically puts young women at a potential disadvantage compared to young men, and consequently at a higher risk of low financial literacy and poor financial decision-making in the period after nest-leaving.