Perseveration on suicidal thoughts and images in daily life: An examination of the cognitive model of suicide through a dynamic systems lens.

According to the cognitive model of suicide, interactions between hopelessness and attentional biases toward suicidal information create a narrowed attentional focus on suicide as a viable solution, particularly in the presence of life stress, leading to increased suicide risk. This study used a dynamic systems approach to examine the short-term temporal patterns between stress, hopelessness, suicide-specific rumination, and suicidal intent. Adults (N = 237; M = 27.12 years; 62% cisgender women; 87% White/European American) with elevated suicidal ideation completed ecological momentary assessments six times a day for 14 days. A multilevel model approach informed by dynamic systems theory was used to simultaneously assess stable and dynamic temporal processes underlying perceived stress, hopelessness, suicide-specific rumination, and suicidal intent. Each variable demonstrated temporal stability. In support of the cognitive model of suicide, we observed (1) a reciprocal relationship between stress and hopelessness such that stress and hopelessness amplified each other (early-stage processes), and (2) reinforcing loops such that hopelessness, suicide-specific rumination, and suicidal intent amplified each other (later-stage processes). A dynamic systems modeling approach underscored the negative impact of a perpetuating cycle of suicide-specific rumination, deepening hopelessness, and escalating suicidal intent on increasing suicide risk, which may be targets for intervention.

Farm to Preschool Programs and Its Impact on Children's Dietary Health: Evaluation Through Bronfenbrenner's Socio-Ecological Model.

Children's development is shaped by the world around them. According to Bronfenbrenner's theory, children are influenced by direct interactions and the broader environment, which includes family, community, and society. This concept aligns with initiatives like farm-to-preschool programs. These programs forge connections between communities and local food sources, introducing gardening and nutritional education. This approach aligns seamlessly with Bronfenbrenner's theory, creating a multi-layered learning experience and fostering children's healthier eating habits. This review delves into how farm-to-preschool efforts enhance young children's diets through the ecological model evaluation framework, encompassing health, education, economics, and the environment.

From Stress to Screen: Understanding Cyberloafing through Cognitive and Affective Pathways.

This investigation delves into the pervasive yet insufficiently examined phenomenon of "cyberloafing", characterized by employees engaging in non-work-related internet activities during office hours. Despite its frequent occurrence in contemporary work environments, the fundamental mechanisms underpinning cyberloafing remain largely uncharted. This study uses the conservation of resources theory and the cognitive-affective personality system framework to demystify the relationship between role stress and cyberloafing. We developed a dual-path model to assess the mediating roles of perceived insider status and emotional exhaustion. Employing SPSS and Smart PLS for data analysis, our research sampled 210 corporate employees. The findings reveal that role stress predicts perceived insider status and emotional exhaustion significantly. Notably, while perceived insider status negatively correlates with cyberloafing, emotional exhaustion shows a positive correlation. These factors mediate the relationship between role stress and cyberloafing, underscoring a multifaceted dynamic. Our results provide new theoretical insights into the mechanisms of employee counterproductive behavior, specifically in the context of cyberloafing, and broaden our understanding of its determinants. This study illuminates theoretical nuances and offers practical implications for managerial strategies and future scholarly inquiries into organizational behavior.

Research on factors influencing Chinese parents' support for death education: a cross-sectional survey.

Objective: This study aims to explore the factors influencing Chinese parents' attitudes toward death education. Given the current lack of such education in China, this research is particularly significant. Death education is vital for shaping the values of young people and alleviating mental health issues, such as depression and suicidal tendencies. By identifying these influencing factors, this study seeks to provide guidance for policymakers and educators in promoting the development and widespread adoption of death education. Methods: To do so, a national cross-sectional quota sample of 12,435 Chinese parents was used. Borrowing from social-ecological theory, the researchers carried out multiple stepwise regression analyses to examine the individual, family, and social-level factors that shape the supportive attitudes of Chinese parents toward death education. Results: The findings revealed that at the individual level, parent (ß = 0.04, p < 0.001), education level (ß = 0.07, p < 0.001), and religious belief (ß = -0.02, p < 0.05) were significant predictors of Chinese parents' support for death education. Meanwhile, at the family and social level, average monthly household income (ß = 0.07, p < 0.001), family health (ß = 0.03, p < 0.05), family communication (ß = 0.02, p < 0.05), social support (ß = 0.15, p < 0.001), neighborhood relations (ß = 0.11, p < 0.001), and social network size (ß = 0.05, p < 0.001) were significant predictors of Chinese parents' supportive attitudes toward death education. Conclusion: Based on these findings, it is suggested that the relevant development, planning, publicity, and public welfare groups and government departments should promote death education, provide more social support, and encourage neighborhood harmony. As higher education and average monthly household income were found to significantly impact the support, the government should improve access to higher education and actively work to increase residents' income to facilitate the development of death education.

