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Recently, an acquaintance asked me what to do when she strongly disagreed with a recommendation made by their family doctor for her disabled husband. I've certainly been in that situation. Still each family is different and what works for us, may not work for you.
Really, there are no hard and fast answers that I've found. I strongly prefer a medical practice that encourages dialogue and that is willing to discuss the pros and cons of alternative therapies. We can deal with more autocratic practices. It just isn't as pleasant and straight forward.
Here are seven things that I've found helpful when considering treatments other than what Boo's doctor, physical or occupational therapist, etc. recommends. (Most of the time we do follow the recommendations, even after looking at other options. Not always, but usually. We do always clearly communicate our decision to Boo's primary care doctor. That way he or she is completely aware of what's happening with Boo.)
If this is an emergency situation, clearly state your medical wishes, provide a medical power of attorney and let the professionals save your loved one's life. This is not the time to get in the way.
If the medical professional suggests a therapy or medication that seems out of line, I ask the reasoning behind his or her recommendation. Many times this simple questioning is all it takes for us to understand. It also helps to eliminate second guessing on my part later on.
Once when I questioned a doctor, with whom we were very pleased, he gave me a rather blank look, glanced at the prescription he'd just written for Boo and did a double take. He was in the wrong room. They were exceptionally busy that day and the doctor mistook Boo for a different patient.
After questioning the doctor or therapist and understanding their reasoning if I still disagree with the treatment, I'll ask what alternatives there are. The practices I like best will discuss them. Ultimately this saves a lot of time and a lot of my energy. Many times the alternatives haven't been chosen for a good reason. Sometimes I just need to know the reasoning involved.
At this point, if a medical professional refuses to discuss alternatives, I ask if a different time would be better. Just for the record, that has never been the case. Still, I like to ask. Then, I clearly tell whomever I'm dealing with that I'm uncomfortable with the recommendations they've made and I tell them why I'm uncomfortable. I also tell them that I'll be examining alternatives and that we'll contact their office later.
At home, I promptly search the internet for alternative treatments, the effectiveness of the various treatments and the feasibility of Boo using the different treatments. The Mayo Clinic and Web MD are two good sources of medical information.
I call several good friends to ask questions. One is a retired doctor. Two are nurses and one is an occupational therapist. Many times insurance companies have hotlines with nurses that will answer questions. That's not a bad resource to consider. In our area, we have two large teaching hospitals. Both have public hotlines staffed by nurses, residents and interns who seem knowledgeable.
At this point, I contact the original medical professional again to discuss what I've learned. This has met with mixed results. Usually, they are open to some discussion. On one occasion I was told that, “I don't discuss that type of thing with patients. They aren't doctors. They need to follow my plan or go elsewhere.” We went elsewhere.
Generally this is the point where we come up with a treatment plan that works for all of us. Rarely, that hasn't been the case.
If we haven't reached a treatment plan that both the medical professional and Boo and I are comfortable following, I get a second opinion. Generally Medicare and insurance companies will pay for second opinions with little fuss. Locating another doctor has never been a problem for us. I call the local hospitals. They have referral services. Another alternative is to call the medical licensing board in your state and ask for a referral.
After I've researched different therapies, considered the feasibility of them and talked to the doctor again...or gotten a second opinion, it's time to decide what to do. Make a plan and adhere to it.
Boo's health is too important to dilly dally around. No treatment plan will be perfect. If we come up with one that generally works well, then I'm happy.


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In late January, Stephanie Dinkins’ Secret Garden was one of the featured works at the Sundance Film Festival. Yes, that Sundance Film Festival. Quite an accomplishment for a self-professed “photographer-at-heart” who began her career working in marketing.
Secret Garden is an immersive web experience that highlights the power and resilience in Black women’s stories. In it, interactive audio vignettes tell a multi-generational narrative that incorporates past, present and future, inspired by Dinkins’ own autobiographical and ancestral experiences.
“Photography has always been my artistic background,” said Dinkins, an associate professor in the Department of Art. “Documenting my life and documenting the lives of others is where I started.”
As an artist, Dinkins said she doesn’t have what she calls “a coder’s brain,” though she’s been interested in technology since she was young. The puzzle to solve was how someone who doesn’t naturally have those technical proclivities can bring them into her world and leverage their enormous capabilities.
“It’s interesting that the creative mind and the technical mind are really just so opposite,” she said. “No matter which side you’re on, it’s intimidating to engage the other side.”
Dinkins said that it’s not necessarily the differences between the creative and technical minds that present the challenge — the challenge is in finding a common language.
“I need to be able to explain in a very particular way exactly what I want,” she said. “If they don’t get it, it’s on me to explain.”
Dinkins describes Secret Garden as an evolution of her previous work with Bina48, a humanoid robot featuring chatbot functionality, and N’TOO (Not The Only One), a multigenerational memoir of a Black American family told from the perspective of a unique deep-learning artificial intelligence.
“Secret Garden is really looking at the process of working with Not The Only One and a memoir based in AI,” she said. “When I was digging into my family history and then running it through an algorithm, I realized how important it is to tell the story in a way that holds its spirit and brings it forward.”
Communication and storytelling are at the core of Dinkins’ work.
“There’s a space in which Black women’s stories are not valued on the same level as other stories are or not heard in the same way,” said Dinkins.
She began the Secret Garden project years ago, and was intending to go to South by Southwest®, an annual gathering of interactive media, music festivals and conferences that takes place in mid-March in Austin, Texas. Then the COVID-19 pandemic hit, resulting in a six-month hiatus. During that time, the Sundance opportunity came up.
Creating Secret Garden was a very different experience as an artist.
“This was created with a team and was much more of a media project,” she described. “I was the lead artist, but we also had a lead technologist and other specialists. I had some trepidation and it was a very different experience, but in the end, we came together and created something that I’m really proud of.”
While 2020 was a difficult year for many, Dinkins said if there is a silver lining to be found, it’s that people found a way through a crisis and adapted, which is another central theme in much of her work.
“Figuring out a way to not only survive but to have space for joy and just being has been part of my world my whole life,” she said. “I think COVID made a lot of people experience that. My studio has been doing work that intersects Black Lives Matter and ideas of social isolation and social belonging all along. For me there’s just been a fluid ‘ongoingness.’ I’ve been like, ‘Welcome to my world.’ People are now seeing something that I’ve seen for a long time. Now we need to keep it moving.”
The theme of Black History Month at Stony Brook is Black creativity, something Dinkins said has shaped her whole life.
“Black creativity goes hand-in-hand with Black survival,” said Dinkins. “I think a lot about what that means in terms of my own self. What do we really want in our heart of hearts, what do we want to create? That bubbles up whether it’s black, white, green, whatever. And many times it bubbles up in ways that not only the person who made it can relate to, but others can relate to as well.”
Dinkins began her career in the corporate world working in the creative department of a major record label and then as a publicist at a Japanese publishing house and describes a growing feeling of “how plastic and how meaningless it all felt.” She said it was the 1992 Los Angeles riots that made her future path clearer.
“People were worried about getting books into the world when the world was literally burning,” she said. “I knew I needed to break away from that. I decided to put my energies into something more societally productive. I think we’re in another one of those moments now where a lot of people will come to a crossroads and find the thing that they need to be doing versus the thing to do to make money. I hope so. My aim is to impact society in some way, whether we call it art or not.”
Dinkins added that as a Black person in America, it’s important to find the power you hold and believe in it, even though the world is often telling you you’re powerless.
“We’re told we don’t have privilege and we buy it,” she said. “So the idea of being able to recognize one’s power regardless of what the world is saying and having the resilience to withstand what the world is telling you becomes really important to me. You have to get up every time you’ve been punched in the face and carry on. We’ve had to survive in this world for 200 years under those conditions.”
Dinkins said it’s amazing to be able to do what she does, coming from a family whose last generation worked in the same place for 40 years because they didn’t have the opportunity to do anything else.
“My aunt always says that she’s happy that I’m out doing what I want to do,” she said. “But if I’m really listening to that, I hear ‘I worked in the same factory for 40 years, and I’ve watched you out in the world, traveling all the time, going places, getting grants and awards.’ It must be unfathomable to her in many ways.”
Much of Dinkins’ current work is about helping future generations understand the struggle, their power and their resilience.
“I already see that the connection to what I got from my family is missing for the next generation, and I think it’s important to understand your trajectory and where you come from because that’s where that power of understanding lies,” she said. “I’m asking that people understand that they stand on each other’s stories, whether it’s past or future. That’s where your power comes from.”
— Robert Emproto

