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Limitations and Future Directions
Published Online: March 27, 2014
Promoting Healthy Lifestyles With Aging: Development and Validation of the Health Enhancement Lifestyle Profile (HELP) Using the Rasch Measurement Model
Jengliang Eric Hwang
Jengliang Eric Hwang, PhD, OTR/L, is Assistant Professor, Department of Occupational Therapy, California State University–Dominguez Hills, 1000 East Victoria Street, Carson, CA 90747; ehwang@csudh.edu
Geriatrics/Productive Aging / Health and Wellness / Productive Aging
American Journal of Occupational Therapy, September/October 2010, Vol. 64, 786-795. https://doi.org/10.5014/ajot.2010.09088
Jengliang Eric Hwang; Promoting Healthy Lifestyles With Aging: Development and Validation of the Health Enhancement Lifestyle Profile (HELP) Using the Rasch Measurement Model. Am J Occup Ther 2010;64(5):786–795. https://doi.org/10.5014/ajot.2010.09088
This study was conducted to develop and validate the Health Enhancement Lifestyle Profile (HELP), a self-report measure for examining various aspects of health-related lifestyle in older adults. Data derived from 253 community-dwelling older adults were analyzed through the Rasch measurement model. Unidimensionality and data-model fit of HELP were largely supported through the analyses of principal components of residuals, fit statistics, local dependency, and differential item functioning. The item hierarchy formed through logits provided an expected pattern of healthy lifestyle behaviors. Acceptable to good person separation and reliability statistics supported the clinical applicability and consistency of the HELP scores. Finally, analysis of the rating scale structure confirmed the functioning of the 0- to 5-point rating scale used. HELP can assist in monitoring lifestyle risk factors and measuring the outcome of services aimed at promoting healthy lifestyles among older adults.
The National Center for Health Statistics (2006) predicted that by 2030, the United States will have an estimated population of 70 million older adults age ≥65 yr. This prediction indicates an immense need for increasing health-related services and education that would lead to health and quality of life among older adults. In fact, we are currently witnessing a paradigm shift in the nation's health care focus from treatment of disease to prevention of disease, as well as promotion of healthy lifestyles. The refined Model of Successful Aging by Rowe and Kahn (1997, 1998) provided an optimistic perspective on how older adults actively seek to live a lifestyle that prolongs their years and allows them to enjoy their old age. As supported by the findings of a series of studies sponsored by the MacArthur Foundation Research Network on Successful Aging, lifestyle choices play an important role in determining health and vitality among community-dwelling older adults (Rowe & Kahn, 1998).
Factors such as exercise, nutrition, social and productive activities, leisure, self-care, spiritual and psychological well-being, and health promotion behaviors can be incorporated to construct a framework for services attempting to facilitate successful aging. Exercise and diet, when used as a preventative intervention in older adults, have a significant effect in reducing risk of cardiovascular disease, osteoporosis, arthritis, diabetes, some forms of cancer, obesity, cognitive decline, and depression (Galloway & Jokl, 2000; Woo et al., 2006). Studies also confirmed the positive correlations between the levels of social and productive activity participation and a range of health outcomes, including physical and cognitive functions, self-efficacy, and quality of life (Everard, Lach, Fisher, & Baum, 2000; Lawton, Winter, Kleban, & Ruckdeschel, 1999). Adequate habits, routines, and capability for activities of daily living (ADLs) and instrumental activities of daily living (IADLs) are linked to small risks of institutionalization, mortality, and depression (Sousa & Figueiredo, 2002; Steeman, Abraham, & Godderis, 1997). Religious involvement and spiritual activities of older adults have been found to be associated with a greater sense of well-being, life satisfaction, and purpose in life (Koenig, 2000; Thoresen, 1999); fewer physical symptoms (Koenig, George, Hays, et al., 1998; Matthews et al., 1998); and less anxiety and depression (Koenig, George, & Peterson, 1998; Matthews et al., 1998; Thoresen, 1999). Moreover, other lifestyle factors such as health literacy, self-management of health, cigarette smoking, and drug or alcohol use have been found to significantly affect various domains of health and function in older adults (Peel, McClure, & Bartlett, 2005; Pronk, Peek, & Goldstein, 2004; Wolf, Gazmararian, & Baker, 2007). All of these research findings support the protective effects of healthy lifestyle behaviors against aging.
Occupational therapy has been known to adopt a holistic approach in evaluating and managing different lifestyle factors and occupations that can determine health and wellness (Clark et al., 1997, 2001; Hay et al., 2002). The overarching statement of the Occupational Therapy Practice Framework: Domain and Process,2nd Edition, "supporting health and participation in life through engagement in occupation" (AOTA, 2008, p. 626), suggests the role of occupational therapy in helping people shape their lifestyle through health-promoting occupations. The range of the lifestyle factors that contribute to successful aging are, in fact, deeply embedded in the domain and process of the Framework such as ADLs, IADLs, rest and sleep, work, leisure, social participation, habits and routines, create or promote, and prevention. As professionals emphasizing the holistic care approach, occupational therapists must be aware of lifestyle choices in older adults and provide opportunities for enhanced levels of health and wellness.
By far, few, if any, psychometrically sound measurements encompass the diverse aspects of health-related lifestyle. A comprehensive, systematic measure of various lifestyle factors will reflect the nation's current health care emphasis as well as the role of occupational therapy in services for older adults.
The Health Enhancement Lifestyle Profile (HELP) is a newly developed self-report questionnaire designed for screening and monitoring health-related lifestyle factors and examining the outcome of interventions aimed to promote healthy lifestyles with aging. A synthesis of the existing literature on successful aging and lifestyle factors, the domain and terminology included in the Framework, and input from community-dwelling older adults provided a strong framework for the conceptualization and formation of HELP. This article aims to describe the development and validation of HELP through the application of the Rasch measurement model.
Health Enhancement Lifestyle Profile
The HELP consists of two major sections. The first section consists of personal background and health information such as age, gender, ethnicity, marital status, chronic disease or disabling conditions, and self-rated heath. The second section of HELP includes seven scales measuring different aspects of health-related lifestyle: (1) exercise, (2) diet, (3) social and productive activities, (4) leisure, (5) ADLs, (6) stress management and spiritual participation, and (7) other health promotion and risk behaviors (sample items are available online at www.ajot.ajotpress.net [navigate to this article, and click on "supplemental materials"]). Each scale consists of eight items (questions) that examine the frequency of the respondent's engagement in various health-related activities or events. People are asked to respond to each question according to their typical or routine performance during the past 3-mo period. Response categories generally include (1) never, (2) 1–2 days, (3) 3–4 days, (4) 5–6 days, and (5) 7 days (per wk). However, as suggested by participants in the field pretesting study, an additional category "(6) 1–2 days a month" was added. For scoring, each response was given a numerical value reflective of the relative frequency, which results in a 0- to 5-point rating scale. Scores from negatively worded items are to be reversed. A subtotal score can be computed for each HELP scale, ranging from 0 to 40, where a higher score indicates a more favorable level of lifestyle. The total score of HELP ranges from 0 to 280.
Piloting of HELP was completed through the methods of focus group and field pretesting. A focus group led by the author included a convenience sample of eight community-dwelling older adults solicited from three local senior citizen centers. Discussion involved confirming the definition and scope of various aspects of health-related lifestyle as well as reviewing the content of HELP on an item-by-item basis. Accordingly, revisions were made to enhance the relevance and clarity of this measurement tool so as to better reflect the perspectives of healthy lifestyle among older adults. Subsequently, field pretesting of the revised HELP was conducted with another convenience sample of 16 participants representative of the target population. On the completion of the measure, each participant was given a one-on-one debriefing interview in which the participant related how he or she experienced the HELP questions and identified any confusion or suggestions for improving the understandability of the questions. Each briefing interview was led by one of the six occupational therapist senior graduate students specially trained for this research project. As a result, further revisions and modifications were made to different technical aspects of HELP such as question formation (e.g., separation of double-barrel questions), item wording, and response categories. Positive comments and quotes on HELP were also documented throughout the interviews. Some sample quotes recorded are as follows:
I think it's a good survey; it was fairly easy, and it asked questions about the type of stuff I typically do to keep me healthy.
I felt better self-esteem after completing the questionnaire, and also the diet and nutrition questions helped promote deeper awareness.
Questionnaire was damn good altogether, straight forward and well written; it made me think about some risky health behaviors that I should change and should start more activities from the psychosocial well-being part to relieve my stress and anger better.
Participants and Data Collection Procedures
Participants in this study consisted of community-dwelling (noninstitutionalized) older adults age ≥55 residing in southern California who were cognitively intact and able to communicate in English. No other specific exclusion criteria were considered. The study was approved by the institutional review board of the California State University, Dominguez Hills. Convenience sampling and snowball sampling methods were used to recruit participants from a diversity of community sites, including senior citizen centers, senior residential communities, independent living facilities, adult day health care centers, local senior social and activities groups, and religious groups or organizations. HELP was completed by each participant through one of the following methods: (1) a direct interview in which a graduate student or a staff member read through questions and recorded the responses for a participant, (2) on-site paper-and-pen administration to an individual or a group of participants, and (3) mail survey.
