text:
The social and economic impact of changes to postal services in Manchester
Guy Rubin, John Taylor, Polly Raymond
04 December 2006
The Last Post provides new evidence of the vital social and economic role of urban sub post offices.
The report says that they play a particularly valuable role in deprived urban areas, and outlines the new threats that they now face from changes to the post office network.
Much attention has been focused on rural areas, yet the contribution post offices make to urban areas has been overlooked. In fact, post offices in urban areas have borne the brunt of recent closures.The Last Post provides new evidence of the vital social and economic role of urban sub post offices.
The Government must take significant steps to safeguard the vital role that both rural and urban post offices play at the heart of communities across the UK, says the report.
If you back a recovery plan based around great public services, protecting the planet and reducing inequality, please support NEF to build back better.
Kirsty Styles is joined by Luke Murphy and Rebekah Diski
23 July 2021
Preventing collapse in sectors hardest hit by Covid-19
Christian Jaccarini, Emmet Kiberd, Lydia Prieg
30 June 2021
Workers and communities must be involved to ensure a fair approach to industrial change
10 June 2021
Putting workers and unions at the centre of industrial change in Yorkshire and the Humber
Rebekah Diski, Alex Chapman, Chaitanya Kumar
09 June 2021

domain: sociology


The Avalanche is huge!! The most comfortable ride of almost any truck I've ever been in. Vision to the rear can be challenging depending on your seat position. The fuel economy is decent, I'm averaging about 15mpg combined with mostly city driving. On the highway, figure about a solid 20+mpg. The tranny is silky smooth and shifts without effort. The seats are VERY comfortable and supportive. The instruments, while dated are very functional and easy to read. Yes the plastic trim on the dash seems cheap, but actually very solid. My dash has a crack that I will repair/replace, this is very common for Chevy 2007-2013. I will actually just buy another dashboard (300.00 online from GM). The navagation system is also outdated but does the job just fine (it's dvd based). I bought the vehicle used with 150K on the speedo. Not one rattle at all. Still rides like new and the cabin is totally quiet with no road noise at all. I have updated all bulbs to led including the headlights and they work perfectly. I might upgrade the Nav system in the future, but there is no rush since the factory system performs so well. In total, I love the Avalanche. It has adequate power and can be found for a lot less money than newer designs like the Ram Hemi, and Ford EcoBoost.


Checkpoint Wheel Nut Indicator – Various Sizes
Checkpoint Wheel Nut Indicator is a loose wheel nut indicator that is used extensively by the transport industry as an enhancement and development of fleet safety roadworthiness procedures, daily walk-round inspection and defect reporting and scheduled maintenance requirements. Its use allows accurate monitoring for loose wheel nuts and helps prevent wheel hub damage or the loss of a road wheel should a wheel nut loosen.
Checkpoint Wheel Nut Indicator is fixed to the wheel nut by gripping the six corners of the hexagon of the wheel nut. When the wheel is being fitted the Checkpoint Wheel Nut Indicator pointers should be aligned and set in a recognisable pattern. Should a wheel nut loosen off, the Checkpoint Wheel Nut Indicator has no option but to move with the nut and so break the recognisable pattern that was set, thus indicating the wheel nut has begun to rotate and therefore to loosen.
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text:
Fourier Transform Mass Spectrometry: The Transformation of Modern Environmental Analyses
Unknown compounds in environmental samples are difficult to identify using standard mass spectrometric methods. Fourier transform mass spectrometry (FTMS) has revolutionized how environmental analyses are performed. With its unsurpassed mass accuracy, high resolution and sensitivity, researchers now have a tool for difficult and complex environmental analyses. Two features of FTMS are responsible for changing the face of how complex analyses are accomplished. First is the ability to quickly and with high mass accuracy determine the presence of unknown chemical residues in samples. For years, the field has been limited by mass spectrometric methods that were based on knowing what compounds of interest were. Secondly, by utilizing the high resolution capabilities coupled with the low detection limits of FTMS, analysts also could dilute the sample sufficiently to minimize the ionization changes from varied matrices.

domain: chemistry


text:
Bound By Land And Hate: How The Economics Of West Bank Settlements Can Give Peace A Chance
The book, Normalizing Occupation: The Politics of Everyday Life in the West Bank Settlements, argues that the ideology of the settler movement has taken a backseat and most Israeli settlers are driven by material incentives like everyone else.
This gives rise to a new hope for the peace process in the Holy Land.
Ariel Handel, Marco Allegra, Erez Maggor (editors) Normalizing Occupation: The Politics of Everyday Life in the West Bank Settlements. Bloomington: Indiana University Press, 2017.
Author Sara Yael Hirschhorn makes the counter-intuitive argument in City on a Hilltop: American Jews and the Israeli Settler Movement that American Jews who made aliyah to Israel and went to live beyond the Green Line did not do so out of messianic zeal but as halutzim – pioneers – in the Holy Land. The overwhelming majority were liberals, whose politics was shifted by experience in Judea and Samaria, especially the intifada. Yet these settlers number only about 60,000 – some 15 per cent of the total, excluding the Jerusalem metropolitan area. What motivated the other 540,000 Jews living in the West Bank to move to the middle of nowhere? A new volume edited by Ariel Handel, Marco Allegra and Erez Maggor, Normalizing Occupation: The Politics of Everyday Life in the West Bank Settlements, argues that most Israeli settlers do not partake in the ideology of the settler movement either but are driven by more quotidian considerations such as real estate prices, and the commute between home, office, market and school.
It should be stated at the outset that the authors do not believe that ideology has had no role to play in making settlements attractive to Israelis. Rather, their argument is that bureaucrats, real estate developers and employers created secular conditions in territories beyond the Green Line that attracted large numbers of Jews, who had not been persuaded by the Gush Emunim. To paraphrase Michael Billig's depiction of contemporary nationalism, the actions of the subjects of Normalizing Occupation could best be described as banal 'settlerism'.
The proliferation of settlements, Danny Gutwein argues, is partially due to the dismantling of Israel's welfare state since the late 1970s and the corresponding privatisation of the Israeli economy. The economically lower classes were compensated in a manner for their loss of welfare by the availability of cheap housing, schooling, lower taxes and other material amenities beyond the Green Line. When the Likud Party came to power in 1977, there were about 5,000 settlers; a mere nine years later, that number had increased ten-fold. Today, that number has increased yet another ten-fold to approximately 500,000 settlers. Thus, Gutwein argues, just as the occupation created settlements, privatisation created settlers.
Such economic and demographic change has naturally brought with it political change. For example, the Shas Party is known today to be one of the fervently religious and hawkish groups in the Knesset, drawing its support mainly from lower and lower-middle class Mizrahim. In 1992, however, its leader, Rabbi Ovadia Yosef, gave religious sanction to an Israeli withdrawal from the territories that had been occupied in the Six-Day War. Ten years later, the party revoked that ruling as its support base had largely moved to the new settlements.
According to David Newman, even the Gush Emunim could not survive entirely on its ideological platform. He writes, "the earliest settler leaders were always conscious of the fact that in order to succeed, they had to seek a balance between their ideological and political objectives on the one hand, while working with the state system of planning and development on the other." The movement registered its success partly due to the ability of its leaders to superimpose their ideology on the process of rurbanisation and suburbanisation that was going on in Israel at the time. The pioneering spirit in the immediate aftermath of the Six-Day War had disappeared by the mid-1980s and settlers would now need to be enticed by the amenities of modern (sub)urban life.
This is a bold statement, given that many historians of Israel and the Middle East agree that the Bloc of the Faithful almost single-handedly changed the history of the region. Admittedly, Gush Emunim dissolved in 1984, barely a few years into the dismantling of the welfare state, but its ideology has lived on through to later groups. It has also been politically expedient not to play up the economic motives for settlements because material causes could theoretically be made up upon relocation to Israel proper whereas even insincere ideological reasons are harder to pacify.
Israeli rurbanisation and suburbanisation have succeeded so well that a full third of the settlers do not view themselves as living in settlements. This is particularly true of those in neighbourhoods around major Israeli metropoleis like Tel Aviv or Jerusalem. Inhabitants of Ma'ale Adumim, for example, are a stone's throw away from central Jerusalem and easy access by way of transportation and utilities have blurred the reality that the neighbourhood is technically beyond the Green Line and few Israelis would even recognise these as settlements. Ironically, residents of Ma'ale Adumim are more worried about a Haredi invasion of their neighbourhood than a Palestinian one, fearing that an Ultra Orthodox demographic would force a change in their lifestyle. In fact, Allegra believes that the debate over the reversibility of Israel's settlements in the West Bank is less over the iconic Har HaBáyit and more over the "facts on the ground" created by Israel in metropolitan Jerusalem.
Ideology alone does not make settlements bloom and though economic incentives are a strong motive, it does not provide psychological succour in the long term. This is an overlooked and underappreciated aspect of settler behaviour whose parallel can be found in the unrelated scenario of workplace fraud. Called the fraud triangle by psychologists, the theory is that even trusted employees will commit fraud if they have three things – need, opportunity, and the ability to rationalise their behaviour.
The rising cost of living and the collapse of the welfare state becomes the need, the encouragement by the state and organisations like Gush Emunim provide the opportunity, and the ability to rationalise is aided by removing the process from the mind. This essential third component is achieved by cartographic aggression – as Miki Kratsman and Ruthie Ginsburg describe, the Arab names of places are replaced with their Hebrew equivalents on maps and street signs. El-Carmel becomes Carmel and Na’alin becomes Na’aleh.
It is also achieved by building settlements to resemble proper Israeli towns and cities such as Modi’in, Rishon LeZion, Carmiel, Rosh HaAyin, Netanya and others. Gone are the sprawling individual houses of the halutzim; in their stead stand apartment blocs, avenues, shopping malls, and scenes from any crowded metropolitan city. If Modi'in Illit looks just like Modi'in and stand side by side, then surely they are both just Modi'in. Of course, from a strategic standpoint, it is much harder to demolish apartment buildings than it is individual houses.
Despite a stellar analysis of material modes of settlement, the editors do not consider what transformation might occur in settlers after moving across the Green Line. As Hirschhorn showed, liberal immigrants with idealistic notions turned over time into shockingly aggressive, angry and expansionist. Jewish terror began in the settlements as inhabitants found the Army too passive and the politicians too meek to respond "appropriately". Does the same phenomenon apply to economic migrants? If material benefits motivated them to cross the Green Line, would material loss persuade them to cross it back? Does their economic rationality make them less adamant in negotiations? These are several questions that immediately come to mind as one reads this collection of essays. By only following settlers from Israel into the West Bank but not staying with them a little longer, it feels like only half the story has been told.
Normalizing Occupation does not argue that ideology is passe but that the situation is no longer monochromatic, if it ever was. It underscores the power of banality, already noticed by Aristotle, Pierre Bourdieu, Hannah Arendt, Michael Billig and others. Yet Normalizing Occupation also gives hope: if settlers are not uncompromising religious zealots and are swayed by material incentives like everyone else, it might be possible to negotiate and the peace process in the Holy Land may yet have a chance. Handel et al persuade the reader to reconsider preconceived strategies and mechanics of disengagement and is a vital contribution to the understanding of two people bound by land and hate.
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domain: politics


