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Machine Learning systems rely heavily on annotated instances. Such annotations are frequently done by human experts, or by tools developed by experts, and so the central message of this book, Noise: A Flaw in Human Judgment(Kahneman, Sibony, and Sunstein 2021) is of considerable importance to AI/Machine Learning community. The core message is that if a number of experts are asked to annotate tasks that involve judgments, these responses will frequently differ. This observation poses a problem for how analysts choose a particular annotated dataset (from the group), or process the set of responses to give a “balanced” response, or whether to reject all the annotated datasets. A further important aspect of this book is the case studies which demonstrate that differences in judgments between fellow experts have been reported in a significant number of disciplines including, business, the law, government, and medicine. Kahneman, Sibony and Sunstein (2021), referred to as KSS subsequently, discuss how Expert Biases can be reduced, but the main focus of this book is a discussion of Noise, that is, differences that often occur between fellow experts, and how Noise can often be reduced. To address the last point KSS have formulated a set of six decision hygiene principles which include the recommendation that complex tasks should be subdivided, and then each subtask should be solved separately. A further principle is that each task should be solved by individual experts before the various judgments are discussed with fellow experts. Effectively, the book being reviewed covers three main topics: First, it reports several motivating studies that show how judgments of fellow experts varied significantly in the pricing of insurance premiums, and in setting the lengths of custodial sentences. These motivating studies very effectively illustrate the central concepts of Judgment, Noise, and Bias; that section also provides definitions of these core concepts and discusses how Noise is often amplified in group meetings. Secondly, the authors provide detailed discussion of further studies, in a variety of domains, which report the levels of disagreement between experts. Thirdly, KSS discusses how to reduce the levels of Noise between experts, as noted above, the authors refer to these as Principles of Noise Hygiene. These three parts are interwoven in a complex way throughout the book; in our view, the best overview of the book is given in the section Review and Conclusions: Taking Noise Seriously (KSS, p. 361).

A series of polythiophenes with varying side chain density was synthesized, and their electrical and thermoelectric properties were investigated. Aligned and non-aligned thin films of the polymers were characterized in the neutral and chemically doped states. Optical and diffraction measurements revealed an overall lower order in the thin films with lower side chain density, also confirmed using polarized optical experiments on aligned thin films. However, upon doping the non-aligned films, a sixfold increase in electrical conductivity was observed for the polythiophene with the lowest side chain density compared to poly(3-hexylthiophene) (P3HT). We found that the improvement in conductivity was not due to a larger charge carrier density but an increase in charge carrier mobility after doping with 2,3,5,6-tetrafluoro-7,7,8,8-tetracyanoquinodimethane (F4TCNQ). On the other hand, doped aligned films did not show the same trend; lower side chain density instead led to a lower conductivity and Seebeck coefficient compared to those for P3HT. This was attributed to the poorer alignment of the polymer thin films with lower side chain density. The study demonstrates that optimizing side chain density is a synthetically simple and effective way to improve electrical conductivity in polythiophene films relevant to thermoelectric applications.

AbstractObjectivesWe tested whether 100 g/day of dried fruit (vs. no supplemental fruit control) for 6 months alters 24-hr urinary net acid excretion (NAE), bone resorption, weight, body composition, muscle performance, and diet quality. We explored consistency of self-selected dietary composition and potential renal acid load (PRAL).MethodsThis randomized, single-blind, 2-armed study included 83 normal- and over-weight men and postmenopausal women (age ≥50 years) on self-reported low fruit diets. Endpoints included group differences in NAE (primary), 24-hr urinary N-telopeptide (NTX), weight, body composition, muscle performance, and diet quality.ResultsAt baseline, mean (±SD) age was 69 ± 8 years; 86% were Caucasian; body mass index was 24.5 ± 2.8 kg/m2; 46% female, and NAE was 32.4 ± 23.1 mmol with no significant baseline group differences. No significant group differences were noted in NAE (primary), NTX, weight, body composition, muscle performance or diet quality at 6 months. In the cohort as a whole, 6-month change in NAE was positively associated with change in NTX, but no significant associations were noted in other outcomes. PRAL on the day of the urine collection was positively associated with NAE. Comparison of two consecutive baseline 24-hr diet recalls revealed wide intra-individual variability in PRAL in self-selected diets in our participants.ConclusionIn this field study of older adults consuming self-selected diets, making one change to the diet by adding 100 g/day of dried fruit (equivalent to 4 servings per day) had no significant impact on NAE when compared to a no supplemental fruit control. This null finding may be attributable to the high day-to-day variability in consumption of foods affecting NAE. Added fruit also had no significant effect on weight, fat, muscle, or bone outcomes over a 6-month period.

Cystic fibrosis (CF) transmembrane conductance regulator modulators are a cornerstone of CF treatment. However, many patients develop CF liver disease (CFLD) over time, and previous data indicate a risk for transaminase elevation with modulator use. Elexacaftor/tezacaftor/ivacaftor is a commonly prescribed modulator with broad efficacy among CF genomic profiles. Theoretically, elexacaftor/tezacaftor/ivacaftor drug-induced liver injury could exacerbate and further worsen CFLD, but holding modulators can cause a decline in clinical status.

