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Validation study of the Functional Assessment of Cancer Therapy-Cognitive Function-Version 3 for the Portuguese population
Ana F. Oliveira ORCID: orcid.org/0000-0002-0883-73611,
Isabel M. Santos ORCID: orcid.org/0000-0003-2404-40352,
Sofia Fernandes ORCID: orcid.org/0000-0003-2006-81873,
Pedro Bem-Haja ORCID: orcid.org/0000-0002-7547-57431 &
Ana Torres ORCID: orcid.org/0000-0002-8919-03781,4
BMC Psychology volume 10, Article number: 305 (2022) Cite this article
Cancer-related cognitive impairment is a common and potentially debilitating symptom experienced by patients with non-central nervous system (CNS) cancers, with negative impact on their quality of life. The Functional Assessment of Cancer Therapy-Cognitive Function-Version 3 (FACT-Cog-v3) is the most extensively used instrument specifically developed to evaluate cognitive complaints in adult cancer patients. Nevertheless, this self-report measure is not yet validated for the Portuguese population. Therefore, the purpose of this study was to evaluate the psychometric properties of the FACT-Cog-v3 among patients with non-CNS cancers in Portugal.
The validation study was conducted based on a convenience sample of 281 patients with non-CNS cancers, aged between 18 and 65 years, recruited online. A confirmatory factor analysis (CFA) was used to test the factor structure of the Portuguese FACT-Cog-v3 version; internal consistency analysis was also conducted. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (EORTC QLQ-C30–version 3) and the Hospital Anxiety and Depression Scale (HADS) were also used to test the concurrent, convergent, and discriminant validity of the scale.
CFA supported a four-factor model with good fix indexes and internal consistencies: perceived cognitive impairments (α = 0.97), comments from others (α = 0.92), perceived cognitive abilities (α = 0.93), and impact on quality of life (α = 0.92). Concurrent, convergent, and discriminant validities were confirmed. Moderate and strong correlations were found between the FACT-Cog-v3 subscales and the QLQ-C30 cognitive functioning subscale. Good convergent validity, with moderate correlations, was found between the FACT-Cog-v3 subscales and the HADS-A, HADS-D, and QLQ-C30 fatigue, sleep disturbance, and global health status subscales. Acceptable discriminant validity, with weak and moderate correlations, was demonstrated between the FACT-Cog-v3 subscales and the QLQ-C30 pain and nausea/vomiting subscales.
The Portuguese FACT-Cog-v3 version can be considered a reliable and valid measure to assess cognitive concerns of patients with non-CNS cancers, with relevance for research and clinical practice.
Cancer-related cognitive impairment (CRCI) refers to cognitive problems related with cancer and cancer treatments, and is commonly experienced by patients throughout the disease trajectory [1, 2]. Although subtle, problems with short-term and working memory, attention, processing speed, and executive functions can have a significant impact on various domains of the quality of life (QoL) of patients, including work and social life [3]. Given the consequences of CRCI and its high prevalence (from 22 to 41% in patients with non-central nervous system (CNS) cancers compared to healthy patients; [4]), the identification of individuals with CRCI is necessary to guarantee adequate supportive care to those who need it [1].
Cognitive function can be assessed by formal neuropsychological tests (objective cognitive function) and subjective assessments (perceived/subjective/self-reported cognitive function, indifferently named in this study as perceived cognitive functioning or PCF) [5,6,7]. Both objective and PCF are important outcomes in research and clinical practice. Traditionally, formal neuropsychological tests have been viewed as the "gold standard" measure of cognitive function [5], detecting subtle impairments in non-clinical populations [8]. However, these tests can be burdensome for patients and researchers and may not be sensitive to detect subtle changes in cancer patients [8, 9]. Subjective assessment, through the administration of self-report questionnaires, can be a more practical approach, being effective and valid to measure patients' PCF [7, 9, 10]. Although subjective assessment shows a limited correlation with neuropsychological evaluation (see [5, 6] for several factors that may contribute to this difference), it is clinically very useful to understand patient distress, perception of cognitive functioning, and to identify patients with subtle deficits who may benefit from a neuropsychological assessment and/or close monitoring [10]. Thus, some authors advocate that subjective assessment is even more relevant than neuropsychological tests [11]. Furthermore, previous systematic reviews verified a moderate to strong association between self-reported cognitive symptoms and patient reported-outcomes, such as anxiety, depression, fatigue, and lower health status [2, 5].
Most PCF questionnaires were not developed for and have not been properly validated with cancer patients [5, 7]. Two measures have been most commonly used in the literature to assess PCF in cancer patients, namely the cognitive functioning subscale of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (EORTC QLQ-C30-version 3, briefly QLQ-C30) [12] and the Functional Assessment of Cancer Therapy-Cognitive Function-Version 3 (FACT-Cog-v3) [7]. The QLQ-C30 is a measure of QoL and comprises only two items assessing cognitive function, namely memory and concentration. Therefore, considering that this questionnaire does not assess other cognitive domains and does not provide additional information on the impact of the cognitive changes on QoL, its use as a unique indicator of PCF may result in an underestimation of the extent of cognitive difficulties [5]. Consequently, a more comprehensive and multi-dimensional measure is potentially more valid [5, 10]. In this context, the FACT-Cog-v3 [7] is one of the most well-known and the most commonly used instruments [13], both in research and in clinical settings, specifically developed to evaluate cognitive complaints in adult cancer patients [1, 5].
The FACT-Cog-v3 is a relatively brief measure and seems to be one of the most promising self-report instruments to evaluate these specific concerns, incorporating multiple dimensions such as perceived cognitive impairments (CogPCI), comments from others (CogOth), perceived cognitive abilities (CogPCA), and impact on quality of life (CogQoL). This scale was originally developed in English [7] and has been widely administered across clinical settings and validated across different cultures and languages, including French [14], Chinese [15], Korean [16], Japanese [17], Turkish [18], and English [9, 19]. These validation studies have shown good psychometric qualities, including reliability, validity, and demonstration of cross-cultural adequacy.
To our knowledge, in Portugal, there are no validated comprehensive scales to assess PCF among cancer patients. The Functional Assessment of Chronic Illness Therapy (FACIT) team, who developed the FACT-Cog-v3, has also developed other health outcomes measures specific for cancer patients. Among those is the Functional Assessment of Cancer Therapy-General (FACT-G), which has been adapted and validated to the Portuguese population [20]. However, this instrument only assesses quality of life in cancer patients and does not provide any measure of PCF. Therefore, the aim of this study was to evaluate the psychometric properties of the FACT-Cog-v3 among patients with non-CNS cancers in Portugal. The factor structure and internal consistency of this version were explored. Furthermore, the relationship between the FACT-Cog-v3 and theoretically related constructs was examined to determine the concurrent, convergent, and discriminant validity of the measure.
A convenience sample of 281 patients with non-CNS cancers completed the FACT-Cog-v3 online. The inclusion criteria were: (1) age between 18 and 65 years old; (2) diagnosis of non-CNS cancer; (3) undergoing or having received treatments for cancer; (4) ability to read and write Portuguese; and (5) Portuguese nationality. Patients with (1) psychiatric or communication disorders, and/or other serious medical condition; (2) CNS metastasis; and (3) diagnosis of dementia, epilepsy, brain injury (stroke, head injury), and drug or alcohol abuse, were excluded since these conditions might impact on cognitive functioning. Of the total sample, 266 participants additionally filled out the QLQ-C30 and, of those, 258 participants also filled out the Hospital Anxiety and Depression Scale (HADS) (see Measures section for a description of these instruments).
Volunteer cancer patients were recruited through online advertisement disseminated across Portugal. An online survey (LimeSurvey®) located on a server from the University of Aveiro was used to collect data from participants. Participants were a self-selected sample who replied to advertisements posted on social media (Facebook), specifically in support groups, blogs/forums, cancer-related information groups, and pages of national cancer associations that accepted to collaborate in the dissemination of the study, targeting Portuguese adult cancer patients; national cancer associations were also invited to collaborate in disseminating information about the study by e-mail to their associates. Advertisements invited potential participants to access a link to the survey. Those who clicked on the link were then given detailed information about the study's goals, inclusion criteria, and ethical statements. Participants were informed that their participation was voluntary and confidentiality of the data was ensured. Cancer patients who agreed to the study conditions provided their informed consent by clicking on the "Yes" option to the question "Do you accept to participate in this study?". The survey was open for four months, between January and April 2021. The protocol took approximately 30 min to complete. Participants' ethical treatment was safeguarded, in accordance with the Declaration of Helsinki [21] and the guidelines of the American Psychological Association [22]. The Ethics and Deontology Committee of the University of Aveiro (22 January 2020/ No. 30/2019) approved all the procedures of this study.
Participants completed a global self-report questionnaire assessing sociodemographic (e.g., age, education, occupation) and clinical variables (e.g., cancer diagnosis, treatments, brain injuries).
The version 3 of the FACT-Cog [7] used in this study was translated into universal Portuguese by the FACIT team, using an iterative methodology [23, 24]. For the present study, authorization was requested from FACIT to test its psychometric properties. Figure 1 presents an overview of the translation process performed by FACIT as well as a schematic representation of the validation process described in the present article.
Overview of the process of translation and validation of the Portuguese version of the Functional Assessment of Cancer Therapy-Cognitive Function-Version 3 (FACT-Cog-v3)
The FACT-Cog-v3 is a 37-item self-response measure to assess cognitive concerns of cancer patients, consisting of four subscales. For CogPCI (20 items; 0–80) and CogOth (4 items; 0–16) items, the patient indicates how often the situation occurred during the last 7 days, on a 5-point Likert scale ("0 = Never" to "4 = Several times a day"); and for CogPCA (9 items; 0–36) and CogQoL (4 items; 0–16), a 5-point Likert scale ("0 = Not at all" to "4 = Very much") is used to indicate the severity of each situation taking into account the last week. Although two items of CogPCI and two items of CogPCA are not currently scored under the FACT-Cog-v3 scoring algorithm, according to FACIT, they may be included if some additional analyses (i.e., internal consistency and individual item-total correlation coefficients) are conducted to confirm that the items have a good fit with the scale. Therefore, the 37 items were used in this study to test its psychometric properties [19]. Except for the CogPCA subscale, negatively worded items are reverse scored prior to summing all the items. Higher scores indicate better PCF and better QoL. The reliability and validity of these scores have been established [14, 16], including the preliminary evaluation of the Portuguese version that revealed good psychometric properties regarding reliability and concurrent and convergent validity [25].