Rasch analysis of the Andrich's Rating Scale Model (Linacre, 2009) was used to determine the internal validity and clinical applicability of the HELP scales. Analysis was conducted through the WINSTEPS Rasch model computer program, Version 3.68.0 (SWREG Inc., 2009). Psychometric characteristics, including unidimensionality (by means of analyses of principal components of residuals, fit statistics, local dependency, and differential item functioning), item hierarchy, person separation index and reliability, and rating scale validity, were examined for each scale of HELP. Details of these Rasch procedures are described along with their findings in the Results section.
A total of 257 older adults were recruited for this study; 4 were excluded from data analysis because of erroneous or incomplete responses. The remaining 253 participants consisted of 148 women (58.5%) and 105 men (41.5%). Participants' ages ranged from 55 to 92 yr, with a mean of 71.4 and a standard deviation of 10.5. (A summary of participants' demographics and health-related information is available online at www.ajot.ajotpress.net [navigate to this article, and click on "supplemental materials"]). Most participants were unemployed or retired. The most commonly reported health problems or impairments among the participants included hypertension, arthritis, visual impairment, back or neck pain, and diabetes. The number of health problems or impairments reported by each participant ranged from 0 to 10, with a mean of 2.77 and a standard deviation of 2.03. More than half of the participants considered their health status to be "good," and only approximately 5% considered themselves to be in poor health.
Unidimensionality and Data–Model Fit
Unidimensionality of the HELP scales was first confirmed by principal components analysis (PCA) of standardized residuals after an initial Rasch factor has been extracted. The following criteria were adopted to indicate the unidimensional feature of a scale: (1) a cutoff of 60% of the variance explained by the initial Rasch factor, (2) the variance explained by the first contrast in the residuals less than 10%, and (3) the eigenvalue of the first contrast smaller than 3.0 (Linacre, 2009; Smith, 2002). Table 1 depicts the results of PCA with each HELP scale. All but the Social and Productive Activities scale demonstrated >60% of variance explained by the primary Rasch factor, and all seven scales met the other criteria for the variance of residuals (<10%) and eigenvalues (<3.0). The proposed PCA criteria for unidimensionality of HELP were generally met.
Principal Components Analysis of Standardized Residuals of Health Enhancement Lifestyle Profile (HELP)
Principal Components Analysis of Standardized Residuals of Health Enhancement Lifestyle Profile (HELP)×
HELP Scales Variance Explained by the Rasch Factor (%) Variance Explained by the First Contrast (%) Eigenvalue of the First Contrast
Exercise 71.6 4.2 1.5
Diet 69.6 4.8 1.9
Social and Productive Activities 56.3 8.4 2.3
Leisure 65.8 5.3 1.6
Activities of Daily Living 68.7 6.5 1.3
Stress Management and Spiritual Participation 65.4 5.5 1.5
Other Health Promotion and Risk Behaviors 72.7 4.3 1.0
Rasch goodness-of-fit statistics further determined how well the items of each HELP scale fit the one-dimensional model of linear measure. In Rasch analysis, Infit MnSq (i.e., information-weighted mean square residual goodness-of-fit statistic) has been considered a more critical and sensitive indicator of unidimensionality than Outfit MnSq (i.e., outlier-sensitive mean square residual goodness-of-fit statistic), because Outfit MnSq is less threatening to measurement and easier to manage (Bond & Fox, 2001; Linacre, 2002). Given the sizes of the study sample and the scales, a HELP item with an Infit MnSq >1.3 or <0.7 in combination with a ZStd (i.e., standardized mean square) >2.0 was used to indicate the lack of fit in unidimensionality (Bond & Fox, 2001; Linacre, 2002). In particular, an Infit MnSq >1.3 indicates 30% more variance than expected and thus suggests that the item measures a construct different from the overall scale. Table 2 demonstrates fit statistics for HELP, including measures (item calibration: logits), standard errors, Infit MnSqs, and ZStds. Of the 56 items from the seven HELP scales analyzed, 3 were identified as a misfit to the Rasch measurement model, based on the criterion used: "How often during a week do you go to work (paid work)?" in the Social and Productive Activities scale, "How often during a week do you talk with a special someone to share with your life, happiness, and sadness?" in the Stress Management and Spiritual Participation scale, and "How often during a month do you take pain medicine to control any form of body pain (such as migraine headache, arthritic pain, or back pain)?" in the Other Health Promotion and Risk Behaviors scale.
Fit Statistics of Health Enhancement Lifestyle Profile (HELP)
Fit Statistics of Health Enhancement Lifestyle Profile (HELP)×
HELP Item Measure (Logits) Standard Error Infit MnSq ZStd
I. Exercise
1. Walk for 20 min −1.11 0.06 1.25 2.2
2. Yoga or stretching exercise −0.55 0.05 0.96 −0.4
3. Go to the gym or exercise at home −0.39 0.05 0.85 −1.8
4. Perform strengthening exercise 0.36 0.06 0.88 −1.3
5. Bike, jog, or hike 0.52 0.06 0.97 −0.2
6. Swim, surf, etc. 0.89 0.07 0.95 −0.2
7. Play sports 1.29 0.07 1.06 0.4
8. Perform martial arts 1.66 0.08 1.18 0.8
II. Diet
1. Healthy foods rich in protein −1.19 0.06 0.92 −0.9
2. Healthy foods rich in calcium −0.72 0.05 0.99 −0.1
3. Three servings of fruits or vegetables −0.17 0.05 0.86 −1.6
4. Three servings of whole-grain foods 0.14 0.05 0.93 −0.8
5. Foods high in cholesterola 0.49 0.06 1.06 0.6
6. Foods high in sodiuma 0.75 0.06 1.09 1.0
7. Foods high in saturated/trans fata 0.98 0.06 0.95 −0.5
8. Two servings of sweets or dessertsa 1.33 0.05 1.24 2.3
III. Social and Productive Activities
1. Go out with friends or relatives −1.36 0.06 1.07 0.8
2. A social or special interest group −0.46 0.05 0.79 −3.1
3. Go to volunteer work −0.26 0.05 0.77 −2.2
4. Go to paid work 0.09 0.04 1.49 3.6
5. Go to a senior citizen center 0.52 0.05 1.15 1.9
6. Take part in political or community activity 0.85 0.08 0.90 −0.7
7. Participate in informal/nonacademic class 1.04 0.07 1.02 0.2
8. Go to a formal/academic class 1.47 0.09 1.01 0.1
IV. Leisure
1. Read newspaper, magazines, etc. −0.89 0.05 0.96 −0.4
2. Watch a favorite show on TV −0.50 0.04 1.26 2.8
3. Go out for sport games, movies, etc. −0.15 0.06 0.88 −1.2
4. Garden, participate in crafts or art activities 0.28 0.04 0.95 −0.7
5. Play chess, bridge, cards, bingo 0.56 0.04 1.00 0.0
6. Write diaries, journals, vignettes 0.93 0.05 1.05 0.5
7. Picnic, fish, sail, etc. 1.02 0.06 0.79 −2.2
8. Take part in carpentry, auto/house fixing 1.25 0.06 1.20 1.4
V. Activities of Daily Living
1. Skip routine for hygienea −0.85 0.07 0.88 −0.9
2. Skip routine for bathinga −0.57 0.06 1.07 0.7
3. Stay up late at nighta −0.15 0.05 1.11 1.4
4. Go food or merchandise shopping 0.18 0.05 0.90 −1.3
5. Miss/skip meals of a daya 0.22 0.05 1.11 1.4
6. Feel not having enough resta 0.43 0.04 1.03 0.4
7. Perform or help with housework 0.88 0.04 1.10 1.3
8. Prepare or plan a meal 1.16 0.05 0.81 −2.2
VI. Stress Management and Spiritual Participation
1. Have a sense of satisfaction in life −0.91 0.06 1.03 0.4
2. Do things that bring good moods −0.50 0.05 1.19 2.0
3. Talk with special someone −0.27 0.05 1.39 3.8
4. Pray, worship, chant, etc. 0.23 0.04 0.81 −3.1
5. Read spiritual/religious books 0.49 0.05 0.72 −3.3
6. Go to church, temple, mosque, etc 0.88 0.06 0.95 −0.5
7. Watch spiritual/religious programs 0.94 0.05 1.15 1.5
8. Meditate, do yoga, or relax 1.27 0.04 1.03 0.4
VII. Other Health Promotion and Risk Behaviors
1. Drink three servings of alcohola −0.97 0.08 1.04 0.3
2. Smoke five cigarettes in one daya −0.76 0.07 1.02 0.2
3. Take pain medicinea −0.27 0.05 1.29 3.4
4. Take over-the-counter drugsa −0.18 0.06 1.07 0.6
5. Read health-related articles 0.66 0.05 0.80 −2.5
6. Watch health-related programs 0.91 0.06 1.02 0.3
7. Monitor health at home 1.02 0.05 1.03 0.4
8. Attend health promotion programs 1.39 0.08 0.99 0.0
Table Footer NoteNote. Items are presented only in key words. Infit MnSq = information-weighted mean square residual goodness-of-fit statistic; ZStd = standardized mean square.
Note. Items are presented only in key words. Infit MnSq = information-weighted mean square residual goodness-of-fit statistic; ZStd = standardized mean square.×
Table Footer NoteaNegatively conceptualized items that were reverse coded.
Negatively conceptualized items that were reverse coded.×
The correlation of standardized residuals was used to detect "local dependence" between pairs of items, namely, a subsidiary dimension in the measurement that is not accounted for by the initial Rasch factor (Linacre, 2009). In particular, negative local dependence is often an indicator of multidimensionality. The Social and Productive Activities scale demonstrated a low negative residual correlation (r = –.38) between the items "How often during a week do you go to paid work?" and "How often during a week do you go to volunteer work?" That is, the endorsement of either item may contradict the response to the other. Nevertheless, all other residual correlations within the HELP scales remained at the negligible level (rs = –0.20 to 0.20).
The testing of differential item functioning (DIF) further identified potential misfit to the Rasch model through the inspection of the differences in item calibration within the data. DIF occurs when item difficulty estimates vary across demographic groups, thus indicating that the scale is not sufficiently unidimensional and that other exogenous factors may sway the responses (Linacre, 1998). For the DIF analysis, the participants were divided by (1) gender; (2) age, based on the median of 72 ("young-old," 55–72 yr, vs. "old-old," 73–92 yr); and (3) race (White vs. non-White), respectively. The ethnicity categories were dichotomized because of the relatively small and disproportionate samples among the non-White subgroups. The criteria used for the DIF analysis were DIF contrast >0.50 (a difference of 0.5 logits in item difficulty calibrations between two groups) and p < .006 (adjusted for multiple comparisons by a Bonferroni correction; Linacre, 2009). The HELP scales were mostly free of DIF. However, one item in the Leisure scale regarding "carpentering, auto/boat/house fixing, or any other mechanical work for your hobby" was easier to endorse for male participants (DIF = 0.58 logits, t[251] = 2.87, p = .003). The previously identified problematic item "How often during a week do you go to paid work?" in the Social and Productive Activities scale was also found to be easier to endorse for "young-old" participants (DIF = 0.79 logits, t[251] = 3.40, p = .001).
Item Hierarchy
The Rasch model establishes the hierarchy of items and people along an equal-interval continuum. The item measures expressed in logits (see Table 2) were used to arrange the items within each HELP scale in their hierarchical order of difficulty from easiest at the top to most difficult at the bottom. For example, for the Diet scale, the first item, "healthy foods rich in protein" that was the easiest to endorse had a difficulty estimate of –1.19 logits. Consecutively, the second item, "healthy foods rich in calcium," demonstrated a difficulty estimate of –0.72 logits, and, proceeding with the continuum, the last (most difficult to endorse) item, "two servings of sweets or desserts," revealed the highest difficulty estimate (1.33 logits) of the scale.