This article from Prospect features an interview with John Gilhooly, the director of Wigmore Hall, a prestigious concert venue in London. Gilhooly reflects on various personal experiences, such as witnessing Pope St John Paul II's visit to Ireland in 1979 and attending a concert by Romanian pianist Radu Lupu. He also discusses the importance of arts funding and the role of the arts in society. Gilhooly expresses his admiration for Schubert and recommends Taylor Swift as an artist who explores similar themes to 19th-century composers. He also highlights the diverse audience at Wigmore Hall, including the U35 scheme that attracts young visitors. [Extracted from the article]

Organic solar cells (OSCs) based on ADA-type (acceptor–donor–acceptor) non-fullerene acceptors (NFAs) exhibit improved power conversion efficiency (PCE) compared to the conventional fullerene-based analogues. The optoelectronic properties of the OSC active layer are correlated to the underlying structural dynamics of the active layer blend and therefore influence the device performance. Using synergistically different neutron spectroscopy techniques, we studied the dynamics of binary and ternary blends made of the non-fullerene acceptors O-IDTBR and O-IDFBR and the regioregular donor polymer poly(3-hexylthiophene) (P3HT). Considering key factors like structural relaxation, miscibility, and morphology, within a chosen temperature range, we probed the dynamical responses of the neat phases and the blends using time-of flight quasi-elastic neutron scattering and neutron spin echo measurements, complemented by neutron vibrational spectroscopy. We cover the femtosecond to nanosecond time window directly relevant to the operating active layer molecular processes. Blends of protonated O-IDTBR and O-IDFBR with either deuterated or protonated P3HT were considered for a contrast variation purpose. Our study confirms the observation of the hypomiscibilty of O-IDTBR in the binary P3HT:O-IDTBR compared to O-IDFBR in P3HT:O-IDFBR and points toward a molecular alloying character of the NFA blend O-IDTBR:O-IDFBR, not observed in the ternary P3HT:O-IDTBR:O-IDFBR. A main outcome of this work is the evidenced similar dynamical response of the donor and acceptor components in both the binary and ternary blends, within the accessible experimental picosecond–nanosecond time window and up to 400 K. This finding is in contrast with our previous neutron spectroscopy and molecular dynamics studies of the fullerene-based blend P3HT:PCBM (PCBM: phenyl-C61-butyric acid methyl ester), where we highlighted distinct behaviors of P3HT and PCBM in the blend in terms of the vitrification/frustration of P3HT upon blending and the plasticization of PCBM by P3HT. Alike P3HT vitrification is not presently observed, which we ascribe to the resemblance of the chemical structures of O-IDTBR/O-IDFBR and P3HT. The absence or the weak vitrification evidenced here is in line with recent reports and is likely related to the improved PCE exhibited by the ADA-type NFA-based OSCs.

Purpose: The purpose of this paper is to demonstrate how teachers can use their Sgaw Karen students’ names as a means to gaining awareness of their students’ home culture, language and personal stories. Design/methodology/approach: This case study uses interviews with four Karen families to explore the meanings behind the names and nicknames given to Karen individuals. Findings: The findings of this study reveal that Karen names can provide teachers important insights into Karen culture, history and language. Moreover, Karen names can also provide important biographical information about the student. Research limitations/implications: This study only focuses on Sgaw Karen names and does not include other Karen subgroups like the Pwo Karen, who are also resettling in the USA. This study does not include all Sgaw Karen names, but the authors have made efforts to include Karen names from various regions of Burma and of different religious backgrounds. Practical implications: Teachers and others working with culturally and linguistically diverse students like the Karen will gain a better understanding of the various ways that names are given across cultures. While this paper focuses on one particular ethnic group, it is believed that teachers need to expand their notions about how other non-European groups name their children and how these names may reveal something about the student’s heritage culture, history, language and the unique lived experiences of their students. Social implications: Too often teachers and others working cross-culturally do not realize that other cultures follow different naming practices than those used in the USA. Teachers often mispronounce or misunderstand students’ names when the student comes from a cultural group unfamiliar to them. This paper helps a general audience better realize the unique approach Karen culture takes to naming children and how these names are often transformed to fit American naming conventions. As the title suggests, Karen students often feel embarrassed and take on a negative opinion of their given name as a result of a lack of awareness by teachers and others. Originality/value: This paper provides a unique perspective in the literature on the ways cultural naming conventions can serve teachers aspiring to incorporate biography-driven instruction into their classroom practices.