The QLQ-C30 [12, 26] is a 30-item self-response questionnaire that was used to assess health-related QoL. This scale includes a global health status/QoL subscale, functional and symptom subscales, and single items. Each of the items is scored on a 4-point Likert scale ("1 = Not at all" to "4 = Very much"), except the items of the global health/QoL subscale (modified 7-point linear analogue scale). The scores for each subscale range from 0 to 100, with higher scores for functional scales and global health/QoL representing better functioning and QoL, while higher scores in the symptom subscales and single items are indicative of worse symptoms. Of interest in this study was the cognitive functioning, global health/QoL, fatigue, and sleep disturbance subscales. Good psychometric properties were found on the Portuguese validation study [26]. In this study, the subscales used have shown acceptable Cronbach's alpha: Cognitive Functioning = 0.79, Fatigue = 0.88, Pain = 0.88, Nausea/Vomiting = 0.70, and Global Health Status/QoL = 0.91.
This study included use of the HADS [27, 28], a 14-item self-response questionnaire, useful in recognizing emotional components of physical illness. The HADS consists of two subscales, each with seven items, one measuring anxiety (HADS-A) and one measuring depression (HADS-D); these items are answered on a 4-point Likert scale. Each subscale has a score ranging 0–21 points; higher scores indicate a higher level of anxious and depressive symptoms. Good psychometric properties were found on the Portuguese validation study [28]. In this study, Cronbach's alpha was acceptable (0.86) for both subscales.
Statistical analyses were performed with the Statistical Package for the Social Sciences (IBM SPSS, version 28.0; IBM SPSS, Inc., Chicago, IL) and with the lavaan package for R [29, 30].
Descriptive statistics were first calculated for sample's demographic and clinical characteristics. Measurement characteristics, i.e., mean scores, standard deviations (SD), and range, are presented for each subscale.
Reliability, through internal consistency, was measured using the following techniques and cut-off recommendations: mean of the inter-item correlation (adequate if > 0.30), corrected item-total correlation (adequate if > 0.50) [31], and Cronbach's alpha (acceptable if > 0.70 and high if > 0.90) [32,33,34].
To test criterion validity of the scale, concurrent validity was established via correlation coefficients between the scores of the FACT-Cog-v3 and the QLQ-C30 cognitive functioning subscale.
Construct validity was determined by factorial, convergent, and discriminant validity. Confirmatory factor analysis (CFA) was used to test the hypothesis that the construct of PCF, as assessed by the FACT-Cog-v3, is composed of four separate factors of CogPCI, CogOth, CogPCA, and CogQoL [7]. Mardia's Test was performed to assess the multivariate normality of the sample. Regarding sample size requirements for CFA, rules-of-thumb vary from five to 10 subjects per variable, including a minimum of 100 subjects [34] or a range of 200–300 individuals [35, 36]. A CFA using weighted least squares with mean and variance adjustment (WLSMV) estimator was conducted. We considered the following goodness-of-fit indices and respective cut-off recommendations for good adjustment [31, 37,38,39,40]: Chi-Square (χ2); Comparative Fit Index (CFI; 0.90 ≤ CFI ≤ 0.95); Tucker-Lewis Index (TLI; 0.90 ≤ TLI ≤ 0.95); Root Mean Square Error of Approximation (RMSEA; 0.05 ≤ RMSEA ≤ 0.08); and Standardized Root Mean Square Residual (SRMR ≤ 0.08). Local model fit was assessed through the items' standardized factor loadings (λ ≥ 0.50) and individual reliability (R2 ≥ 0.25) [31, 40].
Convergent and discriminant validity were assessed using the Fornell and Larcker [41] criterion and by correlations with external criteria. Convergent validity of the measurement model can be assessed by the average variance extracted (AVE; AVE ≥ 0.50) and construct reliability (CR) for each factor (CR ≥ 0.70) [41], and discriminant validity is supported when the AVE for a construct is greater than the squared interconstruct correlations [31]. Convergent validity was also assessed by examining the correlations between FACT-Cog-v3 subscales and HADS and QLQ-C30 fatigue, sleep disturbance, and global health status subscales. Discriminant validity was further examined through the correlation between FACT-Cog-v3 subscales and QLQ-C30 pain and nausea/vomiting subscales.
Following the guidelines presented by Ratner [42], the correlations were classified as weak (0–0.3), moderate (0.3–0.7), and strong (> 0.7–1.0).
All significance tests were conducted using a significance level of p < 0.05.
The demographic and clinical characteristics of the sample are displayed in Table 1. Cancer patients were 18–65 years-old and the mean age was 45.97 years. The most frequently reported cancer diagnosis was breast cancer (62.7%), followed by Hodgkin lymphoma and colorectal cancer (both 6.0%). More than half of the cancers (68.3%) were diagnosed during the last 5 years. More than 80% of the sample had undergone surgery (82.9%) and chemotherapy (80.8%). Presently, 57.3% of the sample has completed the treatments, while 29.9% are still receiving hormone therapy.
Table 1 Sociodemographic and clinical characteristics of the sample (N = 281)
Description of the Portuguese FACT-Cog-v3
Means, SDs, and range for the Portuguese version of the FACT-Cog-v3 items and subscales are presented in Table 2. The lowest score emerged for CogPCH2 (M = 1.21, SD = 1.13) and the highest score for CogM9 (M = 3.54, SD = 0.86). The mean scores of the four subscales were 47.56 (SD = 20.47), 13.64 (SD = 3.54), 16.33 (SD = 7.70), and 8.64 (SD = 4.51) for CogPCI, CogOth, CogPCA, and CogQOL, respectively.
Table 2 FACT-Cog-v3 subscales means and standard deviations, range, item-total correlations, and Cronbach's alphas (N = 281)
Factor validity
Mardia's Test showed that data is not multivariate normal, g1p = 250.14, χSkew = 11,714.97, p < 0.001; g2p = 1351.46, ZKurtosis = 34.26, p < 0.001; χSMSkew = 11,847.45, p < 0.001. The achieved sample size was enough to ensure stability of a factor solution.
A CFA with WLSMV was used to confirm the four-factor structure of the scale. Results revealed a good global adjustment, χ2(623) = 1096.48; CFI = 0.903; TLI = 0.897; RMSEA = 0.052, RMSEA 90% CI[0.047, 0.057]; SRMR = 0.055. Moreover, all items reached high factor weights and appropriate individual reliabilities on latent variables. The structural model that was tested using CFA and the resultant factor loadings and correlations are displayed in Fig. 2. Factor analysis of the 33-item FACT-Cog-v3 revealed a similar pattern (see Additional file 1).
Diagram of four-factor structure (37 items) obtained using CFA with WLSMV estimator
For FACT-Cog-v3 dimensions of CogPCI, CogOth, CogPCA, and CogQoL, adequate mean inter-item correlations were obtained, 0.604, 0.755, 0.608, and 0.749, respectively, indicating that items in the same factor must be assessing the same construct. Regarding corrected item-total correlations, for each dimension, all items showed adequate item-total correlations (ranging between 0.464 and 0.867), indicating that all items are well correlated with the corresponding dimension. Cronbach's alpha coefficient for FACT-Cog-v3 subscales were 0.97 for CogPCI, 0.92 for CogOth, 0.93 for CogPCA, and 0.92 for CogQoL, indicating high reliability. None of the items would substantially affect reliability if they were deleted, since all values are around the Cronbach's alpha for each subscale. Internal consistency estimates for the FACT-Cog-v3 subscales are displayed in Table 2.
Concurrent validity
Spearman's correlations were calculated between the FACT-Cog-v3 subscales scores and the QLQ-C30 cognitive functioning subscale to establish concurrent validity (Table 3). All FACT-Cog-v3 subscales scores correlated positively (moderate and strong correlations) with QLQ-C30 cognitive functioning subscale.
Table 3 FACT-Cog-v3 Spearman's correlations with cognitive functioning, anxiety, depression, fatigue, sleep disturbance, global health status, pain, and nausea/vomiting scores
Convergent and discriminant validity assessed by the Fornnel and Larcker method
According to the Fornell and Larcker [41] testing system, indicators of convergent validity showed good results: CR of the factors revealed adequate results, with 0.98, 0.95, 0.96, and 0.96 for CogPCI, CogOth, CogPCA, and CogQoL, respectively; and AVE showed adequate values (AVECogPCI = 0.63, AVECogOth = 0.74, AVECogPCA = 0.62, AVECogQoL = 0.75).
Discriminant validity was assessed by comparison of AVEs with the square of the correlation between factors. All factors have discriminant validity, as AVE values were above the square of the correlation between the factors, except between CogPCI and CogPCA (Table 4). Further analyses were conducted to examine if the two factors should be maintained as separate dimensions. As we can see in Table 3, when we conduct partial correlations between CogPCI and the QLQ-C30 global health status controlling for CogPCA, results are not significant; contrarily, between CogPCA and the same QLQ-C30 subscale controlling for CogPCI, the results are significant.
Table 4 Discriminant validity results—Fornell and Larcker criterion
Convergent and discriminant validity by external criteria
Convergent validity was examined through Spearman's correlation between FACT-Cog-v3 subscales and HADS and QLQ-C30 fatigue, sleep disturbance, and global health status subscales (Table 3). All FACT-Cog-v3 scores correlated negatively (moderate correlations) with HADS-A and HADS-D and with QLQ-C30 fatigue and sleep disturbance subscales and correlated positively (moderate correlations) with QLQ-C30 global health status subscale.
For discriminant validity, correlations between all FACT-Cog-v3 scores and QLQ-C30 pain and nausea/vomiting subscales were obtained, showing negative correlations (weak and moderate for pain and weak for nausea/vomiting) (Table 3).
The main goal of the present study was to provide evidence of the reliability and validity of the Portuguese version of the FACT-Cog-v3, thus making available an instrument that assesses PCF to the Portuguese cancer population. Our results demonstrated that the FACT-Cog-v3 is a reliable and valid measure of CRCI among patients with non-CNS cancers in Portugal.
In line with recent recommendations arising from the positive results of Koch et al. [19] study and FACIT scoring instructions, this study used the full 37-item scale, including the additional multitasking items. The findings of the CFA showed a good fit between the hypothesized model and the observed data, as well as acceptable loadings. Thus, all items measuring the factors support the four-factor structure for the FACT-Cog-v3 scale, consistent with the CogPCI, CogQoL, CogOth, and CogPCA subscales proposed by the original authors [7] and other language validations [16, 17]. The results also confirmed that the additional multitasking items load with the expected subscales, as proposed by the original authors [7]. Considering the positive results obtained with the 37 items, this study supports the use of the full scale in research and clinical practice to gain a comprehensive understanding of PCF [19]. We should also note that good psychometric findings were obtained with the 33-item version, and conclude that both Portuguese versions are valid. Thus, each user can opt for the version that best fits their purpose. Moreover, this validation study was conducted with patients with non-CNS cancers, rather than with breast cancer patients only, as most studies previously did [15,16,17], providing support to the robustness and stability of the instrument's multidimensional structure, which is transversal across various cultural contexts and cancer populations.
Furthermore, there was evidence for convergent and discriminant validity of the four-factor model: the results showed a positive correlation between the items of each of the factors and showed that the items from each subscale did not correlate with items of the other subscales, respectively. We should note, however, that although the findings point towards good discriminant validity between factors, there is an exception for CogPCI and CogPCA, with values slightly above the desired. Nonetheless, the literature affirms that these scales represent two separate factors [43] and the results obtained in the present work for partial correlations show that both factors are important to measure different information related to QoL. Therefore, we decided to maintain both factors as separate dimensions, in line with the original scale.
Reliability results supported the dimensionality findings. Our findings indicated very good internal consistency for the factors of the FACT-Cog-v3 (all above 0.91), in line with or even higher than reliability scores found in previous studies [16]. At the item level, all items appeared to be worthy of retention, and the inter-item and item-total correlations indicated the items' adequacy and homogeneity in measuring the construct that the FACT-Cog-v3 intends to. The values of the Cronbach's alpha coefficients also did not improve with the removal of any of the items on the four factors. Taken together, these results confirm the theoretical structure with the four subscales.