Design Principles for Biological Adaptation: A Systems and Control-Theoretic Treatment.

Establishing a mapping between (from and to) the functionality of interest and the underlying network structure (design principles) remains a crucial step toward understanding and design of bio-systems. Perfect adaptation is one such crucial functionality that enables every living organism to regulate its essential activities in the presence of external disturbances. Previous approaches to deducing the design principles for adaptation have either relied on computationally burdensome brute-force methods or rule-based design strategies detecting only a subset of all possible adaptive network structures. This chapter outlines a scalable and generalizable method inspired by systems theory that unravels an exhaustive set of adaptation-capable structures. We first use the well-known performance parameters to characterize perfect adaptation. These performance parameters are then mapped back to a few parameters (poles, zeros, gain) characteristic of the underlying dynamical system constituted by the rate equations. Therefore, the performance parameters evaluated for the scenario of perfect adaptation can be expressed as a set of precise mathematical conditions involving the system parameters. Finally, we use algebraic graph theory to translate these abstract mathematical conditions to certain structural requirements for adaptation. The proposed algorithm does not assume any particular dynamics and is applicable to networks of any size. Moreover, the results offer a significant advancement in the realm of understanding and designing complex biochemical networks.

Differences in Lower-Extremity Joint Coordination During Two Landing Phases of a Drop Jump Task.

The aim of the present study was to compare the differences in joint coordination patterns and variability in the lower extremity between the first and second landing phases of the drop jump. Eighteen resistance-trained men (age: 22.8 ± 1.8 years) performed drop jumps from a height of 0.40 m. An eight-camera motion capture system was utilized to record kinematic trajectories. Modified vector coding technique and circular statistics were used to determine the coordination pattern and variability of the following joint couples during the first and second landings: hip frontal-knee frontal (HfKf), hip sagittal-knee frontal (HsKf), hip sagittal-knee sagittal (HsKs), knee frontal-ankle frontal (KfAf), knee sagittal-ankle frontal (KsAf), and knee sagittal-ankle sagittal (KsAs). Statistical differences in the distribution frequencies of coupling angles and variability between the dominant and nondominant limbs across the two landing phases were compared using two-way repeated analysis of variance and Wilcoxon rank-sum tests. During the second landing phase, the proportion of HsKs, KfAf, and KsAs showing in-phase coordination was reduced but the proportion of KfAf and KsAs showing proximal joint (knee) coordination was increased (p < .05). Significant differences in bilateral asymmetry were observed only for the HfKf and KfAf patients (p < .05). HsKs, KfAf, and KsAf varied considerably during the second landing phase (p < .05). Joint coordination patterns during the second landing phase of the drop jump differed considerably from those during the first landing phase, thereby increasing the risk of knee and ankle injuries.

The selfish network: how the brain preserves behavioral function through shifts in neuronal network state.

Neuronal networks possess the ability to regulate their activity states in response to disruptions. How and when neuronal networks turn from physiological into pathological states, leading to the manifestation of neuropsychiatric disorders, remains largely unknown. Here, we propose that neuronal networks intrinsically maintain network stability even at the cost of neuronal loss. Despite the new stable state being potentially maladaptive, neural networks may not reverse back to states associated with better long-term outcomes. These maladaptive states are often associated with hyperactive neurons, marking the starting point for activity-dependent neurodegeneration. Transitions between network states may occur rapidly, and in discrete steps rather than continuously, particularly in neurodegenerative disorders. The self-stabilizing, metastable, and noncontinuous characteristics of these network states can be mathematically described as attractors. Maladaptive attractors may represent a distinct pathophysiological entity that could serve as a target for new therapies and for fostering resilience.

Couple differentiation and health-related quality of life.

The purpose of this study was to examine whether couple differentiation influenced mental and physical health-related quality of life in couple members. Data for this study were derived from a larger study at a couple a family therapy clinic. One hundred and thirty-three couples were included in a latent profile analysis, and seventy-two couples were included in analyses of mean differences. The latent profile analysis resulted in three distinct groups by level of couple differentiation: high, moderate, or low in differentiation of self. Analyses of variance indicated evidence that couple differentiation influenced health-related quality-of-life measures. Findings are discussed in the context of Bowen Family Systems Theory and the existing literature.