The science and tools of measuring energy intake and output in humans have rapidly advanced in the last decade. Engineered devices such as wearables and sensors, software applications, and Web-based tools are now ubiquitous in both research and consumer environments. The assessment of energy expenditure in particular has progressed from reliance on self-report instruments to advanced technologies requiring collaboration across multiple disciplines, from optics to accelerometry. In contrast, assessing energy intake still heavily relies on self-report mechanisms. Although these tools have improved, moving from paper-based to online reporting, considerable room for refinement remains in existing tools, and great opportunities exist for novel, transformational tools, including those using spectroscopy and chemo-sensing. This report reviews the state of the science, and the opportunities and challenges in existing and emerging technologies, from the perspectives of 3 key stakeholders: researchers, users, and developers. Each stakeholder approaches these tools with unique requirements: researchers are concerned with validity, accuracy, data detail and abundance, and ethical use; users with ease of use and privacy; and developers with high adherence and utilization, intellectual property, licensing rights, and monetization. Cross-cutting concerns include frequent updating and integration of the food and nutrient databases on which assessments rely, improving accessibility and reducing disparities in use, and maintaining reliable technical assistance. These contextual challenges are discussed in terms of opportunities and further steps in the direction of personalized health.Statement of Significance: This article is the first to discuss the status and challenges of current and emerging technology tools designed to measure individual food intake, eating behavior, and physical activity through the perspectives of 3 stakeholders: researchers, users, and developers. The objective of this work is to bring together experts to address interdisciplinary and cross-cutting issues with the shared mission of improving the measurement of energy intake and expenditure.

The science and tools of measuring energy intake and output in humans have rapidly advanced in the last decade. Engineered devices such as wearables and sensors, software applications, and Web-based tools are now ubiquitous in both research and consumer environments. The assessment of energy expenditure in particular has progressed from reliance on self-report instruments to advanced technologies requiring collaboration across multiple disciplines, from optics to accelerometry. In contrast, assessing energy intake still heavily relies on self-report mechanisms. Although these tools have improved, moving from paper-based to online reporting, considerable room for refinement remains in existing tools, and great opportunities exist for novel, transformational tools, including those using spectroscopy and chemo-sensing. This report reviews the state of the science, and the opportunities and challenges in existing and emerging technologies, from the perspectives of 3 key stakeholders: researchers, users, and developers. Each stakeholder approaches these tools with unique requirements: researchers are concerned with validity, accuracy, data detail and abundance, and ethical use; users with ease of use and privacy; and developers with high adherence and utilization, intellectual property, licensing rights, and monetization. Cross-cutting concerns include frequent updating and integration of the food and nutrient databases on which assessments rely, improving accessibility and reducing disparities in use, and maintaining reliable technical assistance. These contextual challenges are discussed in terms of opportunities and further steps in the direction of personalized health.

The way in which conjugated polymers pack in the solid state strongly affects the performance of polymer-based optoelectronic devices. However, even for the most crystalline conjugated polymers the precise packing of chains within the unit cell is not well established. Here we show that by performing resonant X-ray diffraction experiments at the sulfur K-edge we are able to resolve the tilting of the planar backbones of crystalline poly(3-hexylthiophene) (P3HT) within the unit cell. This approach exploits the anisotropic nature of the X-ray optical properties of conjugated polymers, enabling us to discern between different proposed crystal structures. By comparing our data with simulations based on different orientations, a tilting of the planar conjugated backbone with respect to the side chain stacking direction of 30 ± 5° is determined.

ABSTRACTRoger Dominowski made a very substantial and lasting contribution to the study of higher mental processes and particularly to the area of insight problem solving. This is a tribute to his work.

The amount of time spent in poor health at the end of life is increasing. This narrative review summarizes consistent evidence indicating that healthy dietary patterns and maintenance of a healthy weight in the years leading to old age are associated with broad prevention of all the archetypal diseases and impairments associated with aging including: noncommunicable diseases, sarcopenia, cognitive decline and dementia, osteoporosis, age-related macular degeneration, diabetic retinopathy, hearing loss, obstructive sleep apnea, urinary incontinence, and constipation. In addition, randomized clinical trials show that disease-specific nutrition interventions can attenuate progression—and in some cases effectively treat—many established aging-associated conditions. However, middle-aged and older adults are vulnerable to unhealthy dietary patterns, and typically consume diets with inadequate servings of healthy food groups and essential nutrients, along with an abundance of energy-dense but nutrient-weak foods that contribute to obesity. However, based on menu examples, diets that are nutrient-dense, plant-based, and with a moderately low glycemic load are better equipped to meet the nutritional needs of many older adults than current recommendations in US Dietary Guidelines. These summary findings indicate that healthy nutrition is more important for healthy aging than generally recognized. Improved public health messaging about nutrition and aging, combined with routine screening and medical referrals for age-related conditions that can be treated with a nutrition prescription, should form core components of a national nutrition roadmap to reduce the epidemic of unhealthy aging.Healthy nutrition has a broad, underrecognized role in preventing aging-related diseases and conditions. Updated public health recommendations on nutrition are needed to support healthy aging.

The amount of time spent in poor health at the end of life is increasing. This narrative review summarizes consistent evidence indicating that healthy dietary patterns and maintenance of a healthy weight in the years leading to old age are associated with broad prevention of all the archetypal diseases and impairments associated with aging including: noncommunicable diseases, sarcopenia, cognitive decline and dementia, osteoporosis, age-related macular degeneration, diabetic retinopathy, hearing loss, obstructive sleep apnea, urinary incontinence, and constipation. In addition, randomized clinical trials show that disease-specific nutrition interventions can attenuate progression—and in some cases effectively treat—many established aging-associated conditions. However, middle-aged and older adults are vulnerable to unhealthy dietary patterns, and typically consume diets with inadequate servings of healthy food groups and essential nutrients, along with an abundance of energy-dense but nutrient-weak foods that contribute to obesity. However, based on menu examples, diets that are nutrient-dense, plant-based, and with a moderately low glycemic load are better equipped to meet the nutritional needs of many older adults than current recommendations in US Dietary Guidelines. These summary findings indicate that healthy nutrition is more important for healthy aging than generally recognized. Improved public health messaging about nutrition and aging, combined with routine screening and medical referrals for age-related conditions that can be treated with a nutrition prescription, should form core components of a national nutrition roadmap to reduce the epidemic of unhealthy aging.