domain: artistic


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NEW DELHI: NEW DELHI: Four Indian teachers, who were returning to India from Tripoli and Tunis, have been kidnapped in Libya, allegedly by the Islamic State terror group (IS).
Of them, two are from Hyderabad, one from Raichur and one from Bengaluru, Government said today, adding the four Indians were "detained" at a check point, about 50 km from Sirte. The area is under the control of the terror outfit.
"Three of them were faculty members at the University of Sirte and one was working at the Sirte University's brach in Jufra," MEA spokesperson Vikas Swarup said here.
"We are in regular touch with the families concerned and all efforts are being made to ensure the well-being and early release of the four Indian nationals," he said.
|Ministry of External Affair Report|
"Two days ago, on July 29th at around 11 pm, our Mission in Tripoli came to know that four Indian nationals who were returning to India via Tripoli and Tunis, were detained at a checkpoint approximately 50 kms from Sirte. Of the four Indian nationals, two are from Hyderabad, one from Raichur and one from Bengaluru. Three of them were faculty members at the Sirte University and one was working at the Sirte University branch in Jufra," he said.
The Ministry of External Affairs, through its Head of Mission in Tripoli, is ascertaining the details regarding the incident. According to information available through our sources, all the four Indian nationals have been brought back to the city of Sirte, he said.
Official sources said no ransom demand has been made as yet.
They said the area from where the Indians were kidnapped is under the control of the Islamic State, which has taken control of large swathes of Iraq and Syria and has declared itself a caliphate.
Taking serious note of the prevailing situation, the Indian government had in July last year issued an advisory asking its citizens to leave conflict-hit Libya.
The latest incident came even as 39 Indians remain missing in Iraq. They were taken hostage last year at the height of the fighting between Sunni militants and government forces and efforts to get their release have not yielded any results.
Two are from Hyderabad and two are from Karnataka--Vikas Swarup,MEA on 4 Indians reportedly abducted in Libya— ANI (@ANI_news) July 31, 2015
MEA through head of mission in Tripoli is ascertaining details-Vikas Swarup,MEA on 4 Indians reportedly abducted in Libya— ANI (@ANI_news) July 31, 2015
We are in regular touch with their families-Vikas Swarup,MEA on 4 Indians reportedly abducted in Libya pic.twitter.com/lkBBUhLGpa— ANI (@ANI_news) July 31, 2015
Of the 4 Indians abducted in Libya, 3 are faculty in University of Sirte and 1 works at the university-Vikas Swarup,MEA— ANI (@ANI_news) July 31, 2015

domain: news


STILLWATER — Artrell Woods isn't a superstitious guy, but when the calendar turned to June 13 — Friday the 13th — the Oklahoma State wide receiver took notice.
It was a year ago this weekend — Friday, July 13, 2007 — that a weightlifting accident left Woods with a cracked vertebra, possibly unable to walk again. So when Friday the 13th came around last month, Woods was watching his step in the OSU weight room. "I was a little extra-careful in my workout that day,” Woods said with a soft chuckle. But that's what is so amazing about Woods' story. That extra caution was dictated by what the calendar said, not what his body could or could not handle. In Woods' mind, there are no lingering physical effects from the injury. And those who have closely monitored his progress in returning from the injury say he is virtually 100 percent recovered. The sophomore from Bryan, Texas, was medically cleared for regular workouts in January. And last month, he received the all-clear for full football contact. Woods' condition has improved so much so fast that the fact that he is back in the weight room isn't even a surprise to OSU players and staff anymore. Unless they stop to think about where he was a year ago. "The first few days after the accident, my goal was for him to walk again, to just have a normal life,” said OSU head athletic trainer Rob Hunt. "Football wasn't even an issue. Artie and I never talked about him playing football again. "Then he was cleared for non-contact drills in the spring. He sent me a text message asking what time he needed to be there to get his ankles taped. I thought, ‘My gosh, I'm going to get to tape Artrell again.' That's something I didn't think I'd ever do.” Woods, however, never questioned his return to football. "I actually felt like I was gonna be able to come back to football all along,” Woods said. "Once I could feel my legs again, I felt like I'd come back.
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Oklahoma State's Artrell Woods is back in the weight room a year after suffering a cracked vertebra while lifting. By David McDaniel, the oklahoman


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Deputy Minister of the Ministry of Tourism Arts and Culture Mohamed Maleeh Jamal has said that celebrations to mark 40 years since tourism began in the Maldives will extend for one whole year.
He said that the celebrations are being planned to be held in the most festive manner.
“I don’t yet know exactly what activities are being planned, but I know that activities are also being planned in the museum. Discussions are being held to decide what kind of activities to conduct to celebrate 40 years to the tourism industry of the Maldives,” Maleeh said.
Not much was done last year to celebrate World Tourism Day, and Maleeh backs this by saying that not much has been done to celebrate Tourism Day in the Maldives but that it is going to change this year and Tourism Day “will be a very different day” this year.
“Boosting tourist arrivals to one million is part of the preparations to celebrate World Tourism Day and there is a lot more to see yet,” he said.
The first tourist resort in the Maldives Kurumbaa Village was opened on October 3, 1972 thus 2012 marks 40 years since the industry began in the Maldives.