Results obtained from concurrent validity analysis revealed that all FACT-Cog-v3 subscales scores had moderate and strong positive correlations with the QLQ-C30 cognitive functioning subscale. The QLQ-C30 cognitive functioning subscale is an established self-report scale to demonstrate concurrent validity of the FACT-Cog-v3 [16, 19]. This result is thus consistent with the moderate correlations found between the Chinese [15] and Korean [16] versions of the FACT-Cog-v3 and the QLQ-C30 cognitive functioning subscale, providing support for the concurrent validity of the Portuguese version of the FACT-Cog-v3.
Similar to the other validations of the FACT-Cog-v3, evidence of convergent validity of the scale was confirmed by correlations of this scale with theoretically related constructs. Moderate negative correlations were found with anxiety [3, 15, 44] and depressive [3, 16, 44] symptoms, fatigue [3, 15, 19, 44], and sleep disturbance [3, 44]. Moderate positive correlations were found for global health status [15]. These findings are consistent with previous validation studies [15, 16, 19]. In terms of discriminant validity, weak and moderate negative correlations were obtained for pain and weak negative correlations for nausea/vomiting, as described in Koch et al. [19]. Thus, these results provide further evidence of the FACT-Cog-v3's discriminant validity.
Despite the encouraging results, this study has some limitations that should be addressed. First, our sample was recruited online, which may represent a selection bias (i.e., selection of those cancer patients who have digital literacy, access to the Internet, and perhaps are more educated and employed). Therefore, future research should recruit participants in-person, to examine if the good psychometric properties verified in this study are maintained with cancer patients with different sociodemographic characteristics. The study's cross-sectional design is also a limitation, constraining the determination of test–retest reliability. We recommend that the temporal stability of this version should also be examined in the future. In addition to temporal stability, measurement invariance across groups (e.g., sex, age), namely metric, configural, and scalar, should be performed in future studies. Additionally, future studies should consider performing these analyses with bigger samples. Finally, caution is also needed in interpreting these findings, considering the social and health context of the COVID-19 Pandemic in which the study was conducted, since some authors alert for the possible interference of the stress related to this event on cognitive problems reported by cancer survivors [45] and the impact of the COVID-19 disease on cognitive functioning [46]. However, a previous preliminary study conducted outside the context of Pandemic [25] point to similar results, which leads us to believe that it may not have an influence on the validation of the scale.
Notwithstanding these limitations, we believe that our study provides important contributions to the field of CRCI literature, offering evidence of the good psychometric characteristics of the FACT-Cog-v3 scale in a Portuguese sample of patients with non-CNS cancers. Using this measure in clinical practice may contribute to a better understanding of patients' cognitive difficulties, thus helping to provide proper interventions to mitigate the effects of CRCI and improve QoL in this population. Furthermore, future studies can also use the Portuguese version of the FACT-Cog-v3 to assess the efficacy of cognitive intervention programs in cancer patients.
Cognitive symptoms are one of the most frequent and worrying side effects experienced by patients with non-CNS cancers. Considering its detrimental impact on QoL, it is necessary to provide validated instruments to help researchers and clinicians evaluate the nature and extent of these complaints. This study aimed to analyze the psychometric properties of the Portuguese version of the FACT-Cog-v3. Overall, the 37-items four-factor structure of the scale appears to be a reliable and valid measure of CRCI among patients with non-CNS cancers in Portugal.
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
AVE:
Average variance extracted
CRCI:
Cancer-related cognitive impairment
CNS:
CogPCA:
Perceived cognitive abilities
CogPCI:
Perceived cognitive impairments
CogOth:
Comments from others
CogQoL:
Impact on quality of life
Comparative Fit Index
Construct reliability
EORTC QLQ-C30-version 3/QLQ-C30:
European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30
FACIT:
Functional Assessment of Chronic Illness Therapy
FACT-Cog-v3:
Functional Assessment of Cancer Therapy-Cognitive Function-Version 3
HADS:
Hospital Anxiety and Depression Scale
PCF:
Perceived cognitive functioning
R2 :
Individual reliability
SRMR:
Standardized Root Mean Square Residual
TLI:
Tucker–Lewis Index
QoL:
WLSMV:
Weighted least squares with mean and variance adjustment
χ 2 :
Chi-square
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Joly F, Lange M, Rigal O, Correia H, Giffard B, Beaumont JL, et al. French version of the Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog) version 3. Support Care Cancer. 2012;20(12):3297–305. https://doi.org/10.1007/s00520-012-1439-2.
Cheung YT, Lim SR, Shwe M, Tan YP, Chan A. Psychometric properties and measurement equivalence of the English and Chinese versions of the Functional Assessment of Cancer Therapy-Cognitive in Asian patients with breast cancer. Value Heal. 2013;16(6):1001–13. https://doi.org/10.1016/j.jval.2013.06.017.
Park JH, Bae SH, Jung YS, Jung YM. The psychometric properties of the Korean version of the Functional Assessment of Cancer Therapy-Cognitive (FACT-Cog) in Korean patients with breast cancer. Support Care Cancer. 2015;23(9):2695–703. https://doi.org/10.1007/s00520-015-2632-x.
Miyashita M, Tsukamoto N, Hashimoto M, Kajiwara K, Kako J, Okamura H. Validation of the Japanese version of the Functional Assessment of Cancer Therapy-Cognitive Function Version 3. J Pain Symptom Manag. 2020;59(1):139–46. https://doi.org/10.1016/j.jpainsymman.2019.09.027.
Atasavun Uysal S, Yildiz Kabak V, Karakas Y, Karabulut E, Erdan Kocamaz D, Keser İT, et al. Investigation of the validity and reliability of the Turkish version of the Functional Assessment of Cancer Therapy - Cognitive Function in cancer patients. Palliat Support Care. 2021. https://doi.org/10.1017/S147895152100136X.
Koch V, Wagner LI, Green HJ. Assessing neurocognitive symptoms in cancer patients and controls: psychometric properties of the FACT-Cog3. Curr Psychol. 2021. https://doi.org/10.1007/s12144-021-02088-6.
Pereira F, Santos C. Estudo de adaptação cultural e validação da Functional Assessment of Cancer Therapy-General em cuidados paliativos. Referência. 2011;III Série(n.º5):45–54. https://doi.org/10.12707/RIII1041
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Bonomi AE, Cella DF, Hahn EA, Bjordal K, Sperner-Unterweger B, Gangeri L, et al. Multilingual translation of the Functional Assessment of Cancer Therapy (FACT) quality of life measurement system. Qual Life Res. 1996;5(3):309–20. https://doi.org/10.1007/BF00433915.
Eremenco SL, Cella D, Arnold BJ. A comprehensive method for the translation and cross-cultural validation of health status questionnaires. Eval Health Prof. 2005;28(2):212–32. https://doi.org/10.1177/0163278705275342.
Oliveira AF, Santos IM, Torres A. Preliminary validation study of the Portuguese version of the Functional Assessment of Cancer Therapy – Cognitive Function - Version 3 (FACT-Cog-v3). J Stat Heal Decis. 2021;3(1):87–90. https://doi.org/10.34624/jshd.v3i1.24904
Pais-Ribeiro J, Pinto C, Santos C. Validation study of Portuguese version of the QLC-C30-V.3. Psicol Saúde Doenças. 2008;9(1):89–102.
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Pais-Ribeiro J, Silva I, Ferreira T, Martins A, Meneses R, Baltar M. Validation study of a Portuguese version of the Hospital Anxiety and Depression Scale. Psychol Health Med. 2007;12(2):225–37. https://doi.org/10.1080/13548500500524088.
Rosseel Y. lavaan: An R Package for Structural Equation Modeling. J Stat Softw. 2012;48(2):1–36. https://doi.org/10.18637/jss.v048.i02
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Hair JF, Black WC, Babin BJ, Anderson RE. Multivariate Data Analysis (8th Edition). Hampshire, UK: Cengage Learning, EMEA; 2019.
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Kline P. The handbook of psychological testing (2nd Edition). Abingdon: Routledge; 1999.
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Wolf EJ, Harrington KM, Clark SL, Miller MW. Sample size requirements for structural equation models: an evaluation of power, bias, and solution propriety. Educ Psychol Meas. 2013;73(6):913–34. https://doi.org/10.1177/0013164413495237.
Brown TA. Confirmatory factor analysis for applied research. New York: The Guilford Press; 2015.
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Kline RB. Principles and practice of structural equation modeling. New York: The Guilford Press; 2011.
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Fornell C, Larcker DF. Evaluating structural equation models with unobservable variables and measurement error. J Mark Res. 1981;18(1):39–50. https://doi.org/10.1177/002224378101800104.
Ratner B. The correlation coefficient: Its values range between +1/-1, or do they? J Target Meas Anal Mark. 2009;17(2):139–42. https://doi.org/10.1057/jt.2009.5.
Lai JS, Wagner LI, Jacobsen PB, Cella D. Self-reported cognitive concerns and abilities: Two sides of one coin? Psychooncology. 2014;23(10):1133–41. https://doi.org/10.1002/pon.3522.
Bender CM, Thelen BD. Cancer and cognitive changes: The complexity of the problem. Semin Oncol Nurs. 2013;29(4):232–7. https://doi.org/10.1016/j.soncn.2013.08.003.
Nekhlyudov L, Duijts S, Hudson S v., Jones JM, Keogh J, Love B, et al. Addressing the needs of cancer survivors during the COVID-19 pandemic. J Cancer Surviv. 2020;14(5):601–6. https://doi.org/10.1007/s11764-020-00884-w
Becker JH, Lin JJ, Doernberg M, Stone K, Navis A, Festa JR, et al. Assessment of cognitive function in patients after COVID-19 infection. JAMA Netw Open. 2021;4(10):8–11. https://doi.org/10.1001/jamanetworkopen.2021.30645.
The authors thank the study participants. Furthermore, the authors would like to thank the Functional Assessment of Chronic Illness Therapy (FACIT) organization for giving authorization to use and validate the FACT-Cog-v3 in Portugal.
This work was supported by national funds through FCT - Fundação para a Ciência e a Tecnologia, I.P., within CINTESIS R&D Unit (UIDB/4255/2020 and UIDP/4255/2020), the project RISE (LA/P/0053/2020), and the William James Center for Research R&D Unit (UIDB/04810/2020). The first author was awarded a PhD fellowship (SFRH/BD/138785/2018). The funding agency had no role in the study design, data collection, and analysis; decision to publish the manuscript; or preparation of the manuscript.
Center for Health Technology and Services Research of the Health Research Network (CINTESIS@RISE), Department of Education and Psychology, University of Aveiro, 3810-193, Aveiro, Portugal
Ana F. Oliveira, Pedro Bem-Haja & Ana Torres
William James Center for Research (WJCR), Department of Education and Psychology, University of Aveiro, 3810-193, Aveiro, Portugal
Isabel M. Santos
Department of Education and Psychology, University of Aveiro, 3810-193, Aveiro, Portugal
Sofia Fernandes
Department of Psychology and Education, Faculty of Human and Social Sciences, University of Beira Interior, 6200-209, Covilhã, Portugal
Ana Torres
Ana F. Oliveira
Pedro Bem-Haja
AFO, IMS, and AT contributed to the study conception and design. Material preparation and data collection were performed by AFO, IMS, SF, and AT, and formal analyses were performed by AFO, IMS, and PB–H. The first draft of the manuscript was written by AFO and SF and all authors commented on all versions of the manuscript. All authors read and approved the final manuscript.
Correspondence to Ana F. Oliveira.
This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics and Deontology Committee of the University of Aveiro (22 January 2020/ No. 30/2019). Informed consent was obtained from all individual participants included in the study.
Additional file 1
. Factor analysis of the 33-item FACT-Cog-v3.
Oliveira, A.F., Santos, I.M., Fernandes, S. et al. Validation study of the Functional Assessment of Cancer Therapy-Cognitive Function-Version 3 for the Portuguese population. BMC Psychol 10, 305 (2022). https://doi.org/10.1186/s40359-022-01018-w
DOI: https://doi.org/10.1186/s40359-022-01018-w
FACT-Cog-v3