Needs a blooms from May to July-Oct. + 0 ' 21 - j Design Sousions Make more space for nature, says Louisa Gilhooly ~~ How can I turn my tiny front M ~0~~o~~N~ED 11? 99 thehighstreet.com each NHBS 0-,803 1-- m 865913; v/Nw.nhbs.com 1 .I..../-' - /1 kILI'VAI="a.'I,4111 1,&; gscabiosa "Butterfly Blue" Long 10,ris ensata flowering compact Eelegant perennial with «perennial with a mass strappy, green and of lavender blue, cream variegated- Root Lily Bench £639.99 ' pincushion-like blooms leaves and deep purple Homesdirect 365, on tall wiry stems blooms May-July. [Extracted from the article]

Within the text we elaborate on the relationship between war and medicine, particularly as it pertains to neurosurgery and the management of brain trauma, and emphasize neurosurgical advancements in the treatment of brain trauma gleaned from U.S.-involved conflicts of the 21st century.

Single-molecule and bulk biophysical approaches to study protein-DNA interactions on surface-immobilized nucleic acid templates typically rely on modifying the ends of linear DNA molecules to enable surface-DNA attachments. Unless both strands are constrained, this results in topologically free DNA molecules and the inability to observe supercoiling-dependent biological processes or requires additional means to micromanipulate the free DNA end to impose rotational constraints or induce supercoiling. We developed a method using RecA protein to induce the formation of a circularized compliment-stabilized D-loop. The resulting joint molecule is topologically closed, surface anchorable, and stable under microfluidic flow. Importantly, the method obviates the need for subsequent manipulation of surface-tethered DNA; tethered molecules remain supercoiled and retain accessibility to DNA-binding proteins. This approach adds to the toolkit for those studying processes on DNA that require supercoiled DNA templates or topologically constrained systems.

Effective, standardized, and easily accessible weight management programs are urgently needed for military beneficiaries. Videoconference interventions have the potential for widespread scaling, and can provide both real time interaction and flexibility in delivery times regardless of location, but there is little information on their effectiveness and acceptability.

ABSTRACTBackgroundIn 2013, the Accreditation Council for Graduate Medical Education (ACGME) transitioned into a new accreditation system to reduce burden, focus on outcomes, and promote innovation and improvement. One component is a self-study that includes aims, an environmental assessment, and setting improvement priorities. The ACGME initiated voluntary site visits following the self-study.ObjectiveWe explored common themes in program aims and assessment of their environment.MethodsUsing grounded theory, inductive and deductive qualitative methods, and truth grounding, we analyzed data from voluntary site visits of 396 core and subspecialty programs between June 2015 and September 2017, with a focus on common themes.ResultsWe report common themes for aims and the dimensions of the environmental assessment. Themes for strengthsinclude a collegial, supportive learning environment; responsive leaders; and experiences that prepare residents for unsupervised practice. Improvement prioritiesencompass low learner engagement and “content mismatch” in didactic education, balancing education and service at a time of growing clinical volumes, and improving the utility of assessment systems. Common opportunitiesencompass collaborations that improve education, involving alumni and harnessing technology to enrich education, while threatsinclude an unsustainable effort for many program leaders, clinical pressures on faculty, and loss of external sites important for education. Linked dimensions of the environmental assessment suggest benefit in a growing focus on learners, and approaches to ensure a humanistic learning environment that allows for growth, self-determination, and inclusion.ConclusionsThe findings highlight actionable themes for the environmental assessment. We discuss implications for programs, institutions, and the ACGME.

This theoretical review paper investigates the role of first language (L1) in the mainstream scholarship of second/foreign (L2/FL) language education in the context of language learning, teaching, and bilingual education. The term ‘mainstream’ refers here to the scholarship that is not informed by sociocultural theory in general and Vygotskian sociocultural theory in particular. The paper later explains a Vygotskian perspective on the use of L1 in L2/FL language education and discusses how the perspective may help content teachers in (a) employing L1 in teaching L2/FL content and (b) helping L2/FL students to become self-regulative users of the target language.