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ENGROSSED SUBSTITUTE HOUSE BILL 2116
State of Washington
2020 Regular Session
ByHouse Education (originally sponsored by Representatives Callan, Eslick, Frame, Klippert, Blake, Ramos, Lovick, Davis, Doglio, Leavitt, Senn, Pollet, and Santos)
READ FIRST TIME 02/06/20.
AN ACT Relating to establishing a task force on improving institutional education programs and outcomes; creating new sections; providing an expiration date; and declaring an emergency.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
NEW SECTION. Sec. 1. The legislature recognizes that the federal every student succeeds act of 2015, P.L. 114-95, reauthorized and amended the elementary and secondary education act of 1965, the federal policy and funding assistance framework for the nation's public education system.
Two of the stated purposes of the every student succeeds act are to provide all children with a significant opportunity to receive a fair, equitable, and high quality education, and to close educational achievement gaps.
The legislature further recognizes that Article IX of the state Constitution provides that it is the paramount duty of the state to make ample provision for the education of all children residing within its borders, without distinction or preference on account of race, color, caste, or sex.
While the partnership of federal and state law is critical in ensuring that the civil and education rights of students are upheld, efforts in Washington to fully realize state and federal objectives, especially with respect to the delivery of education services in institutional facilities, remain unfinished.
The legislature, therefore, intends to establish a task force on improving institutional education programs and outcomes, with tasks and duties generally focused on educational programs in the juvenile justice system. In so doing, the legislature intends to examine issues that have not been significantly explored in recent years, build a shared understanding of past and present circumstances, and develop recommendations for improving the delivery of education services, and associated outcomes, for youth in institutional facilities.
NEW SECTION. Sec. 2. (1)(a) The task force on improving institutional education programs and outcomes is established, with members as provided in this subsection.
(i) The president of the senate shall appoint two members from each of the two largest caucuses of the senate, with two members serving on the committee with jurisdiction over education issues, and two members serving on the committee with jurisdiction over basic education funding.
(ii) The speaker of the house of representatives shall appoint two members from each of the two largest caucuses of the house of representatives, with two members serving on the committee with jurisdiction over education issues, and two members serving on the committee with jurisdiction over basic education funding.
(iii) The governor shall appoint one member each from the state board of education and the department of children, youth, and families, and one member representing an organization that provides free legal advice to youth who are involved in, or at risk of being involved in, the juvenile justice system.
(iv) The superintendent of public instruction shall appoint three members: One member representing the superintendent of public instruction; one member who is a principal from a school district with at least twenty thousand enrolled students that provides education services to a juvenile rehabilitation facility; and one member who is a teacher with expertise in providing education services to residents of a juvenile rehabilitation facility.
(v) The task force must also include one member representing the educational opportunity gap oversight and accountability committee, selected by the educational opportunity gap oversight and accountability committee.
(b) The task force shall choose its cochairs from among its legislative membership. One cochair must be from a minority caucus in one of the two chambers of the legislature. A member from the majority caucus of the house of representatives shall convene the initial meeting of the task force by May 1, 2020.
(2) The task force shall examine the following issues:
(a) Goals and strategies for improving the coordination and delivery of education services to youth involved with the juvenile justice system, especially youth in juvenile rehabilitation facilities, and children receiving education services, including home or hospital instruction, under RCW 28A.155.090
(b) The transmission of student records, including individualized education programs and plans developed under section 504 of the rehabilitation act of 1973, for students in institutional facilities, and recommendations for ensuring that those records are available to the applicable instructional staff within two business days of a student's admission to the institution;
(c) Goals and strategies for increasing the graduation rate of youth in institutional facilities, and in recognition of the transitory nature of youth moving through the juvenile justice system, issues related to grade level progression and academic credit reciprocity and consistency to ensure that:
(i) Core credits earned in an institutional facility are considered core credits by public schools that the students subsequently attend; and
(ii) Public school graduation requirements, as they applied to a student prior to entering an institutional facility, remain applicable for the student upon returning to a public school;
(d) Goals and strategies for assessing adverse childhood experiences of students in institutional education and providing trauma-informed care;
(e) An assessment of the level and adequacy of basic and special education funding for institutional facilities. The examination required by this subsection (2)(e) must include information about the number of students receiving special education services in institutional facilities, and a comparison of basic and special education funding in institutional facilities and public schools during the previous ten school years;
(f) An assessment of the delivery methods, and their adequacy, that are employed in the delivery of special education services in institutional facilities, including associated findings;
(g) School safety, with a focus on school safety issues that are applicable in institutional facilities; and
(h) Special skills and services of faculty and staff, including associated professional development and nonacademic supports necessary for addressing social emotional and behavioral health needs presenting as barriers to learning for youth in institutional facilities.
(3) The task force, in completing the duties prescribed by this section, shall solicit and consider information and perspectives provided by the department of corrections and persons and entities with relevant interest and expertise, including from persons with experience reintegrating youth from institutional facilities into school and the community at large, and from persons who provide education services in secure facilities housing persons under the age of twenty-five, examples of which include county jails, juvenile justice facilities, and community facilities as defined in RCW 72.05.020
(4) Staff support for the task force must be provided by the office of the superintendent of public instruction, with additional support provided by the department of children, youth, and families, and the department of corrections. The office of financial management, the office of the superintendent of public instruction, the department of children, youth, and families, and the department of corrections shall cooperate with the task force and provide information as the cochairs may reasonably request.
(5) Legislative members of the task force are to be reimbursed for travel expenses in accordance with RCW 44.04.120
. Nonlegislative members are not entitled to be reimbursed for travel expenses if they are elected officials or are participating on behalf of an employer, government entity, or other organization. Any reimbursement for other nonlegislative members is subject to chapter 43.03
(6) In accordance with RCW 43.01.036
, the task force shall report its initial findings and recommendations to the governor and the appropriate committees of the house of representatives and the senate by December 1, 2020. The initial findings and recommendations must address subsections (2)(b) through (f) of this section. The task force shall submit a final report to the same recipients by November 1, 2021, in time for the legislature to take action on legislation that is consistent with the findings and recommendations during the 2022 legislative session. The findings and recommendations submitted by November 1, 2021, may also include recommendations for extending the duration of the task force.
(7) This section expires June 30, 2022.
NEW SECTION. Sec. 3. This act is necessary for the immediate preservation of the public peace, health, or safety, or support of the state government and its existing public institutions, and takes effect immediately.
--- END ---