Person Separation Index and Reliability
The person separation index (PSI), strata, and reliability coefficient of each HELP scale are summarized in Table 3. The number of strata was calculated using the formula Strata = (4PSI + 1)/3 (Wright & Masters, 1982). The greater the strata, the more distinct levels of healthy lifestyle were revealed from the sample. Acceptable to good separation and reliability indexes were demonstrated, and the resultant distinct number of healthy lifestyle strata for each HELP scale approximated to three or more.
Person Separation Index, Strata, and Person Reliability Coefficient of Health Enhancement Lifestyle Profile (HELP)
Person Separation Index, Strata, and Person Reliability Coefficient of Health Enhancement Lifestyle Profile (HELP)×
HELP Scales Person Separation Index Strata Person Reliability Coefficient
Exercise 2.12 3.16 0.82
Diet 2.04 3.05 0.81
Social and Productive Activities 1.72 2.63 0.75
Leisure 1.53 2.37 0.70
Activities of Daily Living 1.86 2.81 0.78
Stress Management and Spiritual Participation 2.28 3.37 0.84
Other Health Promotion and Risk Behaviors 2.09 3.12 0.81
Rating Scale Validity
Table 4 reports the analysis of the functioning of rating scale structure (0- to 5-point scale) for each HELP scale. The results include the observed average measure, model expected measure, MnSq fit statistics, and step calibration of each rating category.
Analysis of the Rating Scale Structure of Health Enhancement Lifestyle Profile
Analysis of the Rating Scale Structure of Health Enhancement Lifestyle Profile×
Response Category Observed Average Measure Model Expected Measure Outfit MnSq Step Calibration
0 −1.53 −1.52 0.97 None
1 −1.02 −1.06 1.08 −1.54
3 −0.28 −0.31 1.06 0.04
4 −0.02 0.02 1.20 0.61
5 0.19 0.35 1.40 1.11
2 0.15 0.13 1.01 −0.49
Social and Productive
3 0.01 −0.02 1.04 0.25
Other Health Promotion
Table Footer NoteNote. Outfit MnSq = outlier-sensitive mean square residual goodness-of-fit statistic.
Note. Outfit MnSq = outlier-sensitive mean square residual goodness-of-fit statistic.×
First, the observed average measure is an empirical indicator of the context in which the rating category is used (Linacre, 1999a, 2009). In general, observations in higher categories must be consistently produced by higher measures. That is, no category disordering should be found; otherwise, the meaning of the rating scale is indecisive for that data set, and consequently any derived measures can be of minimal utility. As seen in Table 4, the average measures by category advance monotonically up the rating scale. This pattern of increase is an empirical confirmation of scale functioning that higher rating categories indicate more of the latent variable measured (i.e., healthy lifestyle). Correspondingly, the expected measures are the values that the Rasch model predicts for the measures of various rating categories (Linacre, 1999a, 2009). The residual difference between the expected values and observed measures assists in determining the degree to which data obtained using the existing rating scale would fit the Rasch model. As shown in Table 4, most rating categories in the HELP scales appear to have their observed average measures reasonably close to the expected values.
MnSq fit statistics for each rating category are also reported in Table 4. For rating scales, a high MnSq fit suggests that there is more unexplained noise than explained noise, thus indicating the existence of misinformation in the observations on the basis of the use of the rating scale. In general, a rating category is thought to be used in an unexpected manner if its unweighted MnSq fit statistics (Outfit MnSq) is >2.0 (Linacre, 1999a, Wright & Masters, 1982). As can be seen in the table, all the rating categories in the HELP scales were found to have an Outfit MnSq smaller than the critical value of 2.0.
Step calibration (or Rasch–Andrich threshold) is a Rasch-model parameter that indicates a relative pairwise measure of the transition between the adjacent rating categories (Linacre, 1999b). A positive value of step calibration indicates that the lower of the pair of categories is more likely to be observed; conversely, a negative value indicates that the higher category of the pair is more likely to be observed. The step calibration is expected to increase with category value. As shown in Table 4, there was no step disordering; the criterion of monotonic advance was met for each set of step calibration in the HELP scales.
Occupational therapists working with older adults should help monitor and manage lifestyle factors as part of their holistic health promotion plan. Up to now, there has been a paucity of instruments that were developed to measure lifestyle factors in a holistic and systematic manner. Although abundant studies have been conducted to determine the effectiveness of programs aimed at promoting healthy lifestyle among elderly people, most of these studies focused on health outcome measures such as physical functioning, health status, quality of life, or life satisfaction, yet failed to include a direct measure of those lifestyle factors or behaviors as a dimension of outcome evaluation. HELP was therefore developed to bridge this gap. Evidence of the preliminary psychometric properties of HELP was provided in this study through the application of the Rasch measurement model with data derived from a sample of community-dwelling older adults.
Several procedures were implemented to ensure the existence of a single, unidimensional variable as well as the data–model fit for each of the seven HELP scales. Despite a small number of problematic items that called for further investigation, the overwhelming majority of the items met the Rasch requirements. First, PCA of the residuals confirmed that there was no factor structure to the residuals (i.e., <10% of variance in the residuals), and, thus, that each HELP scale measured a single distinct aspect of health-related lifestyle. Second, goodness-of-fit statistics further revealed that all but three items fit the Rasch one-dimensional model. Third, the correlation of standardized residuals between pairs of items largely supported the criterion of "local independence" of items within each HELP scale. Finally, the DIF analysis corroborated the consistence of item calibration (i.e., item invariance) across different groups of the study participants.
The different HELP scales were developed with an attempt to encompass the various physical, psychological, social, and spiritual components of lifestyle that have been holistically or separately emphasized in both research and practice. Evidence of the unidimensionality of the HELP scales increases therapists' confidence in using the instrument for assessment, monitoring, and outcome measurement of the targeted lifestyle factors. Although it is important to recognize the framework of healthy lifestyle as a whole, the subtotal score generated from each HELP scale can represent a conceptually distinct contributor to the healthy lifestyle. Accordingly, service planning can emphasize strategies to systematically facilitate or modify behaviors relevant to those specific lifestyle factors concerning the individual. For example, with a goal to improve the subtotal scores of the Exercise, Diet, and ADL scales, intervention strategies can include establishing a routine in which the individual walks to a nearby grocery store and shops for ingredients to cook healthy homemade meals, instead of frequently driving to order meals at a fast-food restaurant.
The Rasch-derived item hierarchy formed using logits provides an expected pattern of healthy lifestyle behaviors, which holds promise for extending the clinical usefulness of HELP. For example, in the Diet scale, the items placed on the "difficult/frequent" extreme of the hierarchy were found to highly reflect the typical dietary pattern of Americans, characterized by high intakes of red meat, sugary desserts and drinks, and high-fat products (Centers for Disease Control and Prevention [CDC], 2007). The formation of dietary pattern can go beyond an individual's habitual decisions into more stubborn, predetermined cultural and environmental factors (Shatenstein & Ghadirian, 1998; Shepherd, 1999), as is the case with the U.S. "meat–sweet diet" (U.S. Department of Health and Human Services, 2007). Accordingly, an individualized goal to improve on those extreme items pertaining to intakes of "desserts and sugary drinks" and "saturated or trans fats" (see Diet Items 7 and 8 in Table 2) is expected to be far more challenging than a goal aimed to emphasize healthy foods rich in protein and calcium (Diet Items 1 and 2 in Table 2). The hierarchical structure of HELP can, therefore, help define a continuum of healthy lifestyle activities or behaviors that can be used to establish successive, realistic goals in promoting health as well as to monitor any progressive change to a series of relevant lifestyle behaviors as a result of intervention.
Acceptable to good PSIs and reliability coefficients found in the HELP scales further support the clinical applicability and consistency of the HELP scores. In particular, the strata derived from the separation indexes suggest that each HELP scale can conceptually differentiate people into at least two to three distinct lifestyle groups. For example, 2.37 strata found in the Leisure scale indicate the capacity of the scale to distinguish people who are highly leisure oriented from those who are not frequently engaged in leisure activities. Similarly, the Exercise scale (3.16 strata) may stratify people into three exercise behavior levels, namely, exercise frequently, exercise sometimes, and barely or never exercise. Given the nondiagnostic purpose of HELP as well as the small set of items in each scale, the numbers of stratum generated, although relatively small, can be considered clinically discriminative and meaningful (Mallinson, Stelmack, & Velozo, 2004).
Finally, Rasch analysis of the rating scale structure confirmed the psychometric functioning of the 0- to 5-point rating scale of HELP. Consistency found between the observed average measures and expected measures along with the agreeable results of fit statistics indicate that the rating categories in the HELP scales correspond to the expected function specified in the Rasch model. The criterion of monotonic advance was met throughout the subsequent step calibrations in the rating scale. The 0- to 5-point rating scale used in HELP consists of response categories that reveal the actual frequency of lifestyle behaviors expressed in numeric form (e.g., 1–2 days/wk, 3–4 days/wk). In fact, numeric-formatted rating scales often provide a sound response categorization that is well defined and mutually exclusive and thus yield a more explicit and precise measure of the construct or behavioral variable than the typical Likert scale using response categories such as never, seldom, sometimes, often, and always (Wright & Stone, 1979). The 0- to 5-point frequency-based rating scale used in HELP has thus proven a suitable method for quantifying various aspects of healthy lifestyle behaviors among older adults.