The foundation of methylmercury (MeHg) bioaccumulation in aquatic systems is uptake and trophic transfer into phytoplankton and zooplankton. Phytoplankton and zooplankton samples were collected seasonally from Long Island Sound (LIS) and its adjacent shelf waters, located along the northeast coast of the United States. Phytoplankton samples were size fractioned into 0.2–5 μm, 5–20 μm, and seston of > 20 μm. Average phytoplankton MeHg concentrations were 0.01–1.5 pmol g−1(wet weight), and MeHg bioconcentration factors (logBCF) ranged from 2.5 to 5.5. There was higher MeHg concentration and logBCF values with increasing phytoplankton size. Zooplankton samples were size fractioned into 0.2–0.5 mm, 0.5–1.0 mm, 1.0–2.0 mm, and > 2.0 mm classes and analyzed for Hg and MeHg as well as carbon (δ13C), nitrogen (δ15N), and sulfur (δ34S) isotopes. The %MeHg in organisms was highest in the > 2.0 mm size class for coastal LIS and shelf species, indicating higher MeHg bioaccumulation with increasing zooplankton sizes. Eastern LIS zooplankton populations yielded higher overall Hg accumulation than western LIS populations, in alignment with phytoplankton fractions. Seasonal differences were evident for plankton %MeHg, although only ELIS displayed an increase in summertime %MeHg throughout the fractions. The results suggest the importance of biodilution in determining plankton MeHg concentrations. The δ13C values infer that zooplankton were opportunistically feeding on food containing variable levels of Hg and MeHg. The δ15N isotopes indicated enrichment characteristic of anthropogenic input in populations at the western end of LIS. The δ34S isotopes signified that organisms were primarily feeding on pelagic plankton.

The relative importance of biotic and abiotic processes in the development of “fertile islands” in dryland systems has rarely been investigated. Here we approached this question by using artificial shrubs, which exclude plant litter production and soil nutrient uptake, but retain the functions of trapping windblown material, funneling of stemflow, and differential rain splash. We conducted a vegetation manipulation study more than a decade ago in the desert grassland of southern New Mexico and subsequently revisited the site in 2012 and 2015. The results show that no notable soil mounds were observed under the artificial shrubs; however, soil texture under the artificial shrubs has gradually changed to resemble the patterns of soil particle‐size distribution under natural shrubs. Our results highlight that with the exclusion of direct biotic additions, soils captured by shrub canopies are not necessarily fertile and thus do not themselves contribute to the development of fertile islands. Artificial shrubs were used to study the relative importance of biotic and abiotic processes in fertile island developmentNo notable fertile islands were observed after 10 yearsAeolian processes are not efficient in fertile island development in the absence of biotic additions

The transition to competency-based medical education (CBME) and adoption of the foundational domains of competence by the Accreditation Council for Graduate Medical Education, Association of American Medical Colleges (AAMC), and American Board of Medical Specialties’ certification and maintenance of certification (MOC) programs provided an unprecedented opportunity for the pediatrics community to create a model of learning and assessment across the continuum. Two frameworks for assessment in CBME have been promoted: (1) entrustable professional activities (EPAs) and (2) milestones that define a developmental trajectory for individual competencies. EPAs are observable and measureable units of work that can be mapped to competencies and milestones critical to performing them safely and effectively.The pediatrics community integrated the two frameworks to create a potential pathway of learning and assessment across the continuum from undergraduate medical education (UME) to graduate medical education (GME) and from GME to practice. The authors briefly describe the evolution of the Pediatrics Milestone Project and the process for identifying EPAs for the specialty and subspecialties of pediatrics. The method of integrating EPAs with competencies and milestones through a mapping process is discussed, and an example is provided. The authors illustrate the alignment of the AAMC’s Core EPAs for Entering Residency with the general pediatrics EPAs and, in turn, the alignment of the latter with the subspecialty EPAs, thus helping build the bridge between UME and GME. The authors propose how assessment in GME, based on EPAs and milestones, can guide MOC to complete the bridge across the education continuum.

Background/Objectives:: Acid-producing diets have been associated with adverse health conditions. Dietary acid load can be estimated from dietary intake data, but the available methods require a full dietary assessment. We sought to identify a simpler means to estimate 24-h urinary net acid excretion (NAE), a robust measure of net endogenous acid production, using self-reported intakes of fruits, vegetables (acid-neutralizing foods), grain and/or protein (acid-producing foods) acquired by two different methods in community-dwelling older adults. Identifying food groups associated with NAE by using a method not requiring a full diet assessment could have a broad clinical application. Subjects/Methods:: Fruit, vegetable, protein and grain servings/day were estimated with a widely used food frequency questionnaire (study A, n=162, 63±8 years). Differences in their intakes across NAE categories (<5, ⩾5 to <15, ⩾15 to <50, ⩾50 milliequivalents (mEq)/day) were analyzed using analysis of variance. The findings were verified in a second study, which estimated dietary intakes, using a more detailed record-assisted 24-h recall (study B, n=232, 67±6 years). Results:: Fruit intake was significantly associated with NAE in both studies. In study A, fruit intake was 9% lower with each categorical NAE increase (unstandardized beta=−0.21, P=0.01) and 7% lower with each categorical NAE increase in study B (unstandardized beta=−0.18; P=0.02). Grain intake was positively associated with NAE in study B only (unstandardized beta=+0.14; P=0.01). Vegetable and protein intake were not associated with NAE in either study. Conclusions:: The inverse association between fruit intake and NAE suggests low self-reported fruit intake may be an indicator of acid-producing diets in older adults.

The authors describe a study which showed that regular engagement with mentally taxing activities was shown to be associated with good cognitive functioning.