Rabies management structures and challenges in the North in a One Health framework.

Rabies is often described as the quintessential One Health problem, linking especially animal health to human health. I examined how rabies is managed in the circumpolar North through semi-structured interviews of key informants in three cases: Alaska, Northwest Territories, and Svalbard. While rabies is controlled at the territorial or state level in the Northwest Territories and Alaska, respectively, the perception of where authority lies in rabies management is less evident in Norway concerning Svalbard than in the other two cases. Respondents generally characterised the working relationship between sectors and scales of governments as positive. However, coordination remains one of the main challenges to rabies management, with harsh environmental conditions and small remote communities adding additional challenges in all three cases. Rabies managers in Svalbard also face unique conditions, such as risks associated with hunting and the particular administrative structure of Svalbard. Due to limited veterinary services in dispersed small and remote communities, dogs present challenges to rabies management in Alaska and the Northwest Territories. Personal relationships are important in disease management across agencies, and the unique challenges in the far North will likely pose challenges in adopting approaches to disease management from temperate climates.

Age-related differences in the interplay of fluency and complexity in Chinese-speaking seniors' oral narratives.

BACKGROUND: Previous studies on language production in normal ageing have primarily focused on distinct dimensions of older adults' spoken language performance, such as fluency and complexity. However, little attention has been paid to the complex, interconnected relations between these dimensions. Additionally, older adults have been treated as a homogeneous group, with little consideration for the differential characteristics of language performance across different stages of ageing. AIMS: This study aims to investigate how increasing age impacts Chinese seniors' oral language performance, focusing on fluency (articulation rate and dysfluency rate), complexity (lexical and syntactic) and the potential interactions between these dimensions. METHODS & PROCEDURES: Spontaneous oral narratives were collected from 60 normally ageing individuals, who were categorised into three groups: young-old (60-69 years old), middle-old (70-79 years old) and old-old (≥80 years old). Four measures for assessing language performance, namely, articulation rate, dysfluency rate, lexical complexity and syntactic complexity, were derived from the oral narratives. Dynamic systems techniques, including moving correlations, locally estimated scatterplot smoothing and Monte Carlo simulations, were employed for data analysis. OUTCOMES & RESULTS: This study revealed two major findings. First, across different age groups, the seniors' oral narratives significantly differed in the aspect of articulation rate and syntactic complexity. Specifically, both the young-old and the middle-old groups exhibited significantly higher articulation rates than the old-old group; the middle-old group also demonstrated significantly higher syntactic complexity compared to the old-old group. Second, the distinct subsystems (i.e., articulation rate, dysfluency rate, lexical and syntactic complexity) of seniors' oral narratives demonstrated varying interactions across different stages of ageing. While these subsystems tended to coordinate with each other in young-old individuals, they exhibited a greater tendency to compete in middle-old and old-old individuals. CONCLUSIONS & IMPLICATIONS: The findings reveal that subsystems of older adults' oral narratives display varying interactions with the increase of age, indicating that focusing solely on one dimension of language performance may result in inaccurate or misleading conclusions. Therefore, a multi-index comprehensive assessment should be employed for the enhancement of clinical evaluations of language performance in older adults. Additionally, it is vital to consider the interactional patterns (i.e., support or competition) between language subsystems when assessing language performance in normal ageing. WHAT THIS PAPER ADDS: What is already known on the subject Previous research on language production in normal ageing has primarily focused on distinct dimensions of older adults' spoken language performance, such as fluency, vocabulary richness and grammatical complexity, overlooking the intricate interconnections between these dimensions. However, investigating these connections is significant for a thorough and in-depth understanding of language production in late adulthood, which operates as a system comprising interconnected components. Furthermore, existing studies have predominantly treated older adults as a homogeneous group, comparing their language use to that of young people. This approach lacks justification, given the substantial variations in language use among seniors at different stages of ageing. What this paper adds to existing knowledge The present findings illuminate the dynamic nature of language production in normal ageing. Not only do the distinct dimensions or subsystems of older adults' oral narratives (e.g., articulation rate, dysfluency rate, syntactic complexity) change with age, but more important, the ways in which these subsystems interact with each other also evolve with age, resulting in changing states of spoken language production in the ageing process. More specifically, our study provides evidence that the interactions among subsystems of older adults' oral narratives predominately transition from supportive relationships in earlier stages to competitive ones at later stages of ageing. What are the potential or actual clinical implications of this work? The present study suggests the use of multiple linguistic indices related to various aspects of language performance to assess the spoken language production of older adults. This is highlighted by the observation that various dimensions of older adults' oral narratives continuously interact with one another across different stages of ageing, and hence focusing solely on one dimension of language performance tends to lead to inaccurate or misleading results. Additionally, the patterns of interaction (i.e., support or competition) between different dimensions of language performance may reflect older adults' capacity to coordinate and control attentional resources and therefore should be taken into consideration in clinical evaluations of language performance in older adults.