(Reuters) – Wall Street’s main indexes hovered near record highs on Thursday as investors counted on more pandemic relief and speedy vaccine rollouts under the Biden administration to support the economy after data showed a weakening labor market recovery.
The number of Americans filing new applications for unemployment benefits dipped to 900,000 last week, but still remained stubbornly high as the COVID-19 pandemic tears through the nation, raising the risk that the economy shed jobs for a second straight month in January.
“It’s still the realization that the disappointment in the employment is not going away anytime soon and that we’re not out of the woods from the economic point of view,” said Ryan Detrick, chief market strategist at LPL Financial in Charlotte, North Carolina.
At 11:53 a.m. ET, the Dow Jones Industrial Average fell 15.14 points, or 0.05%, to 31,173.24 and the S&P 500 gained 1.89 points, or 0.05%, to 3,853.74.
The Nasdaq Composite gained 64.99 points, or 0.48%, to 13,522.24, boosted by a jump in shares of technology heavyweights Alphabet Inc, Apple Inc and Amazon.com Inc ahead of their earnings reports in the coming weeks.
It follows Netflix Inc’s blowout results on Wednesday that revitalized the “stay-at-home” beneficiaries, adding $262 billion in overall market capitalization to the FAANG group of stocks.
In a reversal of the trend earlier this month, the Russell 1000 growth index, which includes mega-cap technology stocks, is far outperforming the Russell 1000 value index this week.
“Investors are going to realize that technology names are still where a lot of impressive earnings growth is coming from and those shares could hold up well because they’ve underperformed for the last couple of months,” Detrick added.
President Joe Biden is expected to launch an array of initiatives during his initial days in office, including ramping up testing and vaccine rollouts.
Democrats took control of the U.S. Senate on Wednesday and Republicans in the Congress signaled a willingness to work on Biden’s $1.9 trillion stimulus plan that would enhance jobless benefits and provide direct checks to households.
Communication services, consumer discretionary and technology were the only S&P sectors in green.
Energy, financial and industrial stocks, which have helped the S&P 500 rally 14% since the Nov. 3 presidential election, fell between 0.7% and 2.6%.
With valuations near a 20-year high, corporate results could present an important test of whether the stock market rally has run ahead of fundamentals.
Earnings at S&P 500 companies are expected to rise by 24% in 2021 after falling 15% in 2020, as per Refinitiv data as of Jan. 15.
United Airlines Holdings Inc dropped 7% after posting a fourth straight quarterly loss due to the COVID-19 pandemic but said it aims to cut about $2 billion of annual costs through 2023.
Ford Motor Co jumped 9% extending gains for a second straight day after Deutsche Bank raised its price target on the U.S. automaker’s stock.
Declining issues outnumbered advancers by a 1.6-to-1 ratio on the NYSE and by a 1.6-to-1 ratio on the Nasdaq.
The S&P 500 posted 18 new 52-week highs and no new low, while the Nasdaq recorded 270 new highs and eight new lows.
Source: Read Full Article


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text:
CUBAN CULTURE GALA
Saturday, September 24, 2022 | 8:00pm
154 East 10th Avenue, Vancouver, BC, V5T 1Z4
Welcome to a celebration of Cuban culture featuring its signature ambassadors in Vancouver:
Julio Avila Cuban Band
Yula & Toto Berriel
It’ll be an evening of sublime music and beautiful dancing. The night will start with a complimentary dance lesson by Julio Montero at 8:30 pm (everybody is welcome to participate). Our main act will be Vancouver’s new music sensation, the Julio Avila Cuban Band, starting at 9:15 pm and playing two separate sets. In between, you’ll be treated to a Cuban fusion dance performance by Yula, and Toto on drums. Throughout the night, DJ Kubanito will be playing the hottest Cuban music hits.
Date: Saturday, September 24th
Venue: Ukrainian Hall, 154 East 10th Avenue, close to Main and Broadway
Doors: 8:00 pm
Admission: $35 in advance, more at the door.
Licensed event / No minors

domain: entertainment


text:
BNP Paribas: Supporting cinema in all its forms
BNP Paribas’ commitment to the seventh art is backed by the Group’s long history with the film industry. For more than 20 years, the Group has encouraged and participated in a wide range of initiatives benefiting the film industry in many countries. It supports art house, fantasy and crime films, as well as backing film restoration projects, design, young filmmakers and production.
Through this partnership, the bank presents an image of a bank that is close to its customers, their values and their goals, whether these customers are creative artists, industry professionals or film enthusiasts.