Several limitations contribute to the need for caution in the use of HELP as well as for future studies. First, several problematic items identified by the Rasch measurement model call for further scrutiny and revision to strengthen their fit to the unidimensional scale. Second, given the dynamic, multifaceted nature of the lifestyle context, other critical factors, such as motivation, self-efficacy, functional status, and environmental supports or barriers, should be evaluated along with HELP through other methods or instruments for more adequate problem identification and goal setting. Moreover, to substantiate the practical use of HELP, clinical studies can be conducted to endorse various health- and lifestyle-promoting programs with HELP incorporated into the stages of goal establishment and outcome measure. Consequently, the degree of sensitivity of HELP on monitoring change to lifestyle behaviors can be determined. Finally, the current study was based on data derived from a relatively small sample consisting exclusively of community-dwelling older adults who demonstrated a full or partial range of independent living skills. Given the preliminary psychometric properties and promising features of HELP, future funding can be pursued to conduct a normative study through which the norms and cutoff scores can be established for subgroups of older adults with different characteristics (e.g., age, gender, health status, diagnosis, living arrangement).
Both the pilot testing and the thorough item analysis using the Rasch modeling techniques support the preliminary psychometric properties of HELP. The seven scales of HELP provide a holistic view of a wide range of health-promoting occupations and risk behaviors in older adults. Occupational therapists working with elderly populations can carefully review HELP completed by each client and incorporate the results into the client-centered evaluation and intervention planning processes. Personal goals for promoting different aspects of healthy lifestyle behaviors can be established according to the individual's priorities, interests, routines, health and functional status, occupational history, and environmental resources. In turn, readministration of HELP at the conclusion of the service provides the context for a direct, explicit outcome measure of change to lifestyle behaviors.
I thank the participants who contributed their time and effort to complete HELP. I also thank the group of MSOT students for their enthusiasm and participation in the training and data collection of the study. This study was funded by Sally Casanova Memorial Research, Scholarship and Creative Activities Program (RSCAAP), California State University–Dominguez Hills.
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text:
Recent Reading: Lodge and Lively
August 24, 2009 Rohan Maitzen
I enjoyed both David Lodge's Deaf Sentence and Penelope Lively's Cleopatra's Sister. Both take what turns out to be a deceptively light tone to explore ideas that are actually quite serious and interesting.
Deaf Sentence lures us in with the funny side of deafness, particularly the misunderstandings, frustrations, and mishaps that arise from Desmond Bates's attempts to carry on as if he can hear what someone says. Drawing on his own experience, Lodge is very specific about the technical options available to those struggling with hearing loss, including about their inconveniences and shortcomings. But as he remarks early on, deafness is not, really, very funny, and even as he points to the greater pathos conventionally attached to blindness, he frequently invokes the suffering of famous "deafies" including Philip Larkin and, of course, Beethoven, to illustrate the deprivation and isolation that follows from losing one's connection with the sounds of the world. There are a lot of pretty lame puns (of the "deaf in Venice" variety), but the wry chuckles they invite also prove a kind of trickery, as the most common slippage is between "deaf" and "death," and that relationship turns out to be the central one in the novel: death is, after all, our ultimate "sentence," the ultimate end to conversation and relationships. Everything comic in it thus becomes infused with tragic potential: as we age, the novel incessantly reminds us, we lose things–our hearing, our coordination, our minds, control over our bodies, our friends and families, ourselves. There's nothing really very funny about any of that. As Desmond concludes, "'Deafness is comic, blindness is tragic,' I wrote earlier in this journal, and I have played variations on the phonetic near-equivalence of 'deaf' and 'death,' but now it seems more meaningful to say that deafness is comic and death is tragic, because final, inevitable, and inscrutable." The novel, then, explores the uneasy borderland between the comic and the tragic, or perhaps the uncomfortable proximity between the two (the most slapstick comedy depends on the wince of pain, after all). Deafness functions as a comic device, but also as a metaphor for our inevitable isolation from other people, which culminates in death:
The sure extinction that we travel to
And shall be lost in always. Not to be here,
Not to be anywhere,
And soon; nothing more terrible, nothing more true.
Philip Larkin [ Desmond reflects], the bard of timor mortis.
Deaf Sentence is not, I think, an altogether successful novel. Its various parts did not feel well integrated. The apparent main line of the plot, for instance, about the wacky graduate student with her morbid project on linguistic analysis of suicide notes, leads to some funny scenarios. But as the rest of the novel, especially the decline of Desmond's father, took on substance, I had trouble understanding what she really contributed. Like many of Desmond's little set pieces about contemporary life, technology, and politics, the trip to Auschwitz seemed more like something Lodge himself wanted to say than something that had to be in the novel. Of course, the Auschwitz excursion is relevant to the theme (if that's the right word) of death, but its gravitas seemed excessive for the rest of the book, though I thought Lodge's writing during that section was among the best in the novel–strong, spare, and evocative, whereas much of the rest of the novel is a bit too prosy and self-indulgently academic (the academic narrator / protagonist can take the blame, of course, as all this is in character, but still…).
Overall, though, I appreciate that this novel is about something. I've been thinking lately (for another project) about David Masson's line that "the desirable arrangement might be either that our novelists were philosophers, or that philosophers were our novelists" (and, as a contrast, Henry James's objection that in George Eliot's fiction "the philosophical door is always open" and letting in a cooling draft). Events strung together do not make a great novel, though they may make a briefly entertaining one (take note, writers 0f popular historical fiction). It is much more rewarding, as a reader, to feel engaged with a view of the world and how we live in it, whether the emphasis is primarily ethical, aesthetic, political, or something else. Kazuo Ishiguro made a comment in an interview that I like a lot, about fiction being "an appeal for companionship in experiencing life," with the author implicitly saying, "it's like this, isn't it? do you see it this way too?" You can agree or disagree, but either way, you're in a good conversation. Lodge is not playing with any particularly obscure or profound ideas, I don't think, but he's trying to see and say something about where we stand in relation to other people, and what the inevitable end of our life means, or might mean, or should mean, for how we think about ourselves and how we act. In doing so through a (more or less) comic novel, perhaps he's also suggesting we not take these problems too seriously, not so seriously, anyway, that they prevent us from enjoying life's absurdities.
Cleopatra's Sister is another novel thinking about things. In this case, Lively is preoccupied with the issue of contingency: why one thing and not another? She plays out variations on this theme elegantly across the different aspects of the novel, from the big evolutionary questions confronted by her paleontologist protagonist Howard Beamish, to the day-to-day incidents of chance that drive lives forward–Howard's discovery of his first fossil, for instance, which turns out to initiate a life-long interest and thus his career. How far are we responsible for our own lives? is probably the novel's central interest. Co-protagonist Lucy Faulkner, for instance, works hard to develop her credentials as a journalist, but many of her professional advances result from her being in the right place at the right time. If she seizes the moment, is it luck, or can she take credit for her success? What about all the "what ifs"? So many other things might have happened, if things had been just a little different, if somebody had made a different choice, even a minor one. The novel explores the randomness of life: every event is explicable, looking backwards (in this, Lively's outlook resembles George Eliot's version of determinism). But it is not predictable, looking the other way, a fact of which Howard and Lucy are repeatedly reminded, sometimes jarringly. The central episode of the plot, in which Howard and Lucy are among a group of British tourists taken hostage in the fictional country of Callimbia, is the ultimate example of the way events are formed by contingencies: the plane happens to have mechanical problems which happen to become urgent as they are closest to Callimbia, where, as it happens, there has just been a political coup (which, as we know from the interspersed chapters recounting the history of the imagined nation, is itself the outcome of a series of unlikely events). That both Howard and Lucy are on this particular plane is coincidental, or, more accurately, meaningless until later events give their meeting the aura of fate–or would, in a different novel. There is an inevitability about each step, and yet at every moment, it might have been otherwise.
Here, as in Moon Tiger, Lively is particularly interested in the way these moments are collected into histories, which give retrospective meaning because, in hindsight, we can see the steps that made a difference, that turned things in one direction or another. The juxtaposition of the Callimbia 'history' highlights this process (with due reference to the "Cleopatra's Nose" theory of history), and also allows for some play on another theme familiar from Moon Tiger, which is the paradoxical relationship of unimportant individuals to the larger narratives of history. Lucy realizes at one point that all the 'little' people are the real stuff of which politics is made; this is true too of history, and yet most people live historical lives without knowing it. Thus Lucy and Howard's chance experience of the political chaos and violence of Callimbia is also a reminder to them that they do not live outside of history: that their own lives can, for instance, become part of something Lucy might write a feature article about, or end without leaving descendents, like the fossil specimens Howard collects. I won't spoil the ending–the second half of the novel becomes quite suspenseful, and as in Deaf Sentence, the comic potential of the set-up and the light handling of the prose leads us unwarily into much darker territory.
Next up: Joseph O'Neill's Netherland, I think. [Update: What actually happened is that I picked up my copy of Daniel Mendelsohn's The Lost to take a look and became totally engrossed; I actually stayed up much later than I should have last night because I couldn't stop reading it, which is something I haven't felt strongly for a while. It's a remarkable book.]
Lively, Penelope, Lodge, David
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redpajama_set_name: RedPajamaCommonCrawl