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text:
Lego Education's Space-Themed Sets Are Ready for Lift-Off
Students participating in the 2018-2019 FIRST Lego League challenges will get to play with two space-themed sets designed in collaboration with astronauts.
https://www.pcmag.com/news/lego-educations-space-themed-sets-are-ready-for-lift-off
Prepare for lift-off, kids.
Lego Education today provided a glimpse at two new space-themed sets that participants will use for the 2018-2019 FIRST Lego League challenges.
Every year, Lego Education teams up with FIRST, a science and technology-focused youth organization founded by entrepreneur Dean Kamen, for a competition that asks teams of elementary and high school school kids to research a real-world problem (food safety, recycling, energy) and come up with ideas to solve it. They also design, build, and program a robot using Lego Mindstorms and compete on a table-top playing field.
The 2017-2018 season, which focused on Hydro Dynamics, is wrapping up this week with championships in Houston and Detroit. Registration for the 2018-2019 season begins next month and its focus will be space.
Participants will get to play with two new space-themed sets designed in collaboration with astronauts. The "Into Orbit" and "Mission Moon" sets aim to get students excited about space exploration while helping to develop their science, technology, engineering, and math (STEM) skills.
Children ages 9 through 16 will participate in the FIRST Lego League "Into Orbit" challenge, during which "teams will design, build and code an autonomous Lego Mindstorms robot to perform a series of space-themed missions on a playing field," the organizations wrote in a news release. "They will also research a problem they identify and design an innovative solution to that problem."
Meanwhile, children ages 6 through 10 will participate in the FIRST LegoLeague Jr. "Mission Moon" challenge. Teams will use the Mission Moon Inspire Set unveiled today to "build a model based on the challenge and use Lego Education WeDo 2.0 to program it to move," the companies said.
Google, OK Go Partner to Get Students Excited About STEM
Altogether, more than 350,000 children around the world are expected to participate in the Mission Moon and Intro Orbit challenges using these new sets.
"At Lego Education, we believe the skills fostered through fun, developmental programs like those we create with FIRST will teach our children that anyone can release their potential to innovate," Lego Education President Esben Stærk Jørgensen said in a statement. "We are excited to see the FIRST LegoLeague Jr. and FIRST Lego League projects that children around the world will create."