ABSTRACTThis study examined factors that may predict the quality of life (QoL) of stroke survivors in Bangladesh. The objectives were: to examine the relationship between QoL and health-related variables (i.e. disability status, cognitive status, mobility status, self-care, getting along with people, life activities, social participation, and psychological state); and also to examine the influence of demographically related variables (i.e. gender, age, level of education, marital status, and living arrangements) on QoL. Data were collected from 110 stroke survivors in Bangladesh. Data collection tools included a semi-structured questionnaire along with WHOQOL-BREF, WHODAS 2.0, and DASS21. A regression analysis was undertaken to determine the significant independent predictors of QoL. Post stroke psychological distress was found to be the key predictor of QoL. Therefore, psychological interventions need to be incorporated in rehabilitation to enhance better QoL post stroke. Other health and demographically related predictor variables had no influence on overall QoL post stroke.

IMPORTANCE: Calorie restriction (CR) increases longevity in many species and reduces risk factors for chronic diseases. In humans, CR may improve health span, yet concerns remain about potential negative effects of CR. OBJECTIVE: To test the effect of CR on mood, quality of life (QOL), sleep, and sexual function in healthy nonobese adults. DESIGN, SETTING, AND PARTICIPANTS: A multisite randomized clinical trial (Comprehensive Assessment of Long-term Effects of Reducing Intake of Energy Phase 2 [CALERIE 2]) was conducted at 3 academic research institutions. Adult men and women (N = 220) with body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 22.0 to 28.0 were randomized to 2 years of 25% CR or an ad libitum (AL) control group in a 2:1 ratio favoring CR. Data were collected at baseline, 12 months, and 24 months and examined using intent-to-treat analysis. The study was conducted from January 22, 2007, to March 6, 2012. Data analysis was performed from July 18, 2012, to October 27, 2015. INTERVENTIONS: Two years of 25% CR or AL. MAIN OUTCOMES AND MEASURES: Self-report questionnaires were administered to measure mood (Beck Depression Inventory-II [BDI-II], score range 0-63, higher scores indicating worse mood, and Profile of Mood States [POMS], with a total mood disturbance score range of −32 to 200 and higher scores indicating higher levels of the constructs measured), QOL (Rand 36-Item Short Form, score range 0-100, higher scores reflecting better QOL, and Perceived Stress Scale, score range 0-40, higher scores indicating higher levels of stress), sleep (Pittsburgh Sleep Quality Index [PSQI], total score range 0-21, higher scores reflecting worse sleep quality), and sexual function (Derogatis Interview for Sexual Function–Self–report, total score range 24-188, higher scores indicating better sexual functioning). RESULTS: In all, 218 participants (152 women [69.7%]; mean [SD] age, 37.9 (7.2) years; mean [SD] BMI, 25.1 [1.6]) were included in the analyses. The CR and AL groups lost a mean (SE) of 7.6 (0.3) kg and 0.4 (0.5) kg, respectively, at month 24 (P < .001). Compared with the AL group, the CR group had significantly improved mood (BDI-II: between-group difference [BGD], −0.76; 95% CI, −1.41 to −0.11; effect size [ES], −0.35), reduced tension (POMS: BGD, −0.79; 95% CI, −1.38 to −0.19; ES, −0.39), and improved general health (BGD, 6.45; 95% CI, 3.93 to 8.98; ES, 0.75) and sexual drive and relationship (BGD, 1.06; 95% CI, 0.11 to 2.01; ES, 0.35) at month 24 as well as improved sleep duration at month 12 (BGD, −0.26; 95% CI, −0.49 to −0.02; ES, −0.32) (all P < .05). Greater percent weight loss in the CR group at month 24 was associated with increased vigor (Spearman correlation coefficient, ρ = −0.30) and less mood disturbance (ρ = 0.27) measured with the POMS, improved general health (ρ = −0.27) measured with the SF-36, and better sleep quality per the PSQI total score (ρ = 0.28) (all P < .01). CONCLUSIONS AND RELEVANCE: In nonobese adults, CR had some positive effects and no negative effects on health-related QOL. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00427193

Cancer diagnosis and treatment may influence dietary intake. The validity of using self-reported methods to quantify dietary intake has not been evaluated in childhood cancer survivors. We validated total energy intake (EI) reported from Food Frequency Questionnaire (FFQ) and repeated 24-hour diet recalls (24HRs) against total energy expenditure (TEE) measured using the doubly labeled water method in 16 childhood cancer survivors. Dietary underreporting, assessed by (EI-TEE)/TEE?×?100%, was 22% for FFQ and 1% for repeated 24HRs. FFQ significantly underestimates dietary intake and should not be used to assess the absolute intake of foods and nutrients in childhood cancer survivors.

Many specialty foods cannot be found in research-focused food databases. However, some nutrient data can be found for many of these foods through individual website searches using brand and store names. Some popular diet-tracking websites contain data for over 3 million foods, data often entered by consumers, based on non-systematic searches. The reliability of these data to guide dietary data entry decisions are unknown. Five popular diet tracking websites were used to compare availability and accuracy of data for food items from a specialty grocery store that are currently unavailable in research-focused food databases.