Over the last decade, cyber threats have continued to advance in both depth and breadth with the expansion of exploitation, disruption, and destruction activities. In warfighting, as demonstrated in conflicts in Crimea, Syria, and Iraq, cyber capabilities are increasingly being integrated as part of adversarial attack strategies. Cyber vulnerabilities are one of NATO's and its member-states' most significant challenges and continue to undercut the Alliance's deterrent and defense capabilities. In "Cyber, Extended Deterrence, and NATO," Franklin D. Kramer, Robert J. Butler, and Catherine Lotrionte set forth an approach for cyber extended deterrence, focusing on a potential conflict involving NATO. The paper's recommendations aim to strengthen NATO's cyber capabilities and incorporate them into wider Alliance defense strategies, laying out multinational and intergovernmental steps and exploring the role of the private sector.


One of my girlfriends shared this so I had to share it with you… So True.
Do you remember when you graduated high school? I know so many graduate every year, but this year, for my family anyway, there are quite a few graduating and embarking on their next chapter. Congratulations to you all on your graduations!!
High school can be fun or maybe not so much fun. Everyone has his or her own individual experience. But, none the less, we stick it out and graduate. And at the end of that time, you are asked that one question, "What do you want to do with your life?" And, many others of the like. But, not everyone has it all figured out yet and that's ok. You just graduated high school, you don't have to have it all figured out just yet. And if you are one of the few who do, well done. But, most don't. So, if you don't, please don't stress. Once you either get into a college or start a job, you will find your way. Have faith and keep going. Enjoy a little rest after high school, but get back up on that horse and keep going.
Life is too short not to try, not to find something you truly enjoy and go for it. Just do it.
That's the key. Keep going and don't stop. Try to think of something you really enjoy and would love to work at, and go for it. These days you can make just about anything a career. You just have to figure our the steps to go about it. You can do it.
Have faith, trust in yourself and know that your family always have your back. You are loved and wanted the best for so go and get it.
Best of luck to you all and I am very proud of you. Keep up the great work, you got this!
Change comes in all forms and at any given time whether you are ready for it or not. Whether it is a passing of a loved one, a Change in residence, a Change in ones health, or just a Change of heart. Change is all around us. I know Change can be difficult, but in the end, Change must occur in all living things in order for us all to grow. Most times it does not make sense, the Change(s) we endure, but in order for you yourself to grow as an individual we must find a way to accept our Change(s) and overcome. Change can and will, if you let it, make you stronger. Sometimes Change can open ones eyes to new experiences, Change lets you see life through a new set of eyes due to a diagnosis, and most times Change lets one be that positive light to shine for others to see and possibly, just possibly, your Change will help someone else in need accept his or her Change and help hm or her to be stronger because of it.
I myself have had my fair share of Change(s) over the years. And many were not pleasant. But, though they were, at times, tough to go through, I held onto my faith and the knowledge the this too shall pass. Change had to occur in order to get me to the place I am now. A place of strength, a place of positivity, a place of enlightenment, and a place of mindfulness. Through these Changes I became more aware of the things I would and would not accept out of individuals, how they treated others and how they treated every other living thing around us. Life is too short!
Yes, I could have taken the negative roads, the roads that lead down a harder path when these Change(s) occurred. But I made a choice that I would not give into that path because that path was not an option and had no light at the end of the tunnel. Strength, Life, Light and Love were and are the only path for me and I try to share that with my family and friends when they ask or might need a little inspiration.
With that, I attach the below poem I found that can give us all the strength and light we need when it comes to any type of Change in life.
Thank you for taking time out of your day to read a little about Change = Strength. Cheers!
I am not saying I'm perfect and positive 24/7, but I do my utmost to be positive 100% of the time. I'm not hiding from the world, I just choose to see the brighter things in life and all life's little nuances. Why speak negative about all things, even the little things and let negativity creep in when you can put a different spin on life and speak only positive about situations even though they might upset you. Just (as the penguins say) smile and wave boys, smile and wave! Choose the flip side and speak positive about life.
Like the Eagle, show no fear, but only great strength!! Fly above it all! May your heart soar like an Eagle!
I hope everyone had a great weekend. Myself, it was quiet and nice. Most times I fee like I need to be outdoors doing something. But then there are times when I just want to be at home resting and enjoying hearing the birds chirping outside our windows. That goes for social media as well. Most times I enjoy keeping up with family and friends, but there are times when all the media and internet is just too much. Sometimes, you just need a break from all that and head outdoors and leave your phone at home.
My day was Saturday. I was dropped off at my usual Saturday bootcamp class and ran then the 3.2 miles back home. Though it was entirely too hot outside, I did enjoy being out and away from all the hoopla! It's mentally peaceful and physically recharging.
So, get out and away from all the social media when you can and recharge. Having our heads in computers and cell phones all day is exhausting.
In life there are some things that you cannot control, some things that you have to just trust in and have faith that this is the right path and that it all will work out the way it is supposed to in the long run. You have to take those chances, those adventures, those trials, those life choices to find out who you are as an individual both inside and out and when you do, others might not understand it while it is happening, but will respect your decision. Have no regrets for trying something new and out of your element. No regrets! No Excuses!
For me, sometimes it's hard being away from family. I live on the West Coast and the rest are on the East Coast. It's very difficult for me because I am very much a family and friend person. I love to see my family and friends ALL the time and it has been difficult. But, I know that through my constant reaching out to them, prayers for them and asking that they be guided and looked after, I know they have their angels looking over them with me and for me. I have no regrets, but I certainly do miss being there for all their individual things. Like I had been used to for so long. Thank goodness for the internet and cell phones.
But, Life is an adventure and sometimes you just have to jump on that train for the ride while still keeping in touch with and being a part of the lives of those that mean the world to you. Do not look back later in life and say to yourself, what if had taken that chance… I took that chance and have no regrets because I have seen and done many things on this adventure that I would not have otherwise.