domain: artistic


The deaths of two female police officers in Greater Manchester earlier this week has ignited debate as to whether police officers should be armed.
The deaths of two female police officers in Greater Manchester earlier this week has ignited debate as to whether British police officers should be routinely armed.
PC Fiona Bone and PC Nicola Hughes were shot and killed when they went to investigate a suspected burglary.
Dale Cregan has been charged with their murders, along with the murders of father and son, David and Mark Short earlier this year.
He will be remanded in custody until a further hearing at Manchester Crown Court tomorrow.
Britain is one of the few countries in the world without a routinely armed police force.
The tragedy has brought up the ongoing debate as to whether police should carry weapons. It has seen divided views among society.
Chief Constable of Greater Manchester Sir Peter Fahy said: “We are passionate that the British style of policing is routinely unarmed policing.
“Sadly we know from the experience in America that having armed officers certainly does not mean, sadly, that police officers do not end up getting shot.”
Home Secretary Teresa May and Nick Clegg have also expressed their views against arming the police force.
The widower of PC Sharon Beshenivsky who was murdered whilst on call in 2005, and the brother of PC David Rathband, who was blinded in an attack and found dead at his home 17 months later, have both said how the police should be armed.
SW Londoner took to the streets of Wimbledon to find out: Should police officers be armed?
Gemma Talbot, 21
I think they should to protect their safety. People shouldn’t have to die when they’re just doing their job.
Jake Butler, 20
I think they should be armed because there are too many people with weapons around.
Saffron Fradley, 42
It just seems too American to me and I wonder if violence permits violence. But if someone knew had been a victim of it, then I might feel differently. I think it’d just be nicer if there were no guns, rather than more guns.
Elena Acciaioli, 28
People would be a bit more confident to know the police are armed because you never know what’s going to happen.
Ryan Islam, 24
I don’t think they should because where does the line get drawn when you start arming police officers with guns?
Avril Draudt, 66
No, I think one of the things that makes this country so wonderful is policing by consent. You never tell when a policeman is going to feel provoked and if they have arms, you can never tell what’s going to happen. We are much better off the way we are right now. I’ve lived in the States and I think it causes enormous problems to have police armed.
Mason Shine, 24
Yes, they should be armed.
Magda Vaczynska, 29
They should be armed, just for their own safety.
Jal Mina, 67
They should because there’s so much wildness in the world. If they can’t protect themselves and the other people, then innocent people get killed.
Richard Barker, 33
Personally, yes because I think the general consensus amongst people in the street is that police are easy targets. There’s a lot of animosity towards the police. With the right training, it could be a good thing, but then you have to worry about the escalation.
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text:
Photo: Tea Party Conservatives Oppose E-Verify
While the Republican majority in Congress moves forward to make E-Verify mandatory in this country opposition is coming from some unlikely sources: conservatives and Tea Party members.
The critics argue that mandating E-Verify at every business will diminish civil liberties, devastate certain industries, is too expensive and that E-Verify is faulty. The E-Verify program that is endorsed by the Obama White is currently optional but a bill sponsored by Republican Congressman Lamar Smith would mandate all businesses check the legal status of all workers.
Tea Party members feel it could lead to further incursions on employees and lead to more background checks. Some conservatives feel it is expensive and will unfairly burden the small business with more bureaucratic paperwork.
Certain industries like agriculture says it will devastate their business and not give them the workers they need to survive. Experts say the bill does not recognize the need for legal, temporary foreign laborers to work the fields.
Republican Rep. Dan Lungren of California said at hearings on the Hill this week:
“Anybody who suggests that we can do it with American workers, with all due respect, does not understand agriculture in America today.”


text:
It threatens to ‘gherao’ Amarinder Singh’s residence if he does not do so
The Shiromani Akali Dal on Monday said the Punjab government should in the next seven days convene a special Assembly session to declare the entire State a notified ‘mandi’ (principal market area) and reject the Centre’s recent agriculture laws. It should also repeal its own amended APMC Act of 2017.
The SAD core committee announced that in the event of the State government’s refusal to convene the session, the party would ‘gherao’ Chief Minister Amarinder Singh’s residence. The meeting was chaired by party president Sukhbir Singh Badal here.
Harcharan Bains, principal adviser to the SAD president, said: “The ultimatum to Amarinder Singh has become necessary in view of the CM’s continued refusal to take a clear stand against the Central anti-farmer Acts, besides his stubborn refusal to declare the entire State a principal market area where the Center’s Acts would no longer be implementable.”
The SAD core committee also decided to take up the issue of early reopening of the Kartarpur corridor with the External Affairs Ministry soon to ensure Sikh pilgrims could pay obeisance at the shrine in Pakistan during the run up to the 551th ‘Parkash Purab’ of Sri Guru Nanak Dev.
The committee also expressed serious concern at the mishandling of the Hathras incident by the Uttar Pradesh government and asked it to ensure the victim’s family received justice by taking exemplary action against police officials who had cremated the body forcibly, said Mr. Bains.
Source: Read Full Article

domain: law


text:
Mobility has brought us a lot of wealth and prosperity. But there are also challenges such as congestion, global warming, pollution, safety and energy security. When solving those issues and making future predictions, there is a lot of bias thinking such as wrong extrapolations/conclusions, tunnel vision and groupthink. In this workshop, insights from the past and the present are tackled.
The question of what could be reality in 2040 will be discussed.


text:
The game will start after the video
Ursula Brain Surgery
Can you perform a delicate operation on Ursula, the sea witch? Cut, insert healthy new brain pieces and close her skull with the help of Neptune's trident once you're all set! Wait till her hair grows back and choose her outfit so that she feels like herself again after the operation.
Hover Pizza Cats
Play dress up with these characters and get them ready for a crazy Halloween hoverboard race! Collect delicious pizza slices and avoid crashing into the obstacles!
Scooby-Doo: Sandwich Stack
Help our friend Scooby collect the ingredients from the list so that he can make the best sandwich in the world! Dodge the wrong ingredients and get ready to drool!
SpongeBob: Hooked on You
Help Spongebob eat every burger he can find at the bottom of the sea. Dodge the jellyfish
they sting badly!
Ravens Rainbow Dreams
Ride a unicorn and collect as many rainbows as you can! Fly across the sky and ricochet on the clouds avoiding the nightmare balloons. The more rainbows you collect, the further you'll go!
Tom & Jerry Mouse Maze
There's cheese everywhere, and Jerry has decided to collect it all! But be careful -- Tom is on the lookout. Help Jerry run away from him in this classic cat-vs-mouse game! Look for power-ups and special objects, but stay safe!
Unikitty Sparkle Blaster
Blast the negativity that comes for Unikitty and manage to get as many points as you can in 30 seconds! Put your skills to test!
The Great Nickelodeon Slime Rally
Visit every continent with SpongeBob, Kid Danger, Gameshakers, Knight Squad, The Thundermans and The Loud House! Get in your crazy ride and enjoy the most thrilling water races!
Teenage Mutant Ninja Turtles: Skewer in the Sewer
The Ninja Turtles are hungry, so help them skewer delicious food in their swords! Avoid canned food and lettuce - put your reflexes to test and complete the challenge!
Ben 10: Rustbucket Rescue
Help Ben 10 dodge all kinds of obstacles in his way and collect coins. Help him turn into aliens to defeat the villains that want to destroy planet Earth!
Draculaura's heart isn't working properly! Help her stay safe during a complicated operation where your patience and skill will be tested. Prove your surgeon abilities!
Click Play to see the videoguide for Monster High Heart Surgery
There are no gameplays yet. Add the first one!
Help this restless monkey kick their enemies and launch them as far as possible! Collect bananas, spend on upgrades and improve your skills!
Do you remember the Penguin Dinner Game? Then enjoy this great version serving customers who enter into the cafe. The objective of the game is to raise the money indicate in each level. Prove that you are the best waitress at the North Pole.
Get ready to manage a huge cafe while putting your eye for business to test! Serve all sorts of hot drinks, sweet and savory foods! Clear every order as soon as possible and enjoy yourself!
We Bare Bears: Sandcastle Battle!
Help our favorite bears defend their sandcastle from a group of dangerous kids! Throw sandballs at them and cast special attacks when they come in groups!
Save this brave ninja kitten! To do this, help him jump from one mobile platform to another as you collect all the stars on each level and make it safely to the ground - collect the 3 stars from each screen and have a great time!
Yetisports: Pengu Throw
The Internet classic released in 2004 is back! Do you remember the Yeti?
Every penguin dreams about being able to fly but, even though they're birds, they cannot really do it... Help the Yeti hit the penguins with a bat and make them fly as high as possible!
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domain: game