domain: politics


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Human Sex Trafficking is Everyone's Issue
March 21, 2015
Hosted by Yvonne Allen, Rio Wade, and Tamra Wade
Don't think that sex trafficking is something that you need to be concerned about? Think again. Today Paper Hope is honored to have special guest Carolyn Jones, survivor of childhood sexual abuse and sex trafficking with us to discuss why you should be aware of sex trafficking.Carolyn is a speaker with StreetLight USA. This conversation will bring awareness to sex trafficking, predatory grooming, and how to help survivors. Thank you Carolyn and StreetLightUSA for the work you do.
Paper Hope Next Generation
Saturday at 1 PM Pacific Time on VoiceAmerica Empowerment Channel
Paper Hope Next Generation is for all women regardless of age who want to connect and start having real conversations about tough issues. No subject is off limits. We will be talking about issues that impact women with a specific focus on relationships, family, community and self.
Each week the Paper Hope Next Generation will discuss a topic from the unique perspectives of our show hosts and guests – sharing stories and offering solutions to everyday issues. We hope you will be a part of the conversation! Tune in Saturdays at 5 PM Pacific Time on the VoiceAmerica Empowerment Channel.
Yvonne Allen, Rio Wade, and Tamra Wade
At 19 years of age, Yvonne Allen is not like your ordinary teenager. She is focused, committed and believes in following her dreams no matter what gets in the way!
Yvonne is a co-host on the Paper Hope Next Generation radio show on VoiceAmerica Empowerment channel. She has been a radio show host for Paper Hope Street Team on VoiceAmerica Kids and KidStar Radio Network for the past two years. As a radio show host, Yvonne has been able to inspire tweens and teens by sharing her life and promoting a good life.
Yvonne is also in college and hopes to pursue a future in fashion as a shoe designer. Shoes happen to be one of her biggest obsessions!
With all that she is involved in, Yvonne’s goal in life is to make a difference in the lives of others. She has traveled to three countries to help children in need. Most recently in Darien Jungle of Panama, “Being able to help the people of this village was one of the most rewarding experiences I have ever had. I hope to be able to travel to more countries in the future.”
Never shying away from a challenge, Yvonne has recently started to teach herself to play the piano. She has been so successful that she is now performing with her church band.
Being a role model brings her great joy and a drive, “As long as I continue helping others along the way, I am confident everything will fall into place!”
At 19, Rio Wade has accomplished many goals and continues to work towards her life’s work, to make a positive impact on young girls around the world.
Rio is a co-host on Paper Hope Next Generation radio show on VoiceAmerica Empowerment channel. She has been a radio show host for Paper Hope Street Team on VoiceAmerica Kids and KidStar Radio Network for the past two years. She uses her voice on the radio shows to inspire her peers, friends and teens globally to stay true to themselves and never give up on their dreams no matter what obstacles get thrown their way.
Her free spirit and spitfire personality have helped her to accomplish many things. Rio is currently attending collage on a presidential scholarship awarded to students with excellent academics. She is studying to become a dance educator.
Rio works tirelessly as an advocate for women. She works for Dr. Sharon Thompson, OBGYN as a personal assistant. Together with Dr. Thompson she works with the City of Phoenix Women’s Commission addressing the community on events and issues that effect women in her community.
Always staying true to who she is, Rio hopes to work in schools all over the world to inspire young ones to work hard to be the best they can be while still being true to themselves.
Tamra Wade is sometimes considered “Everyone’s mom” by the teens she works with is the founder and director of Paper Hope.
Mother of two daughters one aged eight the other age nineteen, Tamra developed Paper Hope to empower teen-aged girls and their moms to live lives with, courage, strength and openness. She works to help moms and teens develop stronger relationships with each other by employing better and consistent communication.
Tamra is producer and co-host on Paper Hope Next Generation radio show on VoiceAmerica Empowerment channel. She is also the producer Paper Hope Street Team on VoiceAmerica Kids and KidStar Radio Networks. She created these shows as an extension of her blog, Paper Hope, to address everyday issues that affect all teen girls, their families and community.
Working with other women leaders in her community, Tamra tirelessly advocates for women, family and better communication. She has participated on the panel of women guest speakers for the City of Phoenix Women’s Commission, hosts round table events where experts and women in the community can share and be heard on topics like forgiveness, sex education, relationships and more.
She is writing her first book where she is sharing her personal journals spanning the years from high school into her early adult years.

domain: sociology


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The problem is more than race, it is about how humans treat other humans and how little respect we give to those we deem lower than us. The author used the characters to show that the desire to be superior among others goes further than race. She also used a real tragedy, the murder of the NAACP Field Secretary, which allows readers to connect the novel to real life and making the novel more compelling. These key issues make the readers think deeper, allows the novel to surpass others like it, and connect to many human interactions even in today’s
According to the Oxford American Dictionary, a bildungsroman is “a novel dealing with one person 's formative years or spiritual education.” In an interview with Slate.com, Junot Díaz, Pulitzer Prize-winning author and creative writing professor at MIT, and author of The Brief and Wondrous life of Oscar Wao, describes his book as a “textual Caribbean”(O’Rourke). He elaborates on his statement by saying how the work was supposed to be, “Shattered and yet somehow holding together” (O’Rourke). He embeds this concept of a textual Caribbean in The Brief and Wondrous life of Oscar Wao through the theme that disjointed occurrences eventually breed clarified understanding. Given the genre of this book as a bildungsroman, Diaz makes evidence for the preceding theme through the epiphanic encounters of the following two characters in The Brief and Wondrous life of Oscar Wao: Oscar and Beli.
In the the book The Brief Wondrous Life of Oscar Wao, written by Junot Diaz, the author portrays the character of Beli as a bitter and aggressive mother who is most often times seen in the book acting in a cruel and violent manner towards her daughter Lola. However, her relentless attitude towards Lola is as a result of all of her victimized history growing up in the Dominican Republic. Beli’s is a one of the most complex characters within Diaz’s book, therefore her story throughout some parts of the book is narrated in third person rather than the typical first or second person narration. Diaz sets the book up in this style as a way for the audience to grasp a better understanding of Beli as a character. Although Beli is portrayed as a hostile mother towards her daughter Lola, it is a as a result of her traumatic past and through those experiences show that she possess a caring side to her.
She believed that if others told her it would work and that she would love him, then it would happen. As Logan begins to make her work and expects more of her, her window for freedom begins to
For instance, she dislikes her dad, wants to eat the rice herself, but most of all she “dreamed of wearing dresses that would never be hand me downs. (2)” She could deal with her family being poor and help out her family, but she wants something else. For example, seeing “herself walking
The Curse of Oscar Daniel Plummer Charlestown High School Have you ever felt cursed in your life-like anything you do or say causes bad luck? Well, this is Oscar de León. He is the protagonist in the novel, The Brief Wondrous Life of Oscar Wao by Junot Díaz. Oscar de León is a Dominican-American man who grew up in Paterson New Jersey and is the son of Beli, the brother of Lola, and the most cursed one out of all his family members.
This also correlates with her major struggle in leaving her horrid past behind, as she wants to stay young and beautiful. “She moves out of the yellow streak of
She try be herself, she try to be happy but sadly to do this she had to distinct herself from society, which she couldn't really do. In the text it said. "Every step she took toward relieving herself of obligations added to her strength and expansion as an individual. She began to look with her own eyes; to see and to apprehend the deeper undercurrents of life. No longer was she content to "feed upon opinion" when her own soul had invited her."
There’s a direct relationship between the canefields and violence in the book, there had to be a reason for this. The canefields in the Dominican Republic was where the slaves worked when the Spanish colonizers came to the country, they were the cotton fields of the Dominican Republic. This is also when the fuku, or curse, was brought over the Dominican Republic from Europe as the narrator claims.”It is believed that the arrival of Europeans on Hispaniola unleashed the fuku on the world, and we’ve all been in the shit ever since” (page 1). This must mean that canefields are part of the fuku the Europeans brought along. The canefields in The Brief Wondrous Life of Oscar Wao represent where the fuku happens in the Dominican Republic.
In the novel The Brief Wondrous Life of Oscar Wao by Junot Diaz, the Dominican culture is told through a stereotypical Dominican named Yunior. As stated in the title, the novel discusses Oscar Wao’s brief life through his family’s curse called Fukú. The history of his family is presented through their downfalls in love, which overtime accumulates into a burden for Oscar to experience the same events his family members had once experienced. This Fukú that has been lurking within the Cabral family’s history from the Dominican Republic to the United States is commonly found through dysfunctional relationships between men and women. The known concept in relationships called love transforms into a corrupted power source for abuse based on the
She expressed, how she felt about her skin, and provided great reason for how she viewed herself for being colored. She spoke of her ancestors and how they paid the price for her civilization; so therefore, she doesn’t have to feel less of a person because of her skin color. She even mentions a time where she forgets that she was a person o colored until she thrown against the background of white; meaning she sees no color until she is constantly reminded. The author shows core values by being happy in the skin she is in.
The traumatic stress that she is under is to much for her to handle even now she is letting the past run her life now in the future. She can't cope with the issues she has so she decided to run away from them. For example she said “This man, wherever i rent or buy a house in this city, i find him living on my street.” ( page 132). This show she is so traumatized
Beneath the literal brutal violence the narrator is forced into is an overwhelmingly obvious display of severe racism. It is a figurative violence between the rich and powerful whites and the struggling oppressed blacks. The violence is