all improv music, title names where made up (except MJ song).
* with Jason Hann (SCI) on percussion.
% with Ted Tilton (Dead Phish Orchestra) on keyboards.
# with Jason Hann (SCI) on drums (replacing Dave).
^ with Gabe Mervine (The Motet) on trumpet.
@ played in honor of what would have been Michael Jackson's 55th birthday.


Brett McGurk, the special envoy to the coalition battling ISIS who resigned late last week, is a graduate of Conard High School in West Hartford and the University of Connecticut.
McGurk, who helped to lead a 79-member coalition fighting ISIS, was due to retire in early 2019, but decided to quit over President Donald Trump's sudden decision to withdraw American troops from Syria.
"I worked this week to help manage some of the fallout but — as many of you heard in my meetings and phone calls — I ultimately concluded that I could not carry out these new instructions and maintain my integrity," he said.
McGurk is a 1991 graduate of Conard High School and a 1996 graduate of UConn. He is a former clerk for Chief Justice William Rehnquist on the U.S. Supreme Court. He was appointed to the special envoy job by President Barack Obama and stayed on under President Trump. McGurk also served under President George W. Bush as Special Assistant to the President and Senior Director for Iraq and Afghanistan. He was nominated to ambassador to Iraq, but withdrew after a controversy over leaked personal emails.
While at the Department of State, McGurk led secret negotiations in a prisoner swap with Iran where four Americans were released ion 2016, including a reporter from the Washington Post.
In a tweet, Trump said over the weekend that he didn't know his special envoy to the coalition fighting ISIS.