Toward a Theory of Organizational DNA: Routines, Principles, and Beliefs (RPBs) for Successful and Sustainable Organizational Change.

Organizational change is a key mechanism to ensure the sustainability of healthcare systems. However, healthcare organizations are persistently difficult to change, and literature is riddled with examples of failed change endeavors. In this chapter, we attempt to unravel the underlying causes for failed organizational change. We distinguish three types of change with different levels of depth that require different change approaches. Transformations are the deepest forms of change where beliefs and principles need to be modified to successfully influence routines. Renewals are deep forms of change where principles need to be modified to successfully influence routines. Improvements are shallow forms of change where only modifications at the level of routines are needed. Using deoxyribonucleic acid (DNA) as our metaphor, we propose a theory of "organizational DNA" to understand organizations and these three types of organizational changes. We posit that organizations are made up of a double helix consisting of a so-called "social string," which contains the "soft" interaction or communication among the organization's members, and a so-called "technical string," which contains "hard" organizational aspects such as structure and technology. Ladders of organizational nucleotides (i.e., Routines, Principles, and Beliefs) connect this double helix in various combinations. Together, the double helix and accompanying nucleotides make up the DNA of an organization. Without knowledge of the architecture of organizational DNA and whether a change addresses beliefs, principles, and/or routines, we believe that organizational change is constrained and based on luck rather than change management expertise. Following this metaphor, we show that organizational change fails when it attempts to change one part of the DNA (e.g., routines) in a way that renders it incompatible with the connecting components (e.g., principles and beliefs). We discuss how the theory can be applied in practice using an exemplar case.

"100 Things I Wish Someone Would Have Told Me": Everyday Challenges Parents Face While Caring for Their Children With a Tracheostomy.

Equitable access to appropriate care, emergency department services, and in-home support aids are needed to minimize the occurrences of adverse events that have a significant impact on families. However, many families of children with medical complexity (CMC) lack consistent care due to issues of health inequity. We conducted 11 qualitative interviews with primary caregivers who were asked about their experiences of providing care to children who have a tracheostomy and are supported by multiple life-saving machines at home. Guided by ecological systems theory, we identified three themes that contextualize the lived experiences of the participants who expressed needs that arose from poor interactions within the mesosystem. Findings convey participant frustrations that result from insufficient support, ineffective training, and inadequate healthcare coverage. Although each theme is organized systematically to emphasize specific concerns within the mesosystem, together these themes emphasize the inextricable relationship between daily needs with systemic barriers to care. We provide a discussion of these needs with a broader context that also impacts the perceived quality of care among families managing the needs of their children who are supported by life-saving technology. By addressing existing challenges and identifying opportunities for improvement within the healthcare system, we seek to contribute to the collective effort of advocating for ethical systemic change on behalf of CMC and their families.

Exploring the world of food with families: perspectives of low-income families on factors influencing their food choices.

OBJECTIVE: The aim of this study was to investigate the social and environmental factors involved in the food decision-making processes of families living on lower incomes on the Island of Ireland. DESIGN: A qualitative design was employed for this study, using photovoice and creative mapping methods. Parents were requested to take photos and draw maps of their food environments. Interviews were then conducted with parents, using the materials produced by parents as a cue to discuss their food environments, influences and decision-making processes around food choices. SETTING: The participants were interviewed online via Microsoft Teams. PARTICIPANTS: The participants were parents or guardians of children between the ages of 2 and 18 who self-defined as 'living on a tight budget'. RESULTS: Twenty-eight participants were recruited and interviewed for this study, including twelve parents in Northern Ireland and sixteen in the Republic of Ireland. The findings were mapped on to Bronfenbrenner's Ecological Systems Theory and showed that multiple, overlapping and intersecting factors at the individual, micro-, meso-, exo-, macro- and chrono-system were implicated in family food choices. Upstream factors in particular, including structural, policy and commercial determinants, appear to be significant drivers of behaviour. CONCLUSIONS: While the findings suggest that a complex range of factors are involved in family food choices, it is clear that policy measures and regulations are needed to stave off the impacts of rising social inequality and food poverty. Health promoters should strive to find non-stigmatising interventions to bridge the nutritional divide experienced by lower-income families.