domain: literature


text:
December 11, 2020 6:30 pm - 9:30 pm
The Black & White Affair is the annual fundraising event for Studio 23. This evening supports our mission of providing the Great Lakes Bay Region with a vibrant arts center, dedicated to making the visual arts relevant and accessible to all.
During this year’s event, you will enjoy an elegant sit-down dinner, catered by Old City Hall, accompanied by a wine pairing. You will enjoy a quaint setting with your closest friends, while artists paint the night in plein air style. The chef will take us through six courses, each paired with a wine, while we listen to sweet melodies and have fun conversations.
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Course 1 :
Charcuterie board, created by Artigiano
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Finished with roasted pumpkin seeds and citrus-scented sour cream
Winter greens salad with fresh balsamic vinaigrette and fresh sweet rolls
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Slow-braised pork shank with a rich mushroom demi-glace and garlic mashed Yukon gold potatoes
Dark Chocolate Flourless Torte
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domain: food


text:
- Research article
- Open Access
Executive dysfunctions mediate between altered sensory processing and daily activity performance in older adults
BMC Geriatrics volume 21, Article number: 132 (2021)
Sensory processing is essential for the interaction with the environment and for adequate daily function. Sensory processing may deteriorate with aging and restrict daily activity performance. Aging may also affect Executive functions (EFs) which are critical for daily activity performance. Yet, most studies refer separately to the impacts of sensory processing or EFs and use clinical evaluations that do not necessarily reflect functional restrictions in real life. This study aims to describe the prevalence of altered sensory processing in the elderly as expressed in daily life scenarios and explore whether EFs mediate between altered sensory processing and daily activity performance in older adults.
This cross-sectional study included 167 healthy independently functioning people aged 65 and above who were living in the community, had sufficient cognitive status and no symptoms of depression (based on the GDS and the MMSE). All participants completed a socio-demographic-health questionnaire, the Adolescent/Adult Sensory Profile, the Behavior Rating Inventory of Executive Function–Adult Version and the Daily Living Questionnaire.
Altered sensory processing, and mainly by the reduced ability to register and modulate sensory input from daily environment, were prevalent in older adults. Their impacts on daily activity performance were mediated by executive dysfunctions.
Executive dysfunctions may worsen the negative effects of altered sensory processing on daily activity performance in older adults. The interaction between EFs and sensory processing should receive growing attention in intervention and prevention programs for older adults, with the emphasis on their expressions and implications on peoples’ function in real life context.
Sensory processing refers to the way individuals manage incoming sensory information, including its reception, modulation and integration with other brain areas and networks, to produce an adaptive output to environmental demands . Since sensory systems provide the brain with ongoing information about the environment, adequate sensory processing is fundamental for proper cognitive and emotional function, for accurate movements, for learning, for socializing and for other activities that characterize our daily lives .
Altered sensory processing refers to difficulties to modulate and organize the intensity of response to sensory input in a graded and adaptive manner. Altered sensory modulation result in hypo or hypersensitivity to sensory input. Individuals with hypersensitivity respond to sensation faster, intensely and for a longer duration. They are overwhelmed with sensation and even experience “regular” stimuli as painful. This may lead to behavioral dysregulation expressed in stressful behavior, anxiety, irritability and avoidance from interactions with the physical and the social environments . On the contrary, individuals with hyposensitivity tend to miss sensory stimuli and thus fail to respond accurately to environmental demands . Both hyper or hypo sensitivity may restrict adaptive behavior  and interfere with daily activity performance .
One of the theoretical models that refers to the interaction between the neurological-threshold to sensory input and the related behavioral regulation is Dunn’s model . According to this model, the interaction between the neurological threshold and behavioral regulation results in four patterns: (1) Low registration - people with high neurological thresholds (hyposensitive) and passive behavioral strategies that fail to detect sensory information and do not seek for it; (2) Sensory seekers - people with high neurological threshold who actively seek for rich and intense sensory stimuli (3) Sensory sensitivity – people with low neurological thresholds (hypersensitive) and passive behavioral, meaning they do not actively eliminate uncomfortable sensations; thus, they frequently experience discomfort, distraction, and emotional burden (4) Sensory avoiding - people with low neurological thresholds who actively limit their exposure to unpleasant sensations.
The very few studies that used Dunn’s model in older people, found that older people tend to show lower registration of sensory input, lower tendency to seek for sensory input and in some cases have modulation difficulties that result in hyper sensitivity. These alterations were found to significantly interfere with daily activity performance, with participation in daily situations and reduce quality of life [5, 6].
Nevertheless, most studies about sensory processing and modulation in the elderly focus on sensory acuity or sensory impairment in a specific sensory modality, mainly visual, auditory and vestibular [7,8,9,10,11], as measured in laboratory settings. Less is known about the ability of elderly people to process and modulate sensory information from various modalities, in daily life scenarios . Moreover, the literature emphasizes that the aging brain tends to rely increasingly on multisensory integration rather than on a unisensory modality to compensate for the neural and sensory deterioration . Hence, studies should further explore alterations in sensory processing and modulation in older adults, as expressed in all modalities and in daily life scenarios, in order to create better intervention programs, that are not relevant only for the clinical setting, but may be applicable to daily environments. For that, studies should also elucidate the contribution of relevant factors responsible for behavioral regulation that affect the adaptive responses to environmental demands, such as the high cognitive abilities named executive functions (EFs) [13,14,15].
The high cognitive abilities responsible for behavioral regulation, for formulating goals, planning how to achieve them, and carrying them out effectively  named EFs, are extremely affected by aging and significantly interfere with daily activity performance . Decline in EFs in older adults, as a result from neurodegenerative changes  is related to deficient performance of instrumental activities of daily living (IADL), and impairment in elementary activities that enable keeping daily routines, such as: driving, money management, shopping [19,20,21]. The evaluation of EFs in the elderly is also challenging – in most cases EFs are measured by laboratory neuropsychological/cognitive measures, which mainly focus on specific aspects of EFs such as inhibition; shifting, etc. with no referral to the implications on people’s daily function [22, 23]. In order to better reflect the implications of EFs on daily activities, ecological valid assessments that imitate daily scenarios are needed [24,25,26]. One of the efficient ecological valid assessment which evaluates the multicomponent expressions of the EFs in daily life scenarios is the Behavior Rating Inventory of Executive Function–Adult version (BRIEF-A) .
Yet, very few studies refer to the association between sensory processing and EFs. The existing data collected on populations with central nervous system abnormalities such ADHD, brain injuries and stroke, found that altered sensory processing was related to reduced EFs expressed for example in attentional problems, impaired working memory and inhibition problems [28,29,30,31].
Although studies show that altered sensory processing in the elderly affects daily activity performance, and may be related to executive dysfunctions, less is known about the contribution of EFs to the impacts of altered sensory processing on daily activities. Understanding how the ability to regulate behavior, manage actions and decisions modulates the connection between altered sensory processing and daily activity performance is critical for intervention programs. By understanding the role of sensory processing, EFs and the relationships between them, in determining functional resilience or vulnerability, prevention and intervention programs may improve daily function and quality of life in the elderly. Based on the above, this study aimed to profile altered sensory processing in older adults, in all sensory modalities, as expressed in their daily life and to explore whether EFs mediate the relationship between sensory processing and the individual’s ability to perform daily activities. It was hypothesized that EFs indeed mediate the relationship between sensory processing and daily activity performance.
According to Power analysis, with effect size of .20, p = .05, and power of .95, a sample size of 131 participants was recommended. Our sample included 167 healthy and independently functioning people 65 years and older who lived in the community. All participants for this cross-sectional study were recruited via advertisements published in community centers and via contacts with managers of senior-citizen homes. All participants had functional independence and lived in their private or senior-citizen homes. They were proficient in their native language (speaking, reading, and writing), were right-handed, had normal vision and hearing ability (with or without correction) and had at least 8 years of education (because of life circumstances related to the country, part of the elderly population could not complete high school. However, all study participants with 8 to 12 years of education had well independent daily functioning).