redpajama_set_name: RedPajamaCommonCrawl


text:
Kwame Geathers, Shawn Williams suspended for first half of Florida Game
Georgia nose guard Kwame Geathers and strong safety Shawn Williams have each been suspended for the first half of the Florida game, the SEC announced today.
Geathers and Williams were both penalized for their actions during Saturday's game at Vanderbilt. Geathers is being suspended for "fighting" and Williams for a "flagrant personal foul."
Vanderbilt center Logan Stewart was also given a one-half game suspension. His "flagrant personal foul" is what prompted Geathers to retaliate.
Each player was suspended for the first half of the next game. Vanderbilt hosts Army on Saturday while Georgia plays Florida in Jacksonville on Oct. 29.
From the SEC:
Upon review of game tapes of the football game between the University of Georgia and Vanderbilt University, played in Nashville, Tenn. on Saturday, Oct. 15, 2011, Southeastern Conference Commissioner Mike Slive has announced that Vanderbilt sophomore center Logan Stewart, Georgia sophomore defensive lineman Kwame Geathers and Georgia junior defensive back Shawn Williams have been suspended for the first half of their team's next football games.
Vanderbilt hosts Army this Saturday while Georgia plays Florida in Jacksonville on Oct. 29.
Geathers' action was in violation of NCAA Football Rule 2-32-1-a for fighting. By NCAA Football Rule 9-5-1-b, the penalty for violation of the rule in the second half includes suspension for the first half of the team's next scheduled game.
On the same play, Stewart's suspension is the result of a flagrant personal foul which occurred at the 13:09 mark in the fourth quarter. The action is in violation of Rule 9-1 of the NCAA Football Rule Book, which states that a flagrant personal foul offender shall be disqualified.
Williams' suspension is the result of a flagrant personal foul which occurred at the 2:08 mark in the third quarter. The action is in violation of Rule 9-1-4 of the NCAA Football Rule Book, which reads, "No player shall target and initiate contact to the head or neck area of a defenseless opponent with the helmet, forearm, elbow or shoulder."
This action is taken in accordance with Southeastern Conference Constitution, Article 4.4.2 (d), which states that a student-athlete may be suspended if it is determined that the student-athlete has committed a flagrant or unsportsmanlike act.
Below is a video of the clip by Logan Stewart on Kwame Geathers (no. 99). Geathers then turns around and punches Stewart:
Below is a video of the foul by Shawn Williams (no. 36). The hit takes place near the SEC logo and the 30 yard line:


text:
Æbelø (Apfelinsel) ist eine unbewohnte kleine Insel vor der Nordküste der dänischen Insel Fünen () am Eingang des Kleinen Belts. Sie hat eine Fläche von 2,32 km². Die nur selten überflutete Nehrung Brådet verbindet Æbelø mit Æbeløholm. Man erreicht Æbeløholm über einen Wattweg, was die Zwillingsinsel zu einem beliebten Ausflugsziel macht.

Südlich von Æbelø befinden sich die Inselchen Dræet und Ejlinge; Lindø wurde 1871 eingedeicht und ist seitdem mit Fünen verbunden. Alle gehören zur Nordfyns Kommune in der Region Syddanmark.

Die Insel gehört zur Kirchspielsgemeinde  (dän.: Sogn) Klinte Sogn, die bis 1970 zur Harde Skam Herred im damaligen Odense Amt gehörte, danach zur Bogense Kommune im damaligen Fyns Amt, die mit der Kommunalreform zum 1. Januar 2007 in der Nordfyns Kommune in der Region Syddanmark aufgegangen ist. Seit 2009 ist die Insel unbewohnt.

Geologie
Æbelø wurde vor etwa 8000 bis 9000 Jahren zur Insel, als das Gebiet vom postglazialen Littorinameer überflutet wurde. Der Untergrund der Insel besteht aus verschiedenen tertiären, meist tonigen Lagen und aus eiszeitlichen Ablagerungen von mindestens fünf Gletschern, die im Saale-Glazial und im Weichsel-Glazial hierher vorstießen.

An den Steilküsten der Insel wird seit ihrer Entstehung durch Wellenerosion Material abgetragen. Während die größeren Geschiebeblöcke, die vielfach deutlich erkennbare Gletscherschrammen aufweisen, am Fuß der Steilküsten liegen bleiben, wird das feinkörnigere Material um die Insel herum verfrachtet und dort, auf der windabgewandten Seite der Insel, abgelagert. Hieraus entstand eine geradlinig verlaufende Nehrung (Brådet) zum benachbarten Æbeløholm, an dessen Südost- und Südwestküste sich ihrerseits eine Reihe von Nehrungshaken gebildet haben.

Wegen ihrer interessanten geologischen Entwicklung wird die Insel als Gebiet von nationalem geologischen Interesse (nationalt geologisk interesseområde) geführt.

Bewohner und Nutzung
1787 hatte die Insel 17 Einwohner. 1940 waren es etwa 50. Die Insel wurde ursprünglich hauptsächlich als Weideland genutzt. Es gab mehrere Höfe und eine eigene Schule. An der Nordwestspitze Nordre Bråd wurde der Leuchtturm Æbelø Fyr errichtet. Auf Æbelø wurde Anfang des 20. Jahrhunderts Kies abgebaut, den man auch 1935 für den Bau der Eisenbahnbrücke über den Kleinen Belt (Lillebæltsbro) verwendete. Reste der Kiesgruben sind noch erkennbar, ebenso Schienen, auf denen der Kies zu einer Verladestation an der Westseite der Insel gebracht wurde. Auch hiervon sind Relikte erhalten.

Seit den 1960er Jahren nahm die Bevölkerung kontinuierlich ab; heute gibt es keine Dauerbesiedlung mehr. Bis 1995 wurde Æbelø als Jagdrevier genutzt. Dazu wurden Enten, Fasane, Ziegen, Rot- und Damwild ausgesetzt. Darunter litt die Pflanzenwelt; so verschwand der Ilexbestand.

Naturschutz
1995 kaufte die private Umweltstiftung Aage V. Jensen Naturfond Æbelø und die Nachbarinseln von Gutsbesitzer Erik Grevenkop-Castenskiold. 1999 wurde das Gebiet unter Naturschutz gestellt, Vegetation und Küstenlinie sollen dem freien Spiel der Naturkräfte überlassen werden. Entwässerungsgräben wurden aufgegeben, um die Entstehung von Feuchtflächen zu fördern. Die alten Wirtschaftsgebäude wurden abgetragen, mit Ausnahme des Leuchtturmwärterhauses und eines Gehöfts im nördlichen Teil der Insel.