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Looking for a specific food for a specific need? Looking to experience a new gastronomic experience? What are the best healthy foods to eat?
There are certain foods called "Superfoods" that are being hailed as cure-alls. Some of them actually do a good job of helping us stay healthy. Others are more questionable. But there are a myriad of foods that can help prevent disease, lift our spirits, keep our weight at optimal levels, heal us and make us well.
We'll also get into foods that are quick to prepare, so you're not in the kitchen all day, and can get your work done, or get out and have fun.


3. Email Address *This question is required.	 This question requires a valid email address.
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text:
There aren't many exciting new features this time around - our focus in 0.20 has been fixing most of the problems we
introduced in 0.19. Apart from that we've added a few new cops and implemented auto-correct for a bunch of the existing cops.
You'll also notice that the messages produced by most formatters a bit more colorful (and hopefully more readable as well).

You should also note that `AllCops/Includes` and `AllCops/Excludes` have been renamed, so you'll have to update your config files
accordingly.

Below is the list of all the gory details. Enjoy!

### New features

* New cop `GuardClause` checks for conditionals that can be replaced by guard clauses. ([@bbatsov][])
* New cop `EmptyInterpolation` checks for empty interpolation in double-quoted strings. ([@bbatsov][])
* [#899](https://github.com/rubocop-hq/rubocop/issues/899): Make `LineEndConcatenation` cop `<<` aware. ([@mockdeep][])
* [#896](https://github.com/rubocop-hq/rubocop/issues/896): New option `--fail-level` changes minimum severity for exit with error code. ([@hiroponz][])
* [#893](https://github.com/rubocop-hq/rubocop/issues/893): New option `--force-exclusion` forces excluding files specified in the configuration `Exclude` even if they are explicitly passed as arguments. ([@yujinakayama][])
* `VariableInterpolation` cop does auto-correction. ([@bbatsov][])
* `Not` cop does auto-correction. ([@bbatsov][])
* `ClassMethods` cop does auto-correction. ([@bbatsov][])
* `StringConversionInInterpolation` cop does auto-correction. ([@bbatsov][])
* `NilComparison` cop does auto-correction. ([@bbatsov][])
* `NonNilComparison` cop does auto-correction. ([@bbatsov][])
* `NegatedIf` cop does auto-correction. ([@bbatsov][])
* `NegatedWhile` cop does auto-correction. ([@bbatsov][])
* New lint cop `SpaceBeforeFirstArg` checks for space between the method name and the first argument in method calls without parentheses. ([@jonas054][])
* New style cop `SingleSpaceBeforeFirstArg` checks that no more than one space is used between the method name and the first argument in method calls without parentheses. ([@jonas054][])
* New formatter `disabled_lines` displays cops and line ranges disabled by inline comments. ([@fshowalter][])
* New cop `UselessAccessModifiers` checks for access modifiers that have no effect. ([@fshowalter][])

### Changes

* [#913](https://github.com/rubocop-hq/rubocop/issues/913): `FileName` accepts multiple extensions. ([@tamird][])
* `AllCops/Excludes` and `AllCops/Includes` were renamed to `AllCops/Exclude` and `AllCops/Include` for consistency with standard cop params. ([@bbatsov][])
* Extract `NonNilCheck` cop from `NilComparison`. ([@bbatsov][])
* Renamed `FavorJoin` to `ArrayJoin`. ([@bbatsov][])
* Renamed `FavorUnlessOverNegatedIf` to `NegatedIf`. ([@bbatsov][])
* Renamed `FavorUntilOverNegatedWhile`to `NegatedWhile`. ([@bbatsov][])
* Renamed `HashMethods` to `DeprecatedHashMethods`. ([@bbatsov][])
* Renamed `ReadAttribute` to `ReadWriteAttribute` and extended it to check for uses of `write_attribute`. ([@bbatsov][])
* Add experimental support for Ruby 2.2 (development version) by falling back to Ruby 2.1 parser. ([@yujinakayama][])

### Bugs fixed

* [#926](https://github.com/rubocop-hq/rubocop/issues/926): Fixed `BlockNesting` not auto-generating correctly. ([@tmorris-fiksu][])
* [#904](https://github.com/rubocop-hq/rubocop/issues/904): Fixed a NPE in `LiteralInInterpolation`. ([@bbatsov][])
* [#904](https://github.com/rubocop-hq/rubocop/issues/904): Fixed a NPE in `StringConversionInInterpolation`. ([@bbatsov][])
* [#892](https://github.com/rubocop-hq/rubocop/issues/892): Make sure `Include` and `Exclude` paths in a `.rubocop.yml` are interpreted as relative to the directory of that file. ([@jonas054][])
* [#906](https://github.com/rubocop-hq/rubocop/issues/906): Fixed a false positive in `LiteralInInterpolation`. ([@bbatsov][])
* [#909](https://github.com/rubocop-hq/rubocop/issues/909): Handle properly multiple `rescue` clauses in `SignalException`. ([@bbatsov][])
* [#876](https://github.com/rubocop-hq/rubocop/issues/876): Do a deep merge of hashes when overriding default configuration in a `.rubocop.yml` file. ([@jonas054][])
* [#912](https://github.com/rubocop-hq/rubocop/issues/912): Fix a false positive in `LineEndConcatenation` for `%` string literals. ([@bbatsov][])
* [#912](https://github.com/rubocop-hq/rubocop/issues/912): Handle top-level constant resolution in `DeprecatedClassMethods` (e.g. `::File.exists?`). ([@bbatsov][])
* [#914](https://github.com/rubocop-hq/rubocop/issues/914): Fixed rdoc error during gem installation. ([@bbatsov][])
* The `--only` option now enables the given cop in case it is disabled in configuration. ([@jonas054][])
* Fix path resolution so that the default exclusion of `vendor` directories works. ([@jonas054][])
* [#908](https://github.com/rubocop-hq/rubocop/issues/908): Fixed hanging while auto correct for `SpaceAfterComma` and `SpaceInsideBrackets`. ([@hiroponz][])
* [#919](https://github.com/rubocop-hq/rubocop/issues/919): Don't avoid auto-correction in `HashSyntax` when there is missing space around operator. ([@jonas054][])
* Fixed handling of floats in `NumericLiterals`. ([@bbatsov][])
* [#927](https://github.com/rubocop-hq/rubocop/issues/927): Let `--auto-gen-config` overwrite an existing `rubocop-todo.yml` file instead of asking the user to remove it. ([@jonas054][])
* [#936](https://github.com/rubocop-hq/rubocop/issues/936): Allow `_other` as well as `other` in `OpMethod`. ([@bbatsov][])

[@bbatsov]: https://github.com/bbatsov
[@jonas054]: https://github.com/jonas054
[@yujinakayama]: https://github.com/yujinakayama
[@tmorris-fiksu]: https://github.com/tmorris-fiksu
[@mockdeep]: https://github.com/mockdeep
[@hiroponz]: https://github.com/hiroponz
[@tamird]: https://github.com/tamird
[@fshowalter]: https://github.com/fshowalter