Exclusion criteria included presence of systemic severe chronic diseases such as cancer; severe nervous system impairments, such as cerebrovascular accident, Parkinson’s disease, or untreated diabetes; and depression. An initial screening using the Mini-Mental State Examination (MMSE)  revealed that all the participants had sufficient cognitive status based on their score of 24 or above  and no symptoms of depression according to the Geriatric Depression Scale [34, 35] (GDS). Table 1 summarizes participants’ sociodemographic information.
The adolescent/adult sensory profile (AASP)
This self-report tool is based on Dunn’s model  and includes 60 questions about the respondent’s behavior with sensory experiences in daily living in all sensory modalities. The 60 items are sorted equally into the four quadrants of Dunn’s model—low registration, sensation seeking, sensory sensitivity, and sensation avoiding (based on factor analysis)—and reflect various sensory-processing patterns. Each quadrant provides information on multiple sensory systems. Participants indicate how often they respond to the sensory event in the manner described using a 5-point Likert scale from 1 (almost never) to 5 (almost always). Each quadrant’s resultant score can range from 5 to 75. Norms are described for each age group (11–17 years; 18–64; 65 and older). Scores under or above these norms are considered alterations in sensory-processing abilities. This questionnaire has good internal consistency with coefficient alpha values of .692 to .699 for the four quadrants. In the present study the validated Hebrew version was used .
The behavior rating inventory of executive function-adult version (BRIEF-A)
This is a standardized rating scale developed to assess everyday behaviors associated with specific EF domains in adults (18–90 years). It consists of equivalent self-report and informant-report forms, each having 75 items in nine non-overlapping scales; two summary index scales—the behavioral regulation index (BRI) and the metacognition index (MI); and a global executive composite (GEC) scale that reflects overall functioning. The BRI is composed of four scales: Inhibit, Shift, Emotional Control, and Self-Monitor. The MI is composed of five scales: Initiate, Working Memory, Plan/Organize, Task Monitor, and Organization of Materials. The BRIEF-A can serve as a screening tool for possible executive dysfunction and as an indicator of individuals’ awareness of their own self-regulatory functioning. Behavior frequency is rated on a Likert scale from rare to often. Raw scores are transferred into t scores (M = 50, SD = 10). T scores at or above 65 are considered clinically significant. In this study, we used the self-report form. The BRIEF has a validated Hebrew version which was used in this study .
The daily living questionnaire (DLQ)
This is a 56-item self-report developed to evaluate IADL performance with a focus on their relation to cognitive abilities. The respondents report how much mental difficulty they have when performing varied tasks. Part 1 addresses activities and participation (e.g., household tasks, community/participation, and complex tasks). Part 2 addresses cognitive symptoms or impairments (e.g. in working memory, multitasking, and organization). Example items include “Getting ready in the morning” and “Finding items on a crowded shelf or closet.” Respondents score each item as 1 (no difficulty), 2 (some difficulty), 3 (much difficulty), 4 (unable to do), or not applicable (item is not rated). Four additional questions focus on the participant’s perception of their general functional and cognitive abilities from 1 (very good) to 5 (weak). Participants also rate their degree of satisfaction with their ability to perform what they need and want to do in everyday life from 1 (satisfied) to 5 (dissatisfied). High internal consistency has been indicated for the two parts (.88–.92). In this study we used the Hebrew version of the DLQ .
The study was performed based on the ethics approval of the Institutional Review Board of the Israeli Ministry of Health (Study number: 3–5861) and after participants singed the consent to participate in this study. Those who answered the advertisements calling to participate in this study, contacted the research coordinators by phone. In this conversation participants received an elaborated information about the study and a home meeting was set with them. In this meeting participants signed the consent form and completed the socio-demographic-health questionnaire, the GDS, the MMSE, the AASP, the BRIEF-A and the DLQ.
All analyses were performed using the Statistical Package for Social Sciences (SPSS) for Windows 25.0. Descriptive statistics was conducted for all measures in the sample. Chi-square test examined between-group differences in prevalence distribution for the relevant variables. Multivariate analysis of variance examined whether significant between-group differences existed in all dependent measure subscales. Further analyses of variance evaluated the significance of the between-group differences in the total scores of all dependent measures. Bonferroni correction was included.
Structural equation modeling (SEM)  was used to examine relationships among age, sensory profiles (AASP), executive functions (BRIEF-A), and cognitive deficits in IADL performance (DLQ). In addition, goodness-of-fit statistic, goodness-of-fit index, root-mean-square error of approximation (RMSEA), standardized root-mean-square residual, and comparative fit index (CFI) were tested. Here, Chi-square was used for nested model comparisons. The level of significance was set at .05.
To understand the participants’ characteristics better, we first describe their sensory processing abilities, EF, and cognitive deficits in daily activities, as measured by the AASP, BRIEF, and DLQ, respectively.
As presented in Table 2, most participants had normal sensory-processing abilities and were found to be in the normal range of each sensory profile of the AASP.
Table 3 depicts the sample’s EF as measured by the BRIEF-A. The mean scores describe normal values. When measuring the prevalence of executive dysfunctions, most (77%) participants had normal EF (i.e., scored less than 65), whereas 23% had behavioral dysregulation/executive dysfunctions (scored 65 or more).
Daily activities performance
Table 4 depicts participants’ cognitive abilities expressed in IADL performance as measured by the DLQ. Scores ranged from 1 (no difficulty) to 3 (much difficulty).
Differences in EF between people with and without altered sensory processing
According to Aim 1, we examined differences in EF (BRIEF-A) and cognitive deficits in IADL performance (DLQ) between participants with and without altered sensory processing. Those with altered sensory processing showed reduced EF, as measured by most BRIEF scales, than did those in normal ranges of the AASP quadrants. As shown in the mean differences, people with lower ability to register sensory input scored significantly lower in inhibition (M = 7.69, p = .001), shifting efficiency (M = 8.18, p = .004), working memory (M = 9.31, p = .007), behavioral regulation (M = 9.93, p = .001), and GEC (M = 7.53, p = .01) than did those with normal registration.
No significant differences in BRIEF-A scores were found between people in the sensory-seeking profile ranges. However, as described here by mean differences, participants with extreme sensitivity to sensory input had significantly lower scores in inhibition (M = 6.78, p < .0001), initiation (M = 6.68, p = .003), working memory (M = 9.77, p < .0001), plan/organize (M = 9.46, p < .0001), task monitor (M = 6.02, p = .03), behavioral regulation (M = 7.35, p < .0001), meta-cognition (M = 8.69, p < .0001), and GEC (M = 8.19, p < .0001) than did those in the normal range of sensory sensitivity.
People with extreme sensory avoidance scored significantly lower, as shown by mean differences, in inhibition (M = 7.64, p = .001), emotional control (M = 8.50, p = .02), initiation (M = 9.11, p < .0001), working memory (M = 12.05, p < .0001), plan/organize (M = 14.37, p < .0001), task monitor (M = 7.51, p = .02), behavioral regulation (M = 8.55, p = .005), meta-cognition (M = 10.37, p < .0001), and GEC (M = 10.11, p < .0001) than did those in the normal range of sensation avoidance.
Figure 1 depicts the visual presentations of the mean scores of each BRIEF-A scale in each sensory processing pattern.
Differences in daily activities performance between people with and without altered sensory processing
Participants with altered sensory processing showed greater deficits in IADL performance (as measured by the DLQ) than did those scoring in the normal ranges of the AASP quadrants:
participants with lower ability to register sensory input had more difficulties to perform activities related to household (mean difference = .24, p = .006). Participants with greater sensory sensitivity had more difficulties to perform activities as reflected by the following DLQ scales: language (M = .33, p < .0001), community/participation (M = .22, p = .02), complex tasks (M = .28, p = .01), multitask organization (M = .34, p = .002), memory (M = .31, p < .0001), monitoring (M = .35, p < .0001), activity participation (M = .23, p = 001), and cognitive symptoms (M = .33, p < .0001) compared to those in those found in the normal sensory sensitivity range.
Participants with extreme sensation avoidance also had greater to perform activities as reflected by the following DLQ scales: language (M = .23, p = .04), memory (M = .25, p = .02), monitor (M = .32, p < .0001), and had greater cognitive symptoms (M = .25, p = .02) than those found in the normal sensory avoidance range (see Fig. 2).
Relationships between age, EF, sensory processing and daily activities performance
Based on the literature that emphasizes the relationships between aging, worse sensory processing, executive dysfunction and restricted ability to perform daily activities, together with the results described above, a SEM model was created. This SEM model aimed to provide detailed information about the relations between age, the four sensory processing patterns presented in Dunn’s model, the EF as measured by the BRIEF, and examine whether EF mediate between sensory processing and daily activity performance.