Weblinks

 Æbelø Aage V. Jensen Naturfond
 Nationalt Geologisk Interesseområde Æbelø Naturstyrelsen
 Natura 2000-Gebiet Nr. 108 (Æbelø, havet syd for og Nærå) Naturstyrelsen

Einzelnachweise

Insel (Europa)
Insel (Dänemark)
Insel (Kattegat)
Geographie (Nordfyns Kommune)

redpajama_set_name: RedPajamaWikipedia


text:
Q: tf.matmul to find theta that minimizes the cost function I am using TensorFlow to calculate the value of theta that minimizes the cost function  where theta = Inverse of(xT . X) . xT . y
I am following along the tutorial in https://github.com/ageron/handson-ml/blob/master/09_up_and_running_with_tensorflow.ipynb
booktheta = tf.matmul(tf.matmul(tf.matrix_inverse(tf.matmul(XT,X)),XT),y)

mytheta = tf.matmul(tf.matrix_inverse(tf.matmul(XT,X)),tf.matmul(XT,y))

with tf.Session() as sess:
   book_tvalue= booktheta.eval()
   print(book_tvalue)

[[ -3.74651413e+01]
[  4.35734153e-01]
[  9.33829229e-03]
[ -1.06622010e-01]
[  6.44106984e-01]
[ -4.25131839e-06]
[ -3.77322501e-03]
[ -4.26648885e-01]
[ -4.40514028e-01]]

with tf.Session as sess:
   my_tvalue= mytheta.eval()
   print(my_tvalue)

  [[ -3.74218750e+01]
  [  4.35844421e-01]
  [  9.34600830e-03]
  [ -1.06735229e-01]
  [  6.44439697e-01]
  [ -4.22634184e-06]
  [ -3.77440453e-03]
  [ -4.26208496e-01]
  [ -4.40002441e-01]]

I am trying to understand why the two are different and if I am interpreting the way theta is being calculated accurately.

redpajama_set_name: RedPajamaStackExchange


Home security is not something to be taken lightly. Not only is home security important to protect your personal property from theft or damage, but it also protects you and your family from possible harm. Even if you live in a gated community within the Kansas City metro area, it's vital to safeguard your property from potential break-ins and robberies.
It's best to be discreet about any major purchases or new belongings that you've acquired. Thieves look for clues of any valuables that are inside homes. For example, break down any large boxes that hold flat screen televisions. Home security is much easier if you don't show potential robbers all your cool toys.
Just like bad habits develop over time, so do good habits. Begin to lock all windows and doors at night, especially on the first floor. Also, keep your gates closed and locked around your property. If you do need to leave a key for another resident of your house, make sure it's not in an obvious place like under the doormat.
Neighborhood Watch programs are great if you know your neighbors. Make new friends and work together to keep an eye open for any suspicious activities within your neighborhood.
With smart homes becoming more common, people can monitor their property from a remote site. From security cameras to motion detectors, many digital home security systems can text or email you if anything is out of sorts. In some cases, you can even lock and unlock your doors from a different location.
Even with all the home security systems and habits in place, it's equally important to have an emergency plan. Make sure your family understands what to do in a break-in situation. The most important part of home security is to keep you and your family safe!
At Blinds To Go Commercial & Residential, we offer commercial window treatments, residential window treatments from wood blinds to shutters, or woven shades to sun screens — there are many options.


Shop Miss A Hauls are one of my favorite YouTube videos to watch, so I decided that it was time to pick out some new items, especially because it's been 4 years since I last shopped on their site. I purchased some really nice items including the scarf that is in the picture. Check out my YouTube video below, and feel free to comment with your favorite Shop Miss A find!


text:
Market Extra
How investor caution is limiting both stock market gains and declines
Published: Oct. 23, 2017 at 2:53 p.m. ET
Ryan Vlastelica
'Tax reform optimism' has contributed to 5% rally since August: Goldman Sachs
Courtesy Everett Collection
U.S. stock market investors are worried. That's the bad news—and the good news.
There is no shortage of risk on Wall Street, and cautious investors can point to any number of factors—including high valuations, geopolitical tensions, and policy uncertainty surrounding both the Federal Reserve and the U.S. government—as a reason why the market's seemingly unending bull market could come to a screeching halt.
Such headwinds could limit the market's upside potential. At the same time, however, the mere acknowledgment of such concerns could diminish how risky they actually are, as the more investors fret about them, the more they're priced into shares.
"We do not expect an imminent drawdown, but the risks identified most frequently by clients may limit medium-term S&P 500 SPX, +2.43% upside," Goldman Sachs analysts wrote in a research report. However, the investment bank added: "Persistently cautious investor sentiment is one reason we expect limited downside from any economic or policy-related disappointment."
Read more:Stocks are incredibly overbought—why that's not nearly as scary as it sounds
Don't miss:What could derail the stock-market rally? Here's one thing to watch
Goldman has previously stated that because investor euphoria is "nonexistent, an imminent start of a long decline seems unlikely." However, the analysts did see reasons why the market could struggle going forward, noting that the Institute for Supply Management manufacturing index was above 60, a strong reading that nevertheless "typically marks the peak of growth and presages economic and equity deceleration."
"Investors buying the S&P 500 at ISM readings of 60 or higher have gone on to suffer negative three- and six-month returns on average as economic activity slowed," wrote David Kostin, the firm's chief U.S. equity strategist. "In other words, an environment of synchronized global growth acceleration today raises the risk of coordinated global slowdown tomorrow."
Despite that, it speculated that near-term market direction would be dependent on whether tax reform passes in Washington, saying the issue was "the key potential upside and downside risk to equity markets."
"We estimate tax cuts could lift 2018 earnings per share by 7%…, suggesting that tax reform optimism has contributed to the 5% S&P 500 rally since late August," Goldman wrote. "If developments in Washington lift the odds of tax reform closer to 100%, or hint at larger cuts than we currently expect, S&P 500 could continue to rise toward 2,650. On the other hand, a collapse in expectations would likely mean the reversal of the market's recent 5% rally."
Other institutions joined Goldman in seeing near-term risks.
The Wells Fargo Investment Institute wrote that "this is a good time to take profits from U.S. equities and reallocate to areas of the markets where allocations are below target weightings." It added that valuations "appear more reasonable" for overseas markets.
Morgan Stanley noted that the 14-day relative strength index for the S&P 500 has been above 70 for 15 straight days, a level it said was considered "overbought territory from a momentum perspective." In the past, such rallies have been followed by pullbacks in the subsequent 30 days, with a median decline of 4.5%.
"We now believe the market may take a pause here before ultimately ascending to 2,700 early next year," the investment bank wrote.
A pause is long overdue, historically speaking. It has been 20 months since the most recent S&P 500 correction, defined as a 10% drop from a peak, and 332 trading days (16 months) since the latest drop of 5%, the fourth-longest such streak in history. Historically, there is a 5% drop every 92 days, on average.
Even smaller dips have been nonexistent. The S&P 500 hasn't had a 3% decline in more than 11 months, the longest such streak ever, and it has gone 33 straight days without a 0.5% decline, "the longest streak since 1995," according to LPL Financial.
Beyond the bull market, the U.S. economy overall has been enjoying an atypically long period of growth. Bespoke Investment Group noted that the current economic expansion "has now joined the 100-month club," a rare occurrence, and more than twice the average length of expansions, which is 46 months. Going back to 1900, there have only been two expansions that lasted for longer, with the lengthiest, at 120 months, starting in March 1991. While the bull market started in March 2009, when the stock market bottomed after the financial crisis, the economy resumed expanding in June 2009.
Courtesy Bespoke Investment Group
8 tech stocks poised to bounce after Nasdaq plunge, according to AI platform
Shares of Nvidia Corp. top a list of tech shares that would be expected to bounce back strongly over the next month, according to an artificial-intelligence screening platform.
Ryan Vlastelica is a markets reporter for MarketWatch and is based in New York. Follow him on Twitter @RyanVlastelica.


If you're a driver who can appreciate a sophisticated vehicle that offers luxurious comfort, prestige, and a bold performance, you should consider checking out the new West Palm Beach Acura ILX. This model comes in 5 different trims: Standard, Acura Watch Plus, Premium, Technology Plus, and A-Spec. And, while each Acura Model is uniquely different, we are certain that any one of these vehicles will satisfy your needs. With deluxe leather trimmed seats, Hands Free Bluetooth Technology, and a 5-inch Color Center Information Display, this vehicle is going to leave you speechless.And that's not even the best part. There's a lot more where all of this comes from.
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But, more about that later. First, give us a chance to show you what this car do for you. Then fill out the free online form above, and schedule your free test drive.
Are you looking for a new compact sport sedan with performance features that make a difference? If so, come check out the new 2019 Acura ILX for sale near Palm Beach, FL. Built with a 201 horsepower, 180 lb.-ft. of torque 2.4 Liter Direct Inject 4-Cylinder Engine, paired with an 8-speed automatic transmission, this front-wheel drive luxury vehicle can you take you further you can imagine. Combined with an incredible fuel economy, and an expected 100,000 mile Tune Up interval, this car delivers a stellar performance.
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But before we get started, let's take a closer look at the 2019 Acura ILX Specs and Acura ILX Features.
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The 2019 Acura ILX dominates the road with a sophisticated 4-corner MacPherson Strut front suspension, and a multi-link rear suspension. At the same time, the 2019 Acura ILX harnesses the power of a sturdy front and rear stabilizer that makes driving more comfortable.
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Don't wait another minute to jump behind the wheel of a new 2019 Acura ILX.
See and drive a 2019 Acura ILX at Napleton Acura in West Palm Beach!
Have you heard enough? Come test drive the 2019 ILX Acura at Napleton West Palm Beach Dealership. We are located at 6870 Okeechobee Blvd, West Palm Beach, FL 33411.
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Don't wait another minute to jump behind the wheel of a new 2019 ILX Acura.