This study explores the social and cultural uses of digital literacies by adolescent immigrants to cope with their new lives in the United States. This case study focuses on three adolescent ethnic Karen brothers. Two years of participant observations in their home and Karen community, accompanied by formal and informal interviews, served as the data. Findings report the ways in which these adolescent's digital literacy skills serve them and their family throughout the resettlement process by facilitating: (1) the maintaining and building of co‐ethnic friendships, (2) connection to the broader Karen diaspora community, (3) the sustaining and promoting of ethnic solidarity, and (4) the creation and dissemination of digital productions. We argue that the Internet facilitates these youth as they cope with the economic, educational, and social demands of resettlement. This study can inform teachers and others working with immigrant communities about the literacy practices of their students. FREE author podcast

Introduction: Occupational therapists have the knowledge and skills to improve nutritional risk in community-living older adults by improving performance of food-related occupations. However, few tools are available to evaluate these interventions. We developed the first item pool that measures community-living older adults' occupational performance of food activities.Method: In Phase 1 of the research we developed an item pool within a qualitative exploratory study with five older adults. In Phase 2 we designed the Occupational Performance Measure of Food Activities. In Phase 3 we formally assessed the measurement properties of the 15-item measure, using survey responses from 77 community-living older adults. Construct validity, reliability, and utility were evaluated.Findings: A 13-item measure of the occupational performance of food activities showed acceptable validity and reliability in three subscales (Cronbach's α ranged from .70 to .75). The item pool demonstrated good utility. We had comparable results for administration via self-completion survey (n = 38) and interview (n = 39).Conclusion: This unique item pool showed promising validity and reliability for the measurement of the occupational performance of food activities. Occupational therapists are cautioned against modifying existing measurement tools without thorough testing of the resulting new measure of occupational performance.

Introduction: Currently, British health policy requires services to be prioritised according to an individual's level of need. This is particularly necessary for community mental health services, where referral demand far exceeds service availability.Purpose: The purpose of this study was to use expert occupational therapists' referral prioritisation policies, derived from judgement analysis, to train novices in the skill of referral prioritisation.Method: The therapists' policies chosen were those that supported the occupationally focused practice advocated by the profession. Thirty-seven pre-registration students were asked to prioritise a set of referrals, before and after being trained with graphical and descriptive representations of these experts' policies.Findings: Pre-training, the students overvalued the client's history of violence and undervalued the reason for referral and the client's diagnosis, as compared with the experts. Post-training, the students' policies were better matched to those of the experts. The effect of training was demonstrated through several measures: more accurate prioritisation scores when matched with expert ratings on the same referrals, improved consistency on repeat referrals and higher group agreement.Conclusion: Decision training may be useful in promoting the type of service that aims to target clients' occupational needs in the field of community mental health.

Purpose The subclavian vein is thought to be the most appropriate route for central venous access in major maxillofacial surgery. Evidence suggests that left-sided central venous catheters should lie below the carina and be angulated at less than 40° to superior vena cava wall. This reduces perforation risk. With this in mind we audited our current practice for placement of central venous catheters for major maxillofacial surgery. The criteria against which we compared our practice were: 1) all catheter tips should lie below the carina and 2) the angle of the distal 1 cm of the catheter should be no more than 40° to the superior vena cava wall.Methods Left subclavian central venous catheters placed on a weekly operating list between September 2005 and August 2008 were identified retrospectively: 83 patients were identified; 22 were excluded. The angle of the central venous catheter tip and distance from the carina were measured on the first post-procedure chest-X ray. All central venous catheters used were 16 cm long.Results 82% of the catheter tips were located above the carina while 61% were angulated at greater than 40°; 11% of central venous catheters met both standards; 14% of central venous catheters placed by a consultant and 12% of catheters placed by a trainee met both standards.Conclusions 89% of the central venous catheters were not correctly placed. The majority of central venous catheter tips above the carina were at an adverse angle to the superior vena cava wall. We suggest that for left subclavian central lines, 20 cm catheters be used.

The authors aim to determine whether pediatric residents used DSM-IV criteria to diagnose major depressive disorder and how this related to residents’ confidence in diagnosis and treatment skills before and after clinical training with depressed adolescents. Pediatric residents evaluated two different standardized patients portraying major depressive disorder before and after learning about adolescent depression. Residents’ interactions with standardized patients were observed, and checklists containing DSM-IV criteria for major depressive disorder and other pertinent information, such as comorbidities, were completed for each interaction. After the encounter, residents completed a survey asking about the “patient’s” diagnosis and the residents’ confidence in their clinical skills. Residents assessed significantly more checklist items in the second encounter with a standardized patient. Residents’ confidence in treatment was significantly higher after the rotation, while confidence in diagnostic skills was unchanged, remaining high. Even after the rotation, residents did not use all DSM-IV criteria for major depressive disorder in their diagnoses. Major depressive disorder is a common adolescent psychiatric disorder. Pediatricians must be equipped with appropriate interpersonal and diagnostic skills to detect this and other psychiatric disorders. Standardized patients represent one useful way to teach and assess these skills. This study suggests that residents’ interpersonal and diagnostic skills can improve with practice. Although resident scores improved, post-encounter checklists showed that residents were still not asking all the necessary questions for a DSM-IV diagnosis, concluding prematurely that the standardized patients had major depressive disorder before satisfying all diagnostic criteria. The majority did not consider other depressive conditions or comorbid disorders.