text:
It seems no industry is safe from the cybersecurity discussion. From patient platforms to car manufacturers, hackers are after only one thing – money.
But it is true that some industries – and thus organisations – are more susceptible and attractive than others.
In August, the UK electoral commission, Northern Irish police force, and American energy giant Tesla were all victims of data leaks, and the healthcare industry has had its fair share of issues in 2023, too.
In July, HCA Healthcare – one of America’s largest healthcare systems – was hit by a data breach affecting 11 million patients. There was also the unveiling that millions of medical devices in use across the NHS in England are unprotected against cybercrime, after a freedom of information request by Armis Security, a US cybersecurity firm.
Such news means that there is patient worry about the health systems that their data is stored on, along with the devices their health depends on. Is the industry getting on top of cybercrime, or is a cybersecure future in health out of reach?
Healthcare cybersecurity regulations
When it comes to getting ahead on cybercrime, regions have only recently begun to take the bull by the horns, or the data by its firewall as it were, with specialised legislation.
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At the end of 2022, the US Senate passed the $1.7tn 2023 omnibus package. Included in it were powers given to the US Food and Drug Administration (FDA) to ask for cybersecurity requirements in submissions for medical devices by manufacturers.
The FDA issued guidance in May that gave vendors a deadline of 1 October 2023 to prepare submissions meeting the new requirements. Therefore, at the moment, regulatory status for cybersecurity in medical devices is in a state of flux.
The European Parliament passed cybersecurity laws of its own in late 2022 – which encompassed sectors including energy, transport, banking, and health. The Directive (EU) 2022/2555 on the Security of Network and Information Systems (NIS 2 Directive) belatedly gave products such as telehealth platforms, wearable devices, and in vitro diagnostics requirements to be cybersafe.
Why is healthcare attractive for cybercrime?
“Cyber criminals have identified healthcare as a profitable industry that is easy to go after. Weak security posture, high pressure to restore operations, therefore, more likely to pay,” Axel Wirth, chief security strategist at MedCrypt – a company that provides data security for medical devices – tells Medical Device Network.
Wirth adds that compared to other industries, healthcare is seen as having a less mature cybersecurity landscape. A survey by Indusface – a cloud-based application security company – found that over half of health and social care businesses have been targeted by cyberattack. Only four other industries – education, arts and entertainment, accommodation and food, and real estate, reported higher incidents of cyberattacks.
The trends of cyberattacks in healthcare are telling. A 2022 report on healthcare cybersecurity by the Department of Health & Human Services shows a steady increase in data breaches from 2012 to 2021. Moreover, the average ransomware demand grew by 45% from 2020 to 2021. To put this into perspective, the largest ransom in 2020 was $30m, whereas in 2021 it was $240m.
Breaches have affected over 42.7 million US citizens in 2023 so far, a 50% increase from the 28.4 million individuals affected in the same period in 2022.
Wirth continues: “We not only see a steady increase in breaches of healthcare organisations but also the category of malicious breaches – [this is] the sole driver of growth there.”
Hackers see no distinction in targeting manufacturers or individuals, Wirth explains it’s about maximising profit – and extortion can be a big problem in healthcare. Sensitive data stored in specific institutions like psychiatric hospitals or cosmetic surgery clinics means that patients themselves are being contacted and threatened with leaking of their data.
Wirth says that attack trends are shifting and that hackers have identified internet of things (IoT) devices as a valuable target. Any device in a hospital, from a data platform to a security camera, can be used to shut down operations in ransomware.
Ashley Clarke, medical analyst at GlobalData, says: “Hackers can exploit various entry points, ranging from physical medical devices in and outside of medical facilities to gaining unauthorised access to networks from nearly any connected device, medical or not. The implications of such attacks can be far-reaching, affecting patient privacy, interrupting healthcare services, and jeopardising the safety and effectiveness of medical devices.”
Wirth adds that care-disruptive events are much more difficult to recover from: “If your email is down, if your business systems are down, even if your electronic health record is down, you can still operate as a hospital, at least from an emergency perspective. But once your imaging goes down once your heart pumps go down, it gets much more difficult.”
Increased connectivity means increased risk
It’s no surprise that the recent wave of cybersecurity legislation comes amongst a boom in increased connectivity amongst healthcare devices, with IoT being a central pillar of how medical technology is being used in healthcare. Its advantages are plethoric, allowing decentralisation of health provision and empowering patients to take control of their own well-being and health monitoring.
And though there has been a small decline in the number of reported breach events – hinting that systems are beginning to get on top of cyber weaknesses – the prevalence of connectivity in healthtech means the risk will always be there.
The remote patient monitoring market is expected to reach $760m by 2030, growing at a CAGR of 8.9%. The future of telehealth looks promising too as more patients seek digital means to connect with healthcare professionals – the market is expected to grow to $3.8bn by 2030.
A key hurdle to both markets reaching their potential, however, is if patients can be guaranteed their data is safe amidst privacy concerns. For instance, Cerebral, a telehealth company, said earlier this year that 3 million patients on its platform were affected by a data breach.
“Connectivity is increasing the traditional network enterprise boundary that was widely used as a control point historically, this is weakening and we [now] have data in the cloud hosted by various providers. We now have devices that go home with patients and operate in home care type of environment,” Wirth says.
“The challenges of designing a more secure device that can be operated without a lot of security around it in its operating environment, are being met by the industry. Maybe not as quick as some wish but I think we’re making progress.”
Clarke concurs, adding: “As we progress towards a more interconnected healthcare landscape, collaboration with cybersecurity experts, the adoption of advanced technologies like blockchain and zero-trust architecture, and prioritising data security will be vital to safeguard patient information and ensure continuous, secure care.”
Who wins – hackers or authorities?
Reports of data leaks and security breaches in healthcare belie the efforts being made to produce cybersafe devices. Indeed, there is an apparent cyber-arms race in healthcare that in truth is seeing both sides make gains. The FDA’s Refuse to Accept policy for cyber devices gives an incentive for manufacturers to hasten cybersecure technology. If they can’t demonstrate cyber-safety, the device will be duly turned away.
Developing healthcare cybersecurity at the foundational level of medical devices is easier than trying to implement it later in its lifecycle. It’s evident that clamping down on regulatory checkpoints in the infancy of health devices will give the industry longevity in safety risk from hacking.
“Considering that medical devices typically have a long, useful life, and a very long development lifecycle, I think trying to win in a reactive approach in an arms race approach is unrealistic because cybertech moves within weeks or even days… [whereas medtech] …moves in years,” Wirth says.
“If we get the basics right, I think we have a good chance on providing more secure devices out of the gate that easier to defend and can withstand a more aggressive future.”

domain: news


text: The intestinal epithelium is known as one of the most regenerative tissues in our body. The lining of the intestine is composed of a single layer of epithelial cells generated by rapidly renewing stem cells residing at the crypt bottoms, resulting in a flow of cells to the villus tips. The stereotypical crypt–villus architecture makes the intestine an ideal model for stem cell research. Based on recent advances in research of stem cell niche signals in vivo, we have established an intestinal epithelial stem cell culture method. Under this culture condition, single Lgr5+ intestinal stem cells (ISCs) or isolated whole crypts efficiently expand into three-dimensional spherical structures recapitulating the intestinal crypt–villus organization. These organoids can be passaged weekly and maintained for years in culture. Moreover, they can be cryopreserved. As intestinal organoids recapitulate many aspects of the epithelial biology and are amenable to most, if not all, current experimental manipulations, they are widely used to study stem cell biology, cell fate determination, gene function, and disease mechanism.

domain: biology


text:
Let the funds begin...4.57 / 5.00 31,856 Views
Detective Nwar faces off with two thieves who planned on laughing all the way to the bank.4.27 / 5.00 4,187 Views
The Grifms meets The Sweatsons4.05 / 5.00 19,791 Views
Hello everybody. Do you like to see pop culture icons made fun of and disrespected? Well then this is the movie for you!! Phat Dawg and his pals take you down the toilet on a journey through pop culture land. Complete with Osama Bin Laden, Michael Jackson, Saddam Hussain (with his lover, Doritos), Conan O'brien, Kal Penn, and Jon heder. Plus, a pot head teletubby, an alchoholic ferby, and the underwater sex god, Father oceania!! Oh just for the record, i have nothing against Conan O'brien, Kal Penn, or Jon Heder.