text:
Borrow...
Catalog ________________
CATALOG | MY ACCOUNT
CultureGrams Online
CultureGrams Online links you to all CultureGrams editions, including World, Kids, and States. Exclusive online features include: photo gallery, maps, biographies, videos and slideshows, and a unique recipe collection that offers five authentic recipes for every country in the database.
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Funk & Wagnalls New World Encyclopedia
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text:
St. Mary's KC Building
New Wrinkle . . .
Just kidding, really, but what do you call a new addition to the face of this Grand Old Lady who is soon to celebrate her 124th birthday?
Since sometime in the 1970's the exterior signs on the church building have been serviceable, but a bit incongruous with the historic facade of the building. They were black metal boxes with a decorative panel at the top and lit on the inside at night.
Until about 10 years ago, content was spelled out on a felt board inside the sign box with white plastic letters. Content changes were, no doubt, tedious. More recently content was displayed on a foam core board inside the sign box.
One of the projects planned for our Third Century renovation was improvement of outdoor signage. That day has finally arrived. New wooden signs are being installed on the building. They are replicas of signs that were previously in use. They will be mounted in the same position as the old metal sign boxes.
The first step in the installation was to remove the old signs. MTS Contractors of Kansas City are the installers, attaching the signs directly to the exterior masonry. We didn't know the condition of the bricks and mortar under the old signs. On the north side it was fine.
The west side is in need of tuck pointing which will be done later this week, after which the west sign will be installed.
Acme Sign in North Kansas City did a beautiful job on the design and its realization. The hand-painted mahogany signs were stained to coordinate with the red brick building and the mahogany doors installed in 2009. They include removable Lucite panels which will allow St. Mary's to display service times in different seasons of the year and times for special services. The signs direct passers by to the church office on the south side of the building and to the parish Web site.
The sign on the north side went up this morning and it looks great.
Posted by Holy Smoke at 10:03 AM No comments:
Fire Cleanup is Underway
Service Master moved into the church on Tuesday afternoon and started odor abatement immediately. The nave, parish hall and basement have been full of fans and air cleaning machines for the last 36 hours.
Smoke contamination was worst in the basement restrooms which were part of our 2010 renovation. The repair contractors will assess their condition today and tomorrow and develop a plan for repairs.
The floor of the nave is vibrating with the force of half a dozen air filters. They force the air through a charcoal filter and impart hydrogen and oxygen molecules to the space. We're accustomed to having the nave smell like incense - right now it smells more like a new car.
As many of you know, St. Mary's is said to harbor at least one ghost. One wonders about his reaction to the continuous hum and vibration of his haunt since Tuesday evening.
Posted by Holy Smoke at 7:08 AM No comments:
Fire at St. Mary's March 6
Yesterday, Tuesday, March 6, we had a fire at St. Mary's. A carelessly dropped cigarette set dry grass on fire near the building and the high winds fed the fire. It was discovered quickly and the KCFD was able to put it out soon after their arrival. No one was injured.
A small area of the south exterior wall is damaged. The inside of the exterior wall in the basement hallway has minor fire damage. The drywall has been removed because of exposure to water as the fire was brought under control. Much of the building was exposed to smoke. Fortunately the sacristy where vestments and linens are stored was unaffected by smoke. There was a light haze in the nave and more in the parish hall. The downstairs restrooms and west basement were most affected by smoke.
Odor abatement and cleanup of water began last night, a few hours after the fire was controlled. Damage assessment continues in the basement. The areas affected by the fire were included in the parish hall renovation project in the spring and summer of 2010 and the basement and 2nd floor renovation that was completed last spring. It's disheartening to be contemplating repairs on these areas so newly renovated. But the memory of their construction is fresh, and we have recent photos which have been helpful in assessing damage and smoke exposure and planning how it will be addresses.
A sad casualty of the fire was one of the building's original windows. It was fully enclosed between the interior and exterior walls, but happened to be in the path of the fire. It has been removed and stored, but the glass is broken and the frame is charred.
We're working out details of how our hunger relief outreach programs will operate this weekend. Details will be posted on the St. Mary's Facebook page and will be communicated via email to volunteers.
Reprise and Up on the Roof
Almost exactly two years ago we started renovating the building of St. Mary's Episcopal Church.
The original construction of the building began in June 1886 and was completed two years later. The south side of the building, where the parish hall and kitchen are now located was finished first in 1887. Then the nave of the church and the side chapel in its northeast corner were built. So, depending on how you count it, the building is somewhere between 122 and 123 years old. In a building of that age, you're almost guaranteed that something needs work at all times. In 2009, a lot of things needed work. We're addressing them one project at a time.
Earlier posts detail our first project, the replacement of the exterior doors and doorsteps. It began in the spring of 2009 and was completed in November of that year. You can read about that work at http://smckcbuilding.blogspot.com/
After a short break, the work on the parish hall and basement restrooms began. Our hazmat abatement crew moved in the day after Easter - April 5, 2010. They completed their work in a week and the construction crew followed immediately. They completed the parish hall at the end of July. About two weeks later, the work on the choir floor and altar began and continued for about a month.
More recently Holy Smoke has brought you the story of the work in progress on other areas of the parish hall and upstairs offices which started mid-December 2010. Simply stated, during the past 24 months, there have been only about 12 weeks when some kind of renovation work was not in progress on our beautiful, old building.
Today, we shift our attention to the chapel roof which is being replaced as this is written.
The chapel is at the northeast corner of the church building. The nave of the church has a pitched roof, but the parish hall and chapel have flat roofs. Until the winter just past, both of them produced picturesque indoor waterfalls every time we got a hard rain or snow melt. Last summer, the parish hall roof was replaced and we had a worry-free winter in that space.
The chapel remained leaky. And on a warm day after a snow, there's a deluge in the closet at the corner of the sacristy. That began to change last week as a new roof began to go on. This is what it looked like from afar on Wednesday, March 30. Unfortunately, the only route to the roof is up a two-story ladder, up which Holy Smoke is, sadly, not permitted to waft.
Second Floor Office After
You've seen and read about the 2nd floor office space before the renovation. Now for the "after" pictures.
The renovated space has a comfortable, attractive parlor for small social gatherings and meetings. The fireplace supplements the new heat pump which efficiently and economically warms and cools the space. Pishny Contracting skillfully restored the stained glass windows in the parlor area.
A small conference room was created between the parlor and the inner office.
The office space is now beautifully furnished with efficient storage and workable accommodation of office machinery. The addition of a wireless printer will complete the equipment.
The old rest room was artfully reworked to accommodate a "kitchenette" with refrigerator and microwave. The space has accommodated a Vestry meeting, several committee meetings and other small gatherings since it was completed four weeks ago.
Our thanks to Dr. Michael Frost and the crew of MDF Properties for this amazing transformation.
Second Floor Office Before
In 2005 a gift was made for the renovation of the administrative office of St. Mary's. The Brougham-Cave office building is a small separate building on the church grounds between the east and south parking lots. This tiny building is about 20 years "newer" than the church building itself. Its restoration provided a comfortable and efficient work space for our accounting and other administrative functions and Downtown Outreach.
An office for the Rector was located on the second floor of the Parish Hall. This space was originally built in 1888 as a residence for the priest in charge of the parish. Rectors of St. Mary's lived there from 1888 until 1951.
It was an interesting space with original pine floors and the same decorative mill work around windows and doors as in the nave and parish hall and stained glass windows. The original fireplace is still there along with the electric heating unit that replaced it.
But its 19th century design and construction were not meant for 21st or even 20th century office machinery. Wireless internet solved one problem. But retrofitted phone jacks and electrical outlets dictated the position of furniture or resulted in in wires running across the floor.
The stained glass windows looking out to the west were badly deteriorated. The wooden frames had rotted and the lead holding the decorative panes together had deteriorated. The loose panes let in the outside air, making the rooms very uncomfortable in the winter months. The back door, leading out on to the parish hall roof provided "climate control" in the summer. It also admitted wasps, birds and other creatures to the interior office space. The floor boards had roughened over the years making them difficult to keep clean.
Although Rectors have made use of the office as a work space, it was not suitable for meetings, pastoral counseling sessions and other common uses. That changed in December 2010 with a gift from Dr. Michael Frost and the efforts of the MDF Properties renovation crew.
Basement Clean-up
The first step toward transforming the basement of the parish hall into usable space was to clear out the junk. After 123 years, a building can accumulate some interesting things and St. Mary's was no exception.
Our renovation crew began by separating the stuff we would keep from the stuff that would go away. That took about three days. The keepers were put in storage, some things were given away and the remainder was recycled or trashed.
That left a clean, empty space to start work. Our renovation last fall had included extensive work on downstairs plumbing, fire protection and security apparatus. The work this winter was about making the space functional and attractive.
A new ceiling and lighting were first on the list. The room has a southern exposure that provides wonderful natural light that is not too harsh. Fresh, clean ceiling tiles and new light fixtures brightened the space further.
Storage is a perennial problem in this old building. We have a lot more "stuff" than the 1886 design of our building anticipated. An entire wall of cabinets gave would us a tidy solution to the problem of where to put it.
Here are pictures of these "works in progress."
Posted by Holy Smoke at 1:18 PM No comments:


Sarah Senter Luikart is a licensed acupuncturist, the founder of Medicine Kitchen and an all-around advocate for holistic health practices. Elizabeth Bentley is a certified health coach, licensed holistic esthetician and the founder of Neu Skin, where she practices organic skin care. The two specialists and friends have begun working together on a series called "Inside Out," where they share their expertise in a fun and accessible way.
It seems a lucky thing to pair passion and profession, and Elizabeth Bentley has managed to merge the two by opening her new skin-care boutique, NeuSkin. After an early journey of searching for personal skin-care solutions and testing countless products, Bentley, 35, a University of Texas alum and former owner of an Austin massage therapy business, decided to parlay her personal journey into a career.
Eschewing harsh and invasive procedures, aesthetician Elizabeth Bentley offers highly personalized, all-natural facials and microdermabrasion featuring Inventive Eco- Organic products. Recognizing that each individual's skin is unique, Bentley develops a personalized treatment and regimen for each client according to his or her skin type and development over time. A former student of Marisa Hernandez of Inventive Eco-Organic, Bentley admired her mentor's dedication to "delivering the best service and quality possible." Today, Bentley continues that philosophy with a commitment to maintaining a "passion and sensitivity" toward each of her clients' individual needs.
Have you ever had a million questions about something and felt afraid to ask because you didn't want to overwhelm or annoy the knowledgeable person? Well, that's how I am with estheticians. I'm a skincare nerd, and ever since I was 22 have been putting at least 247 different products on my face every day. Lately I have been sort of worried about the true effects of all of these products and wondering if all the good I've been doing is actually bad. Luckily I met the beautiful, accommodating, and knowledgeable Elizabeth Bentley, the owner of Neu Skin here in Austin. She uses only organic products when she gives facials, and she does it out of a stylish and elegant bungalow on West 6th Street.
Dig deep into your dermis' dilemmas at Neu Skin. This bright and airy West 6th bungalow-turned-skincare boutique is the perfect spot to shed some light on your problem areas. Owner and all around cool chick Elizabeth Bentley is the type of esthetician who won't make you feel like an outcast with your blackheads. Relying on a line of eco-organic products, her attention to specifics like hormones and seasonal solutions will help you feel totally comfortable under her revealing magnifying glass. From microdermabrasion to inventive and restorative peels, you'll find your defaults being fixed layer by layer.


text:
Ilkka Suppanen, född 1968 i Kotka, är en finländsk möbelformgivare och arkitekt.

Ilkka Suppanen är son till ingenjören Pekka och sjuksköterskan Hanna-Maija Suppanen och växte upp i Esbo stad.  Han utbildade sig till arkitekt på Helsingfors tekniska högskola med examen 1988, och tog också en magisterexamen på Konstindustriella högskolan i Helsingfors 1989. Han har sedan 1996 undervisat på Konstindustriella högskolan.

Han har ritad sitt eget fritidshus, Villa Ilo, i Finska vikens skärgård, färdigt 2004.

Han fick Bruno Mathsson-priset 2006, Torsten och Wanja Söderbergs pris 2015 och Kaj Franck-priset 2020.

Källor
Röhska museets katalog nr. 22 för Torsten och Wanja Söderbergs pros 2015, Göteborg 2015

Externa länkar
Ilkka Suppanens webbplats

Finländska formgivare
Födda 1968
Levande personer
män
Personer från Kotka
Mottagare av Torsten och Wanja Söderbergs pris


text:
Gehrke: How a changing Utah population may lead to a more politically balanced state
Francisco Kjolseth | The Salt Lake Tribune The Salt Lake Tribune staff portraits. Robert Gehrke.
By Robert Gehrke
· Published: July 30, 2018
What might it take for Utah to change from a solidly red state politically to a more purplish hue? Perhaps it's just a matter of time.
We all know Utah's population has been exploding. It was the fastest-growing state in 2016 and has been among the fastest growing states for decades. Between 2000 and 2010, just two states — Nevada and Arizona — saw more growth.
But dig deeper into those trends and forecast what they mean for our future, and you'll see a strikingly different Utah than we've seen in the past — socially, ethnically, religiously and even politically.
Since their arrival in the Salt Lake Valley, The Church of Jesus Christ of Latter-day Saints has dominated Utah's culture and politics.
Initially, that meant Democrats commanded Utah's statehouse. Fueled in part by national Republican efforts to stamp out polygamy, Democrats held 57 of the 61 seats in Utah's first state Legislature.
Over the next several decades, control swung back and forth wildly, until stabilizing during the Great Depression — an evolution that Brigham Young University professor Adam Brown tracks in his soon-to-be-released book, "Utah Politics and Government."
It wasn't until around 1970 that Utah moved decidedly to the Republicans, fueled by social issues: abortion, civil rights, anti-communism and later, homosexuality and same-sex marriage, Brown writes.
Mormons, generally, are the most committed voting bloc the GOP has, and in Utah it is even more pronounced: 78 percent of Utah Mormons identify as Republicans.
Utah's long-standing majority Mormon population, their allegiance to the Republican Party and their inclination to actually turn out and vote, have combined to create a Mormon colossus standing astride Utah politics.
But Brown also points to demographic trends that may slowly erode that dominance.
As a strong economy has attracted more and more outsiders, the state's population is growing faster than the church's membership.
According to data from the Pew Research Center, between 2007 and 2014, the percentage of Utahns who identify as members of the church dropped from 58 percent to 55 percent.
That's not huge, but if the trend continues, we may soon see less than half the state belonging to the church for the first time since early pioneer days.
The other big driver is the growth of Utah's Hispanic population. According to Census data, between 2000 and 2010, the state's Hispanic population grew by a whopping 78 percent and Hispanics account for 30 percent of the entire statewide population growth in that time.
The trend has been especially pronounced in Utah's older cities. Taylorsville, for example, saw 3,909 Hispanics move in, as 3,205 white residents moved out between 2000 and 2010. And Salt Lake City saw 7,383 new Hispanics, losing 3,853 white residents in that period.
Hispanics currently make up 13 percent of Utah's population — up from 5 percent in 1990.
It is a huge factor in the ethnic diversification of the state. According to research by Pam Perlich, director of demographic research at the Kem C. Gardner Policy Institute at the University of Utah, ethnic minorities make up a little more than 20 percent of the population today. By 2050, that will climb to 30 percent.
Why does that matter? As the population diversifies, voting patterns that have dictated Utah politics for as long as I've been alive could shift.
Brown cites the 2016 Utah Colleges Exit Poll which found that 81 percent of active Mormons identified as Republicans, compared to just 28 percent of non-Mormons. On top of that, 60 percent of white Utahns identified as Republicans, compared to just 26 percent of Hispanics.
"Eventually, this growth and diversification may threaten the Republican Party's decades-long dominance," Brown wrote. "If these left-leaning demographic groups — that is non-Mormons and Hispanics — continue increasing their share of Utah's population, they may someday change Utah's partisan balance even if white Mormons remain solidly Republican."
Some on the right probably consider this wishful thinking. There's no question that the change, if it comes, will be glacial, perhaps not in my lifetime. And, Brown notes, it also depends on one other factor — whether these new Utahns vote.
But as we peer into the crystal ball and see Utah's future, it is likely to be very different from the past, and that slow shift to a more diverse population and toward political balance, a shift from red to purple, will be good for our state.
gehrke@sltrib.com
twitter Follow @RobertGehrke
Flourish Therapy, a Utah LGBT therapy service, relies on donors after partnership with Encircle ends
By The Associated Press • 12h ago
By Alanna Durkin Richer | The Associated Press • 13h ago
By Thomas Burr • 14h ago


text:
Gayle: Jamaica will do well in sprints
Published:Friday | July 18, 2014 | 12:00 AM
Manager for Jamaica's 67-member track and field team to the 20th Commonwealth Games, Garth Gayle, is excited about the team's prospects at the multi-discipline event, which he believes forms the perfect platform for much of the island's upcoming talent.
Gayle, as well as several other members of the sport's management team, plus eight local-based athletes, along with members of the swimming and squash delegations, are scheduled to leave the island today through Montego Bay for the July 23-August 3 event, which is set for Scottish city, Glasgow.
Athletics superstars Usain Bolt, Veronica Campbell-Brown, Shelly-Ann Fraser-Pryce, Warren Weir, Kaliese Spencer, Novlene Williams-Mills and Nickel Ashmeade are among what is perhaps Jamaica's strongest track and field team to the games.
big names
Gayle, the general secretary of the Jamaica Athletics Administrative Association (JAAA), while underlining the impact and influence of having the big names in the squad, also pointed to the opportunities for the less established figures to advance their careers.
"The team is a very strong team, both in numbers and in strength. We are expecting, as always, to do well in the sprints, but we will also make a good account of ourselves in the field events, Gayle told The Gleaner. "We have some very good discus throwers, and for the first time, we will be having female hammer throwers, and that speaks well to the continued development of events that Jamaicans don't normally compete in."
The other members of the team are expected to meet up in Glasgow over the next couple days to tighten up preparations ahead of the start of athletics on July 27.
"We get in early, we are set to arrive on July 19, competition does not begin until almost a week, so the coaching staff will be using the week to get more acclimatised and further the understandings as well as work on the baton changes," Gayle said.
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