Background and aims:Caloric restriction (CR) attenuates biological aging in animal models but there is little information on the feasibility and efficacy of CR regimens in humans. We examined the effects of consuming an insoluble cereal fiber supplement on ability to sustain CR over 1 year in healthy overweight adults. Methods:In 34 healthy overweight women and men (BMI 25–30 kg/m2, age 20–42 yr), a 30% CR regimen meeting national recommendations for dietary fiber was provided for 24 weeks, and for an additional 24 weeks subjects were counseled to prepare the same regimen at home. During 5–10 weeks of CR, subjects were randomized to consume an extra 20 g/day of dietary fiber from a high fiber cereal (+F) or to not consume additional fiber (-F). After this time, all subjects were encouraged to consume the extra fiber. Outcomes included adherence to the provided and self-prepared CR regimens (energy intake determined using doubly labeled water), changes in body weight, and self-reported satisfaction with the amount of consumed food. Results:During 5–10 weeks of CR when all food was provided, both +F and -F groups were highly adherent to the CR regimen and there was no significant difference between groups in energy intake (p=0.51), weight change (p=0.96), or satisfaction with amount of provided food (p=0.08). During self-prepared CR from 25 to 48 weeks, mean adherence was lower than during the food-provided phase and there was a significant association between fiber intake and % CR (r=0.69, p<0.001), decreased BMI (r=- 0.38, p=0.04) and satisfaction with the amount of consumed food (r=0.59, p=0.002). Conclusions:A high fiber cereal intake may facilitate CR in humans self-selecting their own food; longer-term intervention studies are needed to confirm these findings.

Meiotic recombination occurs between homologous euchromatic regions of human chromosomes in early meiosis. However, such exchanges have been thought not to occur in the stalk regions of acrocentric chromosomes. We describe a child whose chromosome analysis suggests that crossovers do occur in homologous stalk regions. The proband, initially seen as a term female infant, was born to a 28‐year‐old mother. Dysmorphic features included wide metopic sutures, low anterior hairline, hypertelorism, external ear malformations, and cleft lip and palate. Blood chromosomes of the proband and parents were studied by G‐banding, Q‐banding, R‐banding, and silver staining. The infant karyotype showed a sub‐metacentric chromosome 22; that of the mother showed a pericentric inversion of chromosome 22. Chromosomes of the father were normal. In the infant, the abnormal chromosome 22 long arm appeared normal, but with additional long arm material attached to the distal short arm. In the mother, the distal long arm of the abnormal chromosome 22 was translocated to the distal short arm. The abnormal chromosome stalk in the child was intermediate in size to the stalk size of the abnormal and normal chromosomes 22 in the mother. Fluorescent in situ hybridization (FISH) analysis using chromosome 22 paint and ARSA gene probe confirmed that the duplicated material in the proband was of chromosome 22 origin; the karyotype interpretation is: 46,XX,rec(22)dup(22q)inv(22)(p13q13.1)mat. This abnormal karyotype is most likely due to a crossover event within the inversion loop during meiosis. The stalk length discrepancy suggests that the crossover site occurred in the stalk region. © 2005 Wiley‐Liss, Inc.

The aim of this research was to conduct a cluster analysis on data from 40 community mental health occupational therapists to determine if subgroups of therapists had differing referral prioritisation policies. A Ward's cluster analysis showed four clusters to be present.These four subgroups of occupational therapists were found to differ according to several factors: the percentage of role dedicated to specialist occupational therapy or generic work, satisfaction with the balance in these roles, the number of hours worked, the number of professionally trained team members and the presence of referral prioritisation policies. The subgroups were named the aspiring specialists, the satisfied specialists, the satisfied genericists and the chameleons (those not set in applying a consistent or specific policy).The policies that led to mainly generic working gave greatest importance to clients who were potentially violent or at risk of suicide. The policies that led to more of an occupational therapy role gave particular importance to the reason for referral and the client's diagnosis.The College of Occupational Therapists has recommended that the majority of casework should be focused on specialist occupational therapy interventions (Craik et al 1998): most of the participants in this study were not meeting this recommendation. Although some aspired to being more specialist, the pressures to work generically may have been affecting referral policies.

The current study explores the role of three components of working memory in age differences in an executive task, the Tower of London (TOL). The TOL task is sensitive to frontal lobe damage, and is widely used to measure planning ability. Dual tasks were used to test the involvement of the phonological loop (articulatory suppression), visuospatial buffer (pattern tapping), and central executive (random generation) in age effects on the TOL. Older adults showed greater reliance than young on domain-specific verbal and spatial memory components in performing the TOL. In terms of executive function, qualitatively different interference patterns were seen in young and old participants. However, the validity of using random generation tasks to assess executive function in older populations can be questioned. For older participants, performing the TOL loads all components of working memory, whereas for the younger participants the TOL more specifically loads executive functioning.