The SEM model revealed good fit indices, including normed fit index (NFI), χ2(15) = 21.68, p = .12; CFI = .98; NFI = .97; RMSEA = .05. There was a direct effect between age and sensory seeking (β = −.20, p = .009), in which older participants had less tendency to seek sensory input in their daily environment. The effect between age and low registration was close to significant (β = .13, p = .08), as was the effect between age and sensory avoiding (β = .14, p = .06). Hence, these results show a tendency for the older participants to have higher avoidance and greater difficulty registering sensory input. Nevertheless, low registration and sensory sensitivity were directly related to BRIEF-A scores (β = .32, p < .001; β = .40, p < .001 respectively). This means that greater difficulties with register sensory input correlated with worse EF (BRIEF-A) and with greater cognitive deficits expressed in IADL performance (DLQ). Further, the BRIEF-A was directly related to the DLQ total score (β = .39, p < .001), but no significant indirect effect was found between age and BRIEF-A scores or between age and DLQ scores.
Sensory sensitivity and low registration had significant indirect effect to the DLQ (.16 and .12, respectively) mediated by the BRIEF-A for sensitivity (p = .001) and low registration (p = .002), 95% CIs [.07, .31], [.04, .27], respectively (see Fig. 2). This model explains 46% of the BRIEF-A variance and 42% of the DLQ variance.
In sum, older people had less tendency to seek sensory input in their daily environment. Their greater difficulties registering sensory input correlated with worse EF (BRIEF-A) and greater cognitive deficits expressed in IADL (DLQ). Sensory sensitivity and low registration had significant indirect effects with DLQ mediated by BRIEF-A (Fig. 3). Hence, executive dysfunctions may worsen the negative effects of altered sensory processing on daily activity performance in older adults.
This study focused on altered sensory processing, executive dysfunctions and their impacts on daily activity performance in older adults. The main findings are that (a) older adults have less efficient sensory processing and reduced EFs, as expressed in their daily life scenarios (b) EFs mediate the relation between altered sensory processing and daily activity performance. This means that, even if sensory processing is altered in older adults, it is the better or worse EFs that define their level of impact on daily activity performance.
When referring to the specific sensory processing profiles - most participants scored within the normal range of each AASP sensory profile. Since this study’s sample included relatively healthy and functional older adults, the sample appears representative of sensory processing in the older population. However, when examining the prevalence of participants with extreme sensory processing, according to the AASP, 9% had difficulties registering sensory input and about 25% had lower tendency to seek for sensory input. Indeed, older adults may require a greater amount of sensory input to react. If this amount is not provided, it may lead to lower awareness of the environment [39, 40, 41]. A similar prevalence of above- and below-AASP norms was noted in sensory patterns with low neurological thresholds (sensory sensitivity and avoidance), highlighting the modulation difficulties.
Whether sensory input from the daily environment is experienced as overwhelming, or, on the contrary, is missed because of hyposensitivity, other abilities - physical, cognitive, and emotional - may decline [42,43,44]. Thus, the individual’s interaction with the environment may be impaired and restrict the engagement in daily occupations and activities. These functional limitations may contribute to social withdrawal  and isolation  known to be prevalent in the elderly and severely reduce quality of life and well-being . Thus, prevention programs should screen for sensory-processing alterations in older adults and understand their implications on daily life and on the persons’ well-being.
The second significant outcome of this study emphasizes that referring only to sensory processing is insufficient. Science and practice should also consider other key factors that may affect the interactions between the individual and his/her physical and social environments. In this study, the assumption was that hyper or hypo sensitivity to sensory input does not stand alone as a factor that influences the interaction with the environments and the performance of daily activities. As mentioned in Dunn’s model , it is the interaction with the person’s ability to regulate his/her behavioral response to the sensory input, that contributes to activity performance. Indeed, in this study, the high cognitive abilities named EFs, that are responsible for an individual’s-controlled goal-oriented behavior mediated between sensory processing and daily activity performance. Executive dysfunctions, as expressed in daily life situations, were found in about one-third of the sample. This result highlights several points: first, the vulnerability for executive dysfunctions warrants attention also among “normal” older adults. Second, due to the EFs domain’s complexity, it is not enough to evaluate separate EFs components in the lab. A transition to real- life context is necessary. For that, appropriate performance-based measures should be used to evaluate EFs expressions and functional impacts in the real world . Evaluations such as the BRIEF-A and DLQ provide clinicians with practical functional knowledge that bridges clinical observations with people’s function in their natural environments. Third, the analysis of the SEM model showed that altered sensory processing was associated with reduced EFs as reflected in behavioral regulation and in meta-cognition measured by the BRIEF, supporting the study hypothesis. Neuro-imaging findings explain this association by referring to the connection between the prefrontal cortex (which plays a central role in EFs), the sensory cortical areas and the thalamic reticular subnetworks [30, 48, 49]. However, additional implications should be derived. First, the SEM model highlights the role of different facets of each of the EFs domains. For example, the interaction between AASP and BRIEF-A scores was most emphasized in sensory patterns related to passive strategies in Dunns’ model (low registration and sensory sensitivity). Moreover, low registration and sensory sensitivity had significant indirect effect on DLQ, mediated by the BRIEF-A. This may suggest that people who use passive strategies to deal with sensory input are more vulnerable and have less efficient coping mechanisms, which in turn, restrict their daily activity performance. On the other hand, individuals who seek for sensory input and enjoy it in their daily life, experience better well-being and quality of life . This point should be examined in further studies.
Prevention and intervention programs for older adults should refer to both sensory processing and EFs . Given that sensory-processing alterations worsen with age, earlier screening is a significant preventive aid. The relationships between altered sensory processing and EFs (meta-cognition and behavioral regulation) and their influence on daily activity performance should receive growing attention in clinical programs for older adults. For that, assessments with ecological validity that reflect how age-related dysfunction are expressed in people’s real lives and affect daily performance are most relevant. These assessments may elevate the individuals’ awareness to their dysfunctions. Individuals may better notice when and how their dysfunctions interfere with daily activity performance. With this knowledge, clinicians may suggest strategies to deal with difficulties related to altered sensory processing and EFs, and overcome obstacles in daily activity performance . These strategies promise better intervention outcomes in terms of enhanced participation in daily settings and better quality of life, which are the main measures of intervention efficiency according to the World Health Organization .
Altered sensory processing and executive dysfunctions may be prevalent in older adults. Among older adults with altered sensory processing, better or worse EFs may define the level of daily activity performance. Thus, evaluations of sensory processing should be proceeded in measuring EFs. By using measures with ecological validity, clinicians may better understand the expressions and impacts of altered sensory processing and executive dysfunctions on people’s daily life. This information may be useful for focusing intervention goals and strategies based on the individual’s specific profiles and needs in real life context.
This study included older adults who represent “normal aging,” meaning they are relatively healthy and functional. Future studies should explore aging impacts on sensory processing and EFs as expressed in daily lives of “normal” older populations, as well as populations with difficulties or specific health conditions. Sociodemographic effects as gender and socio-economic level should be also considered. Longitudinal studies are also recommended to examine the efficiency of prevention and intervention programs that focus on sensory and cognitive/EFs aspects in enhancing daily function, health, and well-being in the elderly.
Availability of data and materials
The datasets used and/or analyzed during the current study available from the corresponding author on reasonable request.
The Behavior Rating Inventory of Executive Function–Adult version
The Mini-Mental State Examination
Geriatric Depression Scale
The Adolescent/Adult Sensory Profile
The Daily Living Questionnaire
Structural equation modeling
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We acknowledge the Israeli Ministry of Health for funding this study.
The study was funded by the Israeli Ministry of Health. The funding supported the costs of the collection and analysis.
Ethics approval and consent to participate
The study was performed based on the ethics approval of the Institutional Review Board of the Israeli Ministry of Health (Study number: 3–5861 and after participants singed the consent to participate in this study.
Consent for publication
We have no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Engel-Yeger, B., Rosenblum, S. Executive dysfunctions mediate between altered sensory processing and daily activity performance in older adults. BMC Geriatr 21, 132 (2021). https://doi.org/10.1186/s12877-021-02032-0
- Older adults
- Executive functions
- Sensory processing
- Activities of daily living