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“World’s only double-bill event” to be held in Bangkok in October
Billed as “the world’s only double-bill event”, combining one of the biggest international MICE shows plus a conference and exhibition on corporate travel, IT&CMA and CTW covering the Asia-Pacific region is preparing to launch on October 2-4. To be held at the Bangkok Convention Centre at CentralWorld in Thailand, the event will match hundreds of travel buyers and sellers in a three-day exhibition showcase.
Meanwhile, more than 70% of exhibitors at IT&CM China 2012, held this spring, have already signed up to be part of next year’s event. The show will return to the Shanghai World Expo Exhibition & Convention Centre on 17-19 April 2013. The organisers say that this proves the event is assessed positively by exhibitors, adding that feedback from delegates has been encouraging.
[photo courtesy IT&CMA]


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The purpose of this study was to examine the psychometric properties of the Autism Program Environment Rating Scale (APERS), an instrument designed to assess quality of program environments for students with autism spectrum disorder. Data sets from two samples of public school programs that provided services to children and youth with autism spectrum disorder were utilized. Cronbach alpha analyses indicated high coefficients of internal consistency for the total APERS and moderate levels for item domains for the first data set, which was replicated with the second data set. A factor analysis of the first data set indicated that all domain scores loaded on one main factor, in alignment with the conceptual model, with this finding being replicated in the second data set. Also, the APERS was sensitive to changes resulting from a professional development program designed to promote program quality.
Autism spectrum disorder (ASD) has markedly increased in prevalence in the last two decades. Once thought to be an extremely low prevalence disorder (i.e., 2 in 10,000 children identified in the early 1980s), the current prevalence rate is 1 in 68 (Baio 2014; Christensen et al. 2016). In the United States, there has been a parallel increase in the number of students with ASD enrolled in special education programs [i.e., a 350% increase 2004–2013 according to Office of Special Education Programs (2015)]. With this increase has come the need to provide appropriate and high quality educational programs, and in fact, parents of children with ASD have brought legal actions against school systems for not providing such programs (Zirkel 2011). When school systems lose these law suits, it is in part because they are not able to document the quality of the programs they provide (Yell et al. 2003). The purpose of this paper is to describe the development of an assessment of program quality for students with ASD, called the Autism Program Environment Rating Scale (APERS) and its psychometric characteristics. After a brief review of previous research on assessment of program quality for students with ASD, the APERS instrument development process and history will be described, followed by a report of its reliability and validity. The paper will conclude with a discussion of the instrument’s utility and current use in research, program evaluation, and professional development.
For this study, “program” will refer to educational services operating in public schools for children and youth with ASD. The Individuals with Disabilities Education Improvement Act (IDEIA 2004) specifies that for children with disabilities between the ages of 3 and 22, public schools have to provide free and appropriate educational services in the least restrictive environment. The law provides a number of specific details about these requirements (e.g., each student must have an individualized education plan; transition program has to start at 16). Environment refers to the physical, instructional, and social features of classrooms and other locations at the school. The professional and research literature, as well as IDEA, specifies the quality of program services, which will be discussed subsequently.
The assessment of the quality of educational program environments has been the strongest in early childhood education. The Early Childhood Environment Rating Scale (Harms et al. 2014) has the longest history, with the Classroom Assessment Scoring System (Pianta et al. 2008) also well established. Both have sound psychometric qualities and are used extensively in state and national evaluations of early childhood education programs. The Inclusive Classroom Profile (ICP, Soukakou 2016) has extended assessment of early childhood education environments to program features that support children with disabilities. The ICP also has sound psychometric qualities (Soukakou 2012).
Assessment of program quality for individuals with ASD has been more limited, although some rating scales have been developed. The Environmental Rating Scale (ERS) (Van Bourgondien et al. 1998) is a staff-administered rating scale designed to measure residential environments for adolescents and adults with ASD. The authors have published evidence of reliability and construct validity, although only 52 adolescents and adults with autism participated in the study. In a revision of the ERS, Hubel, Hagell, and Sivberg (2008) developed a questionnaire version of the scale, the ERS-Q, which could be completed by program staff. They found high internal consistency and substantial concurrent validity between the two scales, although again the number of participants in the study was quite low (n = 18). Also, this scale focused on out-of-school/residential settings for adolescents and young adults rather than school-based programs across the grade range.
To examine learning environments for school-age children and youth with ASD, researchers have created several scales. For schools in Belgium, Renty and Roeyers (2005) developed a questionnaire to examine special education and inclusive school programs. The questionnaire was completed by school staff and gathered information about services available, modification of the school environment, staff knowledge of ASD, and parent involvement. The authors did not, however, provide information about the psychometric qualities of their questionnaire and there have been no reports of its use in the United States. A team from the state of New York (Crimmins et al. 2001) developed the Autism Program Quality Indicators. This scale assessed the quality of environments for children with ASD and contained sections addressing both program (e.g., personnel, curriculum, family involvement) and student considerations (e.g., assessment, transitions) (Librera et al. 2004). However, no information is available about its reliability and validity. To measure features of quality in programs for learners with ASD, the Professional Development in Autism program, funded from 2002 to 2007, developed the PDA Program Assessment (Professional Development in Autism, n.d.), which was a checklist containing items representing eight domains. Again, no evidence of reliability or validity has been reported for this measure. Similarly, several state committees (Colorado Department of Education 2016; Kansas State Department of Education, Special Education Services 2013; Librera et al. 2004) have developed assessments of quality programs, often intended for teacher self-study of their programs, with none providing psychometric information.
A team from the National Professional Development Center on Autism Spectrum Disorders (NPDC 2011) developed the APERS. The NPDC was a multi-site center with collaborators from universities in North Carolina, Wisconsin, and California. This center, funded by the U. S. Department of Education, Office of Special Education Programs, was charged to design a professional development program that states would use to promote service-providers’ implementation of evidence-based practices in educational programs for children and youth with ASD. States applied to work with the NPDC to create their professional development program, and NPDC worked with 12 states over a 4-year period. A state-level team made up of administrators and special education leaders in the state identified six classroom programs that would initially participate in the professional development program and eventually serve as models for other programs.
The APERS was an integral part of the NPDC. The operating assumption of NPDC was that the quality of a program serves as the “platform” on which EBPs are implemented, with practitioners’ ease of implementation being directly associated with the level of program quality (Odom et al. 2013). This assumption is similar to the concept in clinical psychology of high quality therapy services having “common factors” (Deegear and Lawson 2003) that serve as the context for specific evidence-based therapies design to address special conditions such as depression or anxiety (Lampropoulos 2000). Recent evidence supports this model in psychotherapy (Wampold 2015). The reason for developing the APERS rather than using other previously developed scales was that the previous scales (a) did not cover all the program areas and features the NPDC team deemed necessary to assess program quality (see Fig. 1), (b) did not have the level of detail sufficient to provide comprehensive formative feedback to programs (i.e., to improve the educational “common elements” serving as the foundation for implementation of EBPs), and/or (c) did not have evidence of reliability and validity.
Theoretical Rationale for APERS
The theoretical foundation for the APERS is based on a traditional Bronfenbrenner (1979) view of ecological systems, in this case at the micro- and meso-system levels, and their influence on individual development and learning. In addition, the APERS draws from the logic of IDEIA, and the assumption that certain features of programs are necessary and important for learners with disabilities. A set of program features exists within classrooms or more broadly school programs, which are the primary educational microsystem(s) in which the learner participates. These include structure and organization, social climate of the classes, assessment, and “content” related instructional or intervention practices that map onto the challenges most common for students with ASD (e.g., communication, social competence, behavior). In addition, there are meso-system influences; that is, influences from outside the immediate classroom/program. These are construed as the interdisciplinary teaming process and family participation. These features (i.e., defined in the APERS as domains) contribute to a cumulative program experience for individual learners with ASD, which we propose is the “quality” of the program (see Fig. 1.). Table 1 contains a brief description of each domain.
Development of the APERS
The development of the APERS, which began in 2007, has been systematic and iterative. The selection of items and the format for the APERS began with a review of the literature on assessment of program and learning environments for children and youth who are typically developing and for individuals with ASD. During the instrument development process, NPDC staff selected and modified items from other scales (e.g., the PDA checklist, the ECERS) or created applicable items, sorted items into categories that reflected important features of learning environment and programs, shared analyses with other members of the team, revised items based on feedback, and assembled items into domains. Team members then wrote item anchors, shared anchors with other team members for review, and revised item anchors based on feedback.
The items and domains were assembled into the APERS Preschool/Elementary (APERS PE) version. This version was then shared with a team of experts and practitioners in middle school and high school programs for learners with ASD and modified to create the middle/high school version [APERS Middle/High School (APERS MH)]. Items were revised to represent the different quality features of middle/high school programs. Initially one domain was added to include a focus on transition; however, the transition items were subsequently embedded within the other domains in the 2013 version of the APERS.
NPDC research team members then pilot tested the APERS in preschool, elementary, middle, and high school programs for learners with ASD in public schools in one school district. Pilot test information was used to revise observation and data collection procedures as well as individual items. Both versions of the APERS were then distributed to the research staff at the three sites of the NPDC (NC, WI, CA). Staff administered the APERS in the fall of 2008 and spring of 2009 in early childhood, elementary, and middle/high school programs. These staff members provided detailed feedback about items and data collection procedures, which were incorporated into the 2011 versions of the APERS.
In 2013, research team members with the Center on Secondary Education for Students with Autism Spectrum Disorders (CSESA) made slight modifications to the middle/high school version of the APERS. The CSESA is a research and development center funded by the U. S. Department of Education-Institute of Education Sciences to establish and evaluate a comprehensive treatment program for adolescents with ASD in high schools (see reference blinded, to be included in final manuscript). Like the NPDC model, CSESA staff initially collected APERS information and provided feedback to school staff in order to build the foundation of quality of subsequent implementation of evidence-based program features. The CSESA model was more comprehensive than the NPDC model in that it was applicable to all programs for students with ASD operating in a specific school (i.e., NPDC typically only operated with the self-contained or inclusive program in a school). The slight modifications were insertion of item notes for the coders to assist them in interpreting the scoring anchors and rubric as applicable for a broader school context. Items and items anchors from the earlier version were not changed, with one exception. The items from the transition domain in the NPDC version were integrated into content domains (e.g., Assessment, Teaming) in the CSESA version.
The purpose of this paper is to examine the psychometric quality of the APERS. The specific questions addressed and hypotheses are:
What is the reliability of the APERS? The authors hypothesized that there would be a high level of internal consistency and moderate to strong inter-rater agreement.
What is the construct validity of the APERS? The authors had two hypotheses: (a) in a confirmatory factor analysis, a single factor reflecting quality would be detected and all APERS domains would load significantly on this factor (see Fig. 1), and (b) the APERS would be sensitive to changes resulting from a professional development program designed to improve program quality.
This study draws from two databases—the original data collection that occurred through the NPDC Project and the data collected through the CSESA project (reference blinded, to be included in final manuscript). The schools and participants will be described in different sections aligned with the analyses. The rationale for including two data sets was to allow replication across samples. Also, because of the nature of the CSESA study, additional research questions that were not possible with the NPDC sample (i.e., inter-rater agreement) could be addressed.
Sample 1: NPDC
As noted, separate versions of the APERS were created to measure specific aspects of program quality for two age ranges: (a) the APERS-PE and (b) the APERS-MHS. The APERS items are organized on a five point rating continuum, with the 1 rating indicating poorest quality and 5 indicating high quality. An example of the rating rubric appears in Fig. 2. To score a 1, the rater codes any indicator in the 1 rating (i.e., 1 rating will occur regardless of any subsequent indicators scored for higher ratings). For a score of 2, at least one but not all of the 3 rating indicators is coded. For a score of 3, all 3 rating indicators are coded. For a score of 4, all 3 rating indicators are coded and at least one (but not all) 5 rating indicators is/are coded. For a score of 5, all 3 and all 5 rating indicators are coded. The coding format is computer-based. The rater codes the individual indicators that reflect quality on a specific item and the software program generates the score for the item and also tabulates domain (e.g., Assessment, Teaming, Families) and total mean item ratings.
To gather information for scoring the APERS, trained coders observed classes and contexts in programs for learners with ASD for 3–4 h that were distributed across 2 days. For items that were not easily observed on a short visit, coders interviewed the lead teacher, team members, and selected family members. They also reviewed students’ Individual Education Plans as well as any other relevant documentation (e.g., behavior intervention plans, individualized transition plans). For NPDC’s work, two children or youth with ASD were identified as “focal students”, in order to situate the observations in classes, school, or community contexts. The criteria for selecting the focal students were that they had an established educational diagnosis of ASD, as defined by their respective states, and that the school staff nominated them as being representative of the students receiving services in the program (e.g., if the program were self-contained and most students had intellectual disability and had limited communication skills, then the focal students had these characteristics).
The APERS-PE is designed to be used in programs serving children with ASD who are 3–10 years of age. The APERS-PE includes 64 items organized originally into 11 domains, although two previously separate learning environment domains were merged because of comparable content, resulting in 10 domains. Each of the domains are included in Fig. 1. The APERS-MHS was designed to be used in programs serving learners with ASD who are 11–22 years of age (or the end high school). The APERS-MHS includes 66 items and 11 domains that focus on all aspects of program quality (i.e., the one extra domain was transition, which was merged with other content domains for this analysis for comparability with the subsequent analysis to be described.).
Staff at each project site participated in a training regimen in which they reviewed items in each domain, discussed interpretation of the items, and practiced observation and item rating with feedback from the trainer, who was one of the original developers of the APERS. They then conducted a complete APERS assessment with a trained rater, examined agreement between ratings and reached consensus on items scored separately. If sufficient consensus occurred between coder in training and trained rater, they then conducted the APERS independently. Sufficient consensus was defined as agreeing within one point on the majority of items and agreeing on interpretation of items, with the trained coder, on items not within one point. Because of the national context, geographical disbursements of site, and resource limitations, inter-observer agreement was not collected for this sample.