Medical student experiences of equality, diversity, and inclusion: content analysis of student feedback using Bronfenbrenner's ecological systems theory.

BACKGROUND: Issues relating to equality, diversity, and inclusion (EDI) significantly impact on medical student achievement and wellbeing. Interventions have been introduced at curricular and organisational levels, yet progress in addressing these issues remains limited. Timely evaluation is needed to assess effectiveness of interventions, and to explore issues and interactions in learning environments impacting on student experience. We introduced an anonymous question concerning students' experiences of EDI into routine online student feedback questionnaires, to scope the nature of ongoing issues and develop greater understanding of students' experiences in our programme environment. Ecological systems theory, which conceptualizes learning as a function of complex social interactions, determined by characteristics of individual learners and their environment, provides a framework for understanding. METHODS: Free-text responses regarding experiences of EDI gathered over 20 months from all programme years (n = 760) were pooled for analysis, providing a holistic overview of experiences in the learning environment. A counting exercise identified broad categories reported by students. Content analysis of the qualitative dataset was undertaken. Bronfenbrenner's ecological systems theory was applied as a framework to demonstrate interdependencies between respondents' experiences and environments, and associated impacts. RESULTS: Three hundred and seventy-six responses were received relating to wide-ranging EDI issues, most frequently gender or ethnicity. Responses mapped onto all areas of the ecological systems model, with frequent links between subsystems, indicating considerable complexity and interdependencies. Interpersonal interactions and associated impacts like exclusion were frequently discussed. Differential experiences of EDI-related issues in medical school compared to clinical settings were reported. Impacts of institutional leadership and wider societal norms were considered by respondents. Respondents discussed their need for awareness of EDI with reference to future professional practice. CONCLUSIONS: Implementation of a regular free-text evaluation question allowed data-gathering across cohorts and throughout several stages of the curriculum, illuminating student experience. Connections established demonstrated intersectionality, and how environment and other factors interact, impacting on student experiences. Students experience EDI-related issues on multiple levels within the educational environment, with consequent impacts on learning. Any successful approach towards tackling issues and promoting equity of opportunity for all requires multi-level actions and widespread culture change. Students can offer fresh and distinct perspectives regarding change needed, to complement and diversify perspectives provided by staff and organisational leadership. Student voice should be enabled to shape change.

The role of emotional dysregulation in the association between family-of-origin conflict and romantic relationship maintenance.

Family-of-origin systems are consequential for the emotional well-being of offspring. These influences are likely to last into adulthood, affecting adult children's romantic relationships. The mechanisms by which family-of-origin environments influence adult romantic relationships are not fully understood. In a sample of 118 different-sex couples, we tested the effects of negative family-of-origin conflict on adult offspring's provision of relationship maintenance to their romantic partner using structural equation modeling. We evaluated emotional dysregulation as a mediator of this effect, using two measures of emotional dysregulation. Results from structural models demonstrated a negative effect of family-of-origin conflict on the provision of relationship maintenance via higher levels of emotional dysregulation. Our results highlight emotional self-regulation as a valuable intervention point for couple therapists.

The ecological dynamics of trumpet improvisation.

The nature of music improvisation continues to provide an interesting showcase of the multifaceted and skilful ways we engage with and act within our environments. Improvising musicians are somehow able to generate musical material in real time that adaptively navigates musical situations. In this article I explore the broader aspects of improvised activity-such as our bodily interactions with the instrument and environment-as they relate to improvised music-making. I do so by drawing upon principles from the embodied cognitive sciences, namely ecological and dynamical systems approaches. Firstly, I introduce the concept of affordances to illustrate the bidirectional relationship between improvisor and environment. I then take a dynamical view, exploring the ways that a trumpet player coordinates their body with their instrument and engages with trumpet affordances in order to navigate musical situations. I continue this dynamical view, taking the improviser to be an adaptive system whose behaviours are self-organised responses to a set of constraints. To conclude, I situate my research within the wider 4E approach. I advocate that 'E' approaches, which take seriously the role of the body-instrument-environment relationship, provide an insightful perspective on the nature of improvisation.

Pillars of theoretical biology: "Biochemical systems analysis, I, II and III".