domain: medical


text:
October 27, 2010
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The SEC recently issued a proposed rule would reform SEC Rule 12b-1 and the fees that are authorized under that rule. The proposed rule would maintain (but rename as new rule 12b-2) the 25 basis points fee that is currently used to compensate registered reps for providing important ongoing services to their clients. The proposal would also attempt to improve the transparency of distribution and marketing fees that are disclosed to consumers by, among other things, abandoning the use of the term 12b-1 fees and replacing it with the terms marketing and service fees and ongoing sales charge.
As a NAIFA member, I support these parts of the proposal.
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Please do NOT implement these changes. Thank you for your consideration.
Todd Grove, CLTC, LTCP

domain: economics


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text:
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text:
Came here for 1 week with a friend, absolutely hated it! Found dead bugs around room including squashed bug on mirror and it was our first day their meaning staff clearly had not cleaned room previously. Spiders hanging from light fixtures, and cobwebs all around the room. Stained bed and bed sheets, which also smelt like stale urine! Room smelt... More
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- Koulouris Beach Hotel Kavos, Corfu
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- The Koulouris is a hotel complex comprising of 5 buildings (Bungalows and Hotel rooms) situated just outside Kavos on the beach in the Aspro Kavos area.It is surrounded by 16.000 m² of beautiful natural landscape gardens on the sea of Asprokavos.The excellent location and good on-site facilities attracts young guests who want to be at the centre of the action in early and late season families will also enjoy the pool, beach and facilities at the Koulouris.A 300 metre walk down the beach will reveal the resort centre of Kavos, which offers the liveliest nightlife. ... more less
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domain: travel