NPDC program staff collected APERS in 72 school-based programs located in 11 states (CA, ID, IN, KY, MI, MN, NM, TX, VA, WI, and WY) in the Fall of the school year. Programs were located in preschool, elementary, middle, and high schools. Selection criteria were: (a) schools in which programs were located had to part of a local education agency (i.e., not charter or private schools); (b) schools had to have inclusive (i.e., defined by students with ASD spending 80% or more of their time in general education classes) and/or self-contained programs for students with ASD; and (c) programs could not be in self-contained schools that only enrolled students with disabilities. The state leadership team identified the specific programs based on geographic distribution around the state (e.g., a program in the north, central, and south parts of the state in north–south oriented state) as well as distribution across preschool/elementary, middle/high school programs. The exception to this process was if the state leadership identified a specific need for the state (e.g., one state team specified middle school as a particular need area), in which case it was given priority. The distribution of grade range and inclusive/ self-contained classes appears in Table 2. Although the states were nationally distributed and the students with ASD in programs were from racial/ethnically diverse families, specific data on the racial/ethnic diversity of the students in the autism programs were not available.
Study 2: CSESA Sample
The CSESA sample was drawn from a randomized clinical trial (RCT) study that took place in 60 high schools located in central North Carolina, central and northern Wisconsin, and southern California. Selection criteria for these schools were the same as stated previously for the NPDC sample. The student participants in the larger RCT study were racially/ethnically diverse, with 43% of the sample classified (by parents) as either African-American or other designated racial group or White-Hispanic. An integral part of the CSESA model is using the APERS, as happened with NPDC, to assess program quality and share with the school staff to create a school-improvement plan.
The CSESA staff modified the APERS-MHS in 2013 based on an item analysis, which resulted in the CSESA version of the APERS-MHS having 10 domains, and 65 items. Previously, the APERS had been designed to assess one program (e.g., a self-contained autism class OR an inclusive program) in a school. As noted previously, the CSESA project modified the instrument to reflect “whole school” quality (e.g. quality of both the self-contained and inclusive classes across the school contexts). As a result, CSESA staff observed in a wider variety of program locations in schools and interviewed a larger set of personnel than occurred for NPDC.
The CSESA staff, as noted, collected data for students in inclusive and self-contained special education programs separately within the same school in the Fall of the school year. School programs began in either the 9th or 10th grade, depending on the local education agency. Students with ASD in the inclusive programs usually graduate with their typically developing peers (i.e., around age 18), whereas students in the self-contained programs may stay until age 22. For the CSESA study, staff selected three students with ASD to situate observations in the school (i.e., at least one from self-contained, one from inclusive, and the third from either based on school context). All of these students met their state’s criteria for eligibility for special education services under the autism category. Like the NPDC sample, all schools were publically funded (i.e., no charter schools) and none were self-contained, special education schools that only had classes for students with disabilities.
Training for coders was conducted following the same process described previously for the NPDC sample. However, for the CSESA sample a trained reliability coder visited each site, simultaneous conducted observations, interviews, and record reviews, and independently scored the APERS for the school for approximately 20% of the sample.
APERS Data Collection
In the fall of the school year, CSESA staff collected the APERS data for 56 inclusive and 43 self-contained programs located in 60 high schools (high schools often had both inclusive and non-inclusive programs).
For the CSESA sample, two research staff simultaneously collected APERS information and completed APERS ratings in 21 programs. Inter-rater agreement at the item level was calculated in two ways: agreement within one rating point and exact agreement. The mean percentage agreement was 95.2 and 76.5% respectively. An ICC was also calculated, yielding a coefficient of .56, and a Pearson correlation based on the mean item rating for the total score by the two coders was .54 (p <. 01). Although we did not have sufficient numbers of ratings to conduct a traditional generalizability study, we did examine mean item ratings averaged across all schools for the two raters. The mean scores were 3.31 (SD = .55) and 3.33 (SD = 0.53) for the two raters. Item ratings were also examined at the individual item level and the difference between coders were calculated. For example, if one coder scored 3 and the other scored 5, the difference was 2; if they both scored the same rating, the difference was 0. The mean item rating difference on this five-point scale (i.e., calculated by subtracting the rating by one coder on an individual item from the rating by the second observer and dividing by the number of items) was .37 (SD = .35).
Question 1: Reliability of the APERS
Data from the NPDC and CSESA projects allowed us to address the question of internal consistency. To examine the former, Cronbach alphas (Cronbach 1951, 1970) were computed for the total score and also for the individual domains of the NPDC and CSESA data sets. First, we computed the alphas for the Preschool-Elementary and Middle-High School forms of the APERS. As can be seen in Table 3, the alphas for both were quite high (.94–.96). The domain scores were lower but nearly all were above the .70 level. Second, to examine the APERS conducted for inclusive and non-inclusive programs, we combined the Preschool-Elementary and Middle-High School dataset, renumbering items so that the items for the two versions “matched up” (i.e., some items had slightly different numbers in the two formats and we matched equivalent items). We then conducted alphas for the inclusive and self-contained settings separately, again finding high alphas for the total (.94–.96) and lower alphas for the domains. For the CSESA data, we calculated alphas for the inclusive and self-contained programs separately. These findings replicate the results from the NPDC data set in that the total score alphas were high (.94 and .96) and domains were lower but generally in the 0.70–.80 range.
Question 2a: Construct Validity–Factor Structure
To test our proposed factor structure for the APERS, we conducted a confirmatory factor analysis (CFA) with the NPDC data set and then repeated the model with the CSESA data set. We based our analyses on the domain scores as the measurement variables. In the initial CFA (see Table 4), we tested a one factor model where all domains were free to load on the latent variable. The analysis confirmed model fit for the single factor solution (RMSEA = .13, CFI = .90, and Chi square (35) = 74.63, p = .0001). The high RMSEA value is of concern as it is outside the commonly accepted guideline of less than .05 for good fit and .08 for acceptable fit. RMSEA is impacted by sample size and is positively biased (i.e., too large) when sample sizes are small (e.g., Rigdon 1996). Recent researchers have argued against its use for small samples or low degree-of-freedom models (Kenny, Kanistan, & McCoach, 2015). Rather than omitting RMSEA, we chose to relax our standard relative to common practice.
We next applied the same structure to the CSESA data. In most of the CSESA schools, we observed two programs: one inclusive, the other self-contained (see Table 5). To account for possible school-level effects in addition to program-level effects in the factor structure, we first fit a multi-level CFA (MCFA) where we allowed for both within program and between program estimates for the factor loadings. The within program loadings are of particular interest, with the between program loadings included primarily to account for the nesting of programs within schools. Model fit for this was comparable to the fit for the NPDC CFA models: RMSEA = .11, CFI = .83, and Chi square (70) = 152.74, p = .0000. However, when the clustering is ignored, model fit is slightly improved (RMSEA = .10, CFI = .92, and Chi square (35) = 70.21, p = .0004) suggesting that the correction is unnecessary (for a more complete discussion of the determination of model selection in the presence of nested data, see Stapleton et al. 2016). The factor loadings for the unadjusted model are very similar to the loadings in the NPDC CFA.
These analyses have been based on factor scores. Having selected a one factor solution and determined that entire sample is best conceived of representing a single population, we tested whether a simple sum score would be adequate compared to score based on the factor scoring. To do this, we refit the CFA with the constraint that all factor loadings were fixed to one. Model fit was very similar to the model with free factor loadings: RMSEA = .12, CFI = .84, and Chi square (44) = 84.74, p = .0000. This difference is not statistically significant [Chi square (9) = 14.52, p = .1048] and examination of the domain factor loadings on the total indicates that they are similar to each other. We conclude that a single sum score based on the APERS domains sufficiently captures the variance in the scale.
Question 2b: Construct Validity–Sensitivity to Program Effects
Assessment instruments are sometimes used to assess the impact of reform or interventions to enhance quality. For those instruments, sensitivity to detecting changes that are predicted by a hypothesis can be viewed as a measure of construct validity (Guyatt et al. 1987; Nunnally and Bernstein 1994). For the NPDC project, staff conducted the APERS in the fall of the academic year and used those data to design and implement a plan with the school staff that would improve quality in the school. NPDC staff then conducted an APERS assessment again in the spring of the school year. The hypothesis was that APERS scores would increase. Univariate t tests were conducted to determine the difference between the pre and post APERS mean item ratings, which indicated a significant difference between the two time points for the total and all domain scores (all t > 4.38; all p < .001; all d > .50; see Table 6). These findings were consistent with the hypothesis and suggest sensitivity of the instrument to program effects. It is important to note that a subset of these data appeared in a previous article published by (Odom et al. 2013).
While there has been an increase in the number of children and youth with ASD served by the public schools and a need for determining the quality of services provided, there has not previously been a standardized, psychometrically validated instrument that assesses program quality for this group of children and youth. This study contributes to the literature by providing psychometric evidence for the reliability and validity of one such instrument—the APERS.
The first research question addressed the instrument reliability of the APERS. Analyses of internal consistency (Cronbach 1951, 1970) occurred for two data sets. Using guidelines for interpreting alphas established by Cicchetti (1994) and others (i.e., < .70 = poor; .70–.79 = fair; .80–.89 = good; ≥.90 = excellent), the overall internal consistency for the APERS was excellent, and alphas for the domain scores were primary in the fair to good range. The lower scores may have been in part due to the small number of items in some domains. Resource limitation prevented collecting inter-rater agreement data for the NPDC sample, but it was collected on the CSESA sample. The ICC and correlation between raters on mean item scores was moderate, but the mean item total APERS score for the two raters when averaged across programs were nearly identical. Even with this evidence for inter-rater agreement, it is important to specify that the APERS is a rating scale rather than a direct observational system in which event, interval-sampling, or momentary-time sampling data are collected. For the latter measures, exact agreement on whether a behavior did or did not occur is necessary (Yoder and Symons 2010). For the APERS, raters gathered information from observations, multiple interviews, and written documents, and used the convergence of information to make judgments about items ratings. For rating scales, measures of internal consistency are more important indicators of reliability (Henson 2001).
From our review of the literature and examination of other assessments of program quality, we proposed a conceptual framework of program quality that contained 10 subdomains. To provide evidence of construct validity, we conducted a confirmatory factor analysis that indicated the domains loaded on a single factor solution. We then replicated this finding with a second, independent set of data collected in high schools. As noted, the RMSEA score was higher than generally considered acceptable, and it is possible that RMSEA may have been affected by our relatively small sample size (Kenny et al. 2015). However, we propose the factor loadings provides stronger evidence for the construct validity of the APERS. These analyses provided support for our hypothesis that multiple features of programs for children and youth with ASD will contribute to an overall construct of program quality.
Another indicator of construct validity is the sensitivity of an instrument to changes consistent with a hypothesized effect (Hale and Astolfi 2014). In a study conducted with the NPDC sample, (Odom et al. 2013) analyzed changes in total APERS score for a group of school programs in which staff implemented a quality improvement plan (i.e., based on APERS pretest scores) in their schools. The APERS detected significant differences across time that were consistent with the researchers’ hypotheses. The next step in this research will be to examine use of the APERS in an experimental study in which a model, like NPDC or CSESA for example, is implemented in a set of schools and is compared to similar set of schools randomly assigned into a control condition to determine if it can detect treatment effects.
Several methodological limitations to this study exist. Although data were collected by a nationally distributed set of researchers, all were members of a single research group. Replication by independent researchers would be a desirable next step. Also, psychometric evaluations of instruments with 60+ items require a large number of participants, which in this case are classrooms or schools. For some analyses (e.g. factor analysis), we approached being “under-powered,” and our analyses would have benefited from having more participants (i.e., schools). In addition, for research involving children and youth with ASD, it is important to include information about the race and ethnicity of the sample (Pierce et al. 2014). This information was available for the CSESA sample but not for the NPDC sample.
Another limitation was that the programs involved in this study were a “convenience sample” (i.e., part of large professional development or experimental research projects). It would have been optimal to have had a stratified random selection of programs. However, when working in authentic settings such as schools in communities, addressing broad, important questions sometimes may come at the cost of control one could achieve with more narrowly defined samples (e.g., individual students vs. schools). Also, we noted that the sample is “small” for the type of psychometric analyses required of assessment instruments, but in comparison to other studies noted in the literature review, this study is the largest, to date, to directly assess program quality in school setting for students with ASD, although Renty & Roeyers (2005) did have a larger number of schools that responded to their survey research study in Belgium.
The conceptual framework proposed in Fig. 1 suggested that program quality may serve as a foundation for implementation of evidence-based practices. We proposed that program quality is similar to the concept of “common factors” clinical psychology therapeutic practice. This concept is new to the field of education. A direction for future research would be to examine empirically the relationship between program quality and the fidelity of implementation of EBPs in programs for children and youth with ASD.
The practical significance of this study is that it demonstrated reliability and validity of a measure of quality for school-based programs for children and youth with ASD. The data from these studies were collected in a geographically diverse set of school programs that were both inclusive and non-inclusive. The psychometric evidence underlying the APERS may allow practitioners and administrators to use with confidence the instrument for a variety of purposes. One purpose may be formative evaluation and program improvement. As noted in (reference blinded, to be included in final manuscript) and previously in this study, focused program development based on the APERS appears to improve program quality. This finding, however, would need to be confirmed in studies that employ randomized experimental design methodology.
Another practical implication is that the APERS may be a tool that could be used to communicate with families the quality of programs for their children with ASD. Often, issues of quality are points of heated discussion between school personnel and family members (Yell et al. 2003). Domains and indicators on the APERS may be beneficial to both parties in that they will allow discussion to focus more on specific practices and processes rather than generalized, ill-defined concepts of quality. In addition to the practical implications, the APERS now provides a psychometrically sound tool that may be used in research on educational programs for children and youth with ASD.
Along with the benefits there are some practical limitations. The APERS does require training. It is not an “off the shelf” product. Training of a single staff member who may then train others in a system takes 3–4 days. Also, the APERS assessment is itself labor intensive. The total staff time for one school (i.e., scheduling, observing, interviewing, reading records) has often required 2 days. It does, however, provide a comprehensive assessment of features of the program that are critically important for students with ASD.
In conclusion, this study provides support for the APERS as a measure of quality for school-based programs for children and youth with ASD. High quality programs establish the foundation for teachers’ implementation of evidence-based practices. The APERS should be viewed as a “starting place” that is necessary, but possibly not sufficient, for implementing instruction or intervention that links student goals to evidence-based focused intervention practices. The further steps of having measureable and observable goals and linking those goals to rigorously identified EBPs (see reference blinded, to be included in final manuscript) are essential in effective programs for children and youth with ASD.
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The authors thank Kara Hume and Laura Hall for a careful final editing of this paper.
The work reported here was supported by the Institute of Education Science, U. S. Department of Education through Grant R324C120006 and the Office of Special Education Programs through Grant H325G07004, both in the U. S. Department of Education.
Conflict of interest
The authors declare they have no conflict of interest.
All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments. Informed consent was obtained for all participants in this study.
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Odom, S.L., Cox, A., Sideris, J. et al. Assessing Quality of Program Environments for Children and Youth with Autism: Autism Program Environment Rating Scale (APERS). J Autism Dev Disord 48, 913–924 (2018). https://doi.org/10.1007/s10803-017-3379-7
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domain: psychology