Michael Savageau's Biochemical Systems Analysis I, II, IIIpapers, published in volumes 25 and 26 of the journal,kickstarted a research programme that originated many of the core concepts and tools of Systems Biology. This article briefly summarizes these papers anddiscusses the most relevant developments in Biochemical Systems Theory since their publication.

Taking Political Determinants of Planetary Health Seriously: Expanding from P4 to P5 Medicine.

Predictive, Personalized, Preventive, and Participatory (P4) Medicine is embedded in the precision medicine conceptual framework to achieve the overarching goal of "the right drug, for the right patient, at the right dose, and at the right time." Science cultures and political determinants of health have normative and instrumental impacts on P4 medicine. Yet, since the age of Enlightenment in the 17th century, science and economics have been disarticulated from politics along the lines of classical liberalism, and with an ahistorical approach that continues into the 21st century. The consequence of this liberal disarticulation is that science is falsely and narrowly understood as an invariably technocratic and objective field. In the aftermath of the Covid-19 pandemic, it is clearer that political determinants of health are the causes-of-causes for disease and health. I propose that we need P5 medicine with a fifth P, political determinants of planetary health. The new "P" can engage not only with instrumental aspects of P4 medicine research and clinical implementation but also with the structural factors that are an integral part of the politics of the P4 medicine. For example, the living legacies of colonialism contribute to the unequal relationships in trade, labor, provision, and production of materials among nation-states and between the Global South and the Global North and shape the class struggles in contemporary society, science, and medicine. A decolonial politics of care in which the political determinants of planetary health are taken seriously is therefore crucial and relevant to building a robust, ethical, responsible, and just P5 medicine in the 21st century.

Engineering Virtuous health habits using Emotion and Neurocognition: Flexibility for Lifestyle Optimization and Weight management (EVEN FLOW).

Interventions to preserve functional independence in older adults are critically needed to optimize 'successful aging' among the large and increasing population of older adults in the United States. For most aging adults, the management of chronic diseases is the most common and impactful risk factor for loss of functional independence. Chronic disease management inherently involves the learning and adaptation of new behaviors, such as adopting or modifying physical activity habits and managing weight. Despite the importance of chronic disease management in older adults, vanishingly few individuals optimally manage their health behavior in the service of chronic disease stabilization to preserve functional independence. Contemporary conceptual models of chronic disease management and health habit theory suggest that this lack of optimal management may result from an underappreciated distinction within the health behavior literature: the behavioral domains critical for initiation of new behaviors (Initiation Phase) are largely distinct from those that facilitate their maintenance (Maintenance Phase). Psychological factors, particularly experiential acceptance and trait levels of openness are critical to engagement with new health behaviors, willingness to make difficult lifestyle changes, and the ability to tolerate aversive affective responses in the process. Cognitive factors, particularly executive function, are critical to learning new skills, using them effectively across different areas of life and contextual demands, and updating of skills to facilitate behavioral maintenance. Emerging data therefore suggests that individuals with greater executive function are better able to sustain behavior changes, which in turn protects against cognitive decline. In addition, social and structural supports of behavior change serve a critical buffering role across phases of behavior change. The present review attempts to address these gaps by proposing a novel biobehavioral intervention framework that incorporates both individual-level and social support system-level variables for the purpose of treatment tailoring. Our intervention framework triangulates on the central importance of self-regulatory functioning, proposing that both cognitive and psychological mechanisms ultimately influence an individuals' ability to engage in different aspects of self-management (individual level) in the service of maintaining independence. Importantly, the proposed linkages of cognitive and affective functioning align with emerging individual difference frameworks, suggesting that lower levels of cognitive and/or psychological flexibility represent an intermediate phenotype of risk. Individuals exhibiting self-regulatory lapses either due to the inability to regulate their emotional responses or due to the presence of executive functioning impairments are therefore the most likely to require assistance to preserve functional independence. In addition, these vulnerabilities will be more easily observable for individuals requiring greater complexity of self-management behavioral demands (e.g. complexity of medication regimen) and/or with lesser social support. Our proposed framework also intuits several distinct intervention pathways based on the profile of self-regulatory behaviors: we propose that individuals with intact affect regulation and impaired executive function will preferentially respond to 'top-down' training approaches (e.g., strategy and process work). Individuals with intact executive function and impaired affect regulation will respond to 'bottom-up' approaches (e.g., graded exposure). And individuals with impairments in both may require treatments targeting caregiving or structural supports, particularly in the context of elevated behavioral demands.