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Though Chadron State College is known for its Rural Health Opportunities Program (RHOP) program options, the college also offers 10 other programs in the health professions.
The RHOP program currently includes nine health professions, but is limited to students who are residents of Nebraska. Only a certain number of positions are available each year, and the program primarily recruits high school seniors interested in the RHOP’s included professions. However, students who reside out-of-state or that may be interested in careers in health care outside of RHOP have options too.
In addition to RHOP, Chadron State offers pre-requisite courses and training to 10 additional fields in health care. Though these students may not receive an undergraduate degree from CSC, these courses fulfill the pre-requisites needed to get into the professional schools of a student’s choosing.
The over-arching goal for the 19 health care professions is to prepare students for their professional careers as well as fulfill pre-requisites here. With programs varying between two to four years for an undergraduate degree, professors, faculty and advisers work with students to make sure they are ready to go into their chosen professions.
Recently, the science departments have received attention from the New Horizon Math Science Initiative, a $29 million plan for improvements in the Math and Science Building. Last fall, the Initiative received a $500,000 gift from the Sunderland Foundation and, additionally, a visit from Gov. Pete Ricketts.
Students outside of the RHOP program can obtain their pre-requisites at CSC in careers such as podiatry, optometry, mortuary science and veterinary medicine.
RHOP’s current options are:
Medical Lab Science, Dental Hygiene, Dentistry, Medicine, Nursing, Pharmacy, Physical Therapy, Physical Assistant and Radiography.
CSC’s current health professions options are:
Chiropractic Medicine, Cytotechnology, Nuclear Medicine, Occupational Therapy, Osteopathic Medicine, Podiatry, Veterinary Medicine, Clinical Perfusion, Mortuary Science and Optometry.

domain: medical


Wireless Sensor Networks (WSNs) are a significant technology attracting considerable research interest. Recent advances in wireless communications and electronics have enabled the development of low-cost, low-power and multi-functional sensors that are small in size and communicate over short distances. Most WSN applications require knowing or measuring locations of thousands of sensors accurately. For example, sensing data without knowing the sensor location is often meaningless. Locations of sensor nodes are fundamental to providing location stamps, locating and tracking objects, forming clusters, and facilitating routing. This research focused on the modeling and implementation of distributed, mobile radar sensor networks. In particular, we worked on the problem of Position-Adaptive Direction Finding (PADF), to determine the location of a non- collaborative transmitter, possibly hidden within a structure, by using a team of cooperative intelligent sensor networks. Position-Adaptive radar concepts have been formulated and investigated at the Air Force Research Laboratory (AFRL) within the past few years. In this paper, we present the simulation performance analysis on the application aspect. We apply Extremum Seeking Control (ESC) schemes by using the swarm seeking problem, where the goal is to design a control law for each individual sensor that can minimize the error metric by adapting the sensor positions in real-time, thereby minimizing the unknown estimation error. As a result we achieved source seeking and collision avoidance of the entire group of the sensor positions.


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2 bus schedules from Zihuatanejo, Gro. to Manzanillo, Col.
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