redpajama_set_name: RedPajamaGithub


We have a long history of working in partnership with local authorities across the UK.
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We provide and maintain valuable community infrastructure – bus shelters, smart bikes, public toilets and wayfinding schemes.
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SAMES KREMLIN's new air hoses have been developed for Airspray, Airmix®, Airless and Electrostatic applications. The new Air hoses deliver important benefits like being lightweight which enhances the operator's range of motion on any Airspray and Airmix® gun. They also deliver very little ground resistance when being moved which can be an inconvenience with long hoses available from the competition. The multi-layered, premium material manufacturing and compatibility with other ATEX equipment of this product demonstrates the higher level of quality we offer our customers.
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This is where it gets real. The blog posts are one thing. The conferences. An inspiring TED talk or coffee exchange with a peer. But eventually it all comes down to you, and the action. And the fear that's present in that moment.
I'm convinced that facing fear is perhaps the biggest skill we can develop as business owners. Heck, as human persons. To me, here's an example of human business, and how developing this skill in business, can actually feed back into our life outside of business. And vice versa. I know it has for me.
1. Acknowledge fear. Sometimes the feeling that we should already know the answer causes us to bury feelings of fear when they surface. Or sometimes it's the desire not to have a problem in this area, so we just don't acknowledge it exists. Or maybe we have such a habit of suppression, we've become out of tune with what's going on inside. We feel an angst, but it's coming from unknown quadrants, and sometimes we're not even aware it has a source. Our blindness leaves us to fight a shadow enemy, and unidentified and unaddressed fears can lead to all types of dysfunction. Coming to terms with ourselves, and admitting we're afraid, is the first step.
2. Recognize fear as part of the process. Because we see fear as weakness, we ignore it or don't face it. But in reality, fear is the doorway to growth, both in business and in life. In his TEDx talk, Dave Allen talks about how fear of a storm while aboard a small boat at sea caused his brain to achieve zen-like clarity on what was important – and to take swift survival actions. All the non-essentials fell away. In his book, The 4 C's Formula, Dan Sullivan describes how fear causes the brain to start grasping for straws, creating new pathways, and finding new solutions to fulfill the commitment we've made. By actually putting ourselves in the middle of fear, we are entering the context where change can happen. By keeping ourselves away from fear, we're stunting our own growth. Fear, as unnatural as it feels, is a natural part of the process. It's okay to be afraid.
3. Deconstruct fear. Begin to take apart and examine the fear you've acknowledged. Is it fear of lost revenue? Fear of looking bad in front of your team or peers? Fear of not being able to feed your family? Fear of not enough revenue to hire that new team member? Fear of not having what it takes to see it through? Fear of rejection by your customer? Fear that this idea won't work out? Once you've identified it, ask yourself, "where does that fear come from?" What is it rooted in? Sometimes it has nothing to do with present situation. Sometimes it has to do with our sense of identity. Deconstructing the fear into pieces helps remove some of its mystery, and therefore part of its power.
4. Challenge fear. Now actively re-wire the mental map that feeds the fear: if you're fearing not having enough revenue to hire that new team member, calculate out how many new customers you would need, and then consider where they would come from. If you're fearing rejection from your customer, consider the worse-case scenario if they leave/don't sign, and how you would weather that. Is the fear rooted in something from your past and perhaps no longer applies? Is the fear irrational and you're ready to unravel it? Re-work the fear emotion to direct it to a new destination. Jason's talk from Xerocon about "blowing stuff up" and "making stuff up" is about releasing yourself from the fear of the leaving the past behind. Talk back to your fears, don't just listen to them.
5. The reward is facing fear. Even if whatever you do doesn't work out, your reward is having actually faced your fear and not having let it stop you. You are building that skill, like a muscle. Because if you can keep facing your fear, what you do will eventually stick. You will get better at choosing your targets, and you will get better at shooting at the targets. And you will eventually start hitting bullseyes. You will never be able to eliminate all risk from the process, and you will never get to a point where you can avoid fear. But you will eventually become thankful for that, because you realize #2 holds true — that fear is actually a signal that marks opportunity for growth and is no longer a "Do Not Enter" sign that hems in the freedom of your movement.
Thanks Melinda — appreciate it!
Adrian, I love how you have turned fear in on itself. The way you state it, it's no longer debilitating, but empowering.
Love the challenges you bring, brother. Thank you.
Thanks Jason! And agree — turning fear in on itself is not easy, but powerful stuff. Thank you for showing that to me too.


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There are plenty of devices out there that can be used to improve the lives of seniors. GPS trackers allow caregivers to keep an eye on their loved ones when they're out and about, helping to ensure their safety. GPS trackers specifically designed for seniors put an emphasis on functions that enhance safety, including emergency buttons and health metrics.
For seniors with Alzheimer's disease or dementia, as well as other conditions that make them prone to wandering, a GPS tracker can be a lifesaver. Even if you live in a state with a Silver Alert program, a GPS tracker can provide peace of mind in knowing that you can quickly locate your loved one should they wander or become lost. And they don't have to be large and obtrusive – in fact, many modern GPS trackers are discrete, allowing you to keep them in the bottom of a bag or even around your neck. Being able to locate your loved one if they vanish could literally save their life.
Depending on your needs, you may require a certain type of GPS tracker. If you prefer something discrete, you'd benefit from a device that can be worn as a necklace, watch, or bracelet. There are also watches and conventional GPS trackers available.
Monthly fees. A lot of GPS trackers have monthly fees. This is because they use cellular technology to pinpoint the location and deliver it to you. There are devices with no fees, although the majority of them are more limited in their tracking abilities.
Many GPS trackers have a lot of additional features bundled in. GPS watches, for example, often double as fitness devices, providing health metrics and other measurements. Other features to look out for include SOS emergency buttons, two-way calling, and audio monitoring.
GPS capabilities. If you need a GPS tracker that's able to track nationwide, you'll want to opt for a more expensive, conventional GPS tracker. Shorter range tracking often requires less of a rigorous device.
To help you find the best GPS tracker for your aging loved one, we've rounded up 50 GPS trackers that are all high quality and deliver results. The devices listed below are broken down into three categories: wearable GPS devices, keychain trackers, and conventional trackers.
If you're looking for an unobtrusive GPS pendant, the Dynotag is perfect for you. It's designed with sturdy, weather-proof stainless steel. With your purchase, you get a lifetime subscription to their services. The device stores your information and allows medical personnel to locate your home, even if you're incapacitated.
There are plenty of GPS watches on the market, but none as affordable as this one. It's made of aluminum alloy and is extremely durable. The design is sleek, going with most styles of clothing, and it's packed with features. With an appropriate SIM card, you can make calls, live track individuals using the app, and send voice messages.
The vivofit is a fitness band with a built-in GPS. It's made to track fitness levels, including steps, calories, and it also monitors sleep schedules. There's a 1-year battery life, and the watch is water-resistant. It comes in many different colors and is highly customizable.
The GPS SmartSole is a device that you hide in your shoe. It uses GPS and cellular technology to track an individual, much like any other GPS device. It's very discreet and your senior parent won't forget to bring it with them, as it's in the shoes they wear every day. The SmartSole was designed for anyone who wanders and may become lost.
The JUNEO GPS Smart Watch is an affordable way to keep track of your senior parents and send them messages without having to give them a complicated smartphone. The watch has an anti-shedding alarm that goes off if the watch falls off, reducing the likelihood that it will get lost. It has a built-in GPS and there's an app that goes along with it.
The Medical Guardian is a device designed specifically for seniors. It helps you schedule medications, doctor's appointments, and simplifies sending text messages. There's a GPS device built-in that can keep you in range of your emergency contacts, which are stored in the watch and notified if you hit the SOS button.
An affordable smartwatch that's designed with a polycarbonate case and a silicone watch band that protects the watch and keeps it safe. The battery lasts for up to 1.5 days and charges quickly. There's a built-in GPS to monitor your route, and it can help seniors get around and find their way home if they leave the house.
The MX-LOCare ships with an already installed SIM card and service plans start at $24.99 a month. It works worldwide and uses cellular and GPS technologies to provide an accurate location straight to the free iOS and Android app. There's a built-in listen-in mode that allows you to hear audio around the watch through the app, which is convenient for checking in on someone.
This smartwatch uses a T-Mobile micro SIM card. There's a 1.22" OLED touchscreen display that is crystal clear and shows large font, making it easy to read. The built-in GPS is accurate and records your location using GPS and cellular technology. It also monitors sleep and can serve as an altimeter, barometer, and thermometer.
This stylish pendant doubles as a GPS. It's perfect for senior women who don't want to carry around a clunky GPS tracker. And if you for some reason need to be discreet, this pendant does the trick. It uses GPRS and GPS for precise precision tracking, and there's also a hidden SOS button as well as voice monitoring.
The Veriot is a GPS tracking device that supports iOS and Android devices as well as tracking on a PC. It supports AT&T's network to provide coverage across the US. There is 24/7 support through the company offered through email or phone. The battery lasts up to 5 days of continuous use.
This mini GPS tracker can be clipped onto a keychain or a necklace. It requires a SIM card, but once you get it set up, you have access to remote tracking. There's a built-in speaker with a microphone that monitors audio and enables two-way conversation through the app and the tracker.
Using Google Maps, this device is able to track people, pets, and luggage. You will need to use a SIM card to access web tracking as well as SMS and voice functions. There's an SOS alarm built onto the tracker, just in case your senior parent has an accident and needs to notify someone.
The Cube is designed to locate whatever it's attached to. Keep it in your senior parent's bag or pocket, or attach it to their clothing, and you can keep track of them using your iOS or Android app. The Cube also has a button built-in that can be used to take photos remotely.
This keychain GPS tracker clips right onto your targets keychain and is lightweight, making tracking quite simple. There's a built-in SOS alarm that alerts a set person when you have an accident. You can also set up a geo-fence, getting an alert when your target passes a certain area that you set up through the app.
With an anti-lost alarm, the GBD Smart Finder is small and easy to carry around. It's designed to track targets short-range. In scenarios where you need to keep an eye on a senior parent while you're out, these are perfect. There's an anti-lost alarm that will go off when your target goes too far away from your cell phone, which has an app to control the tracker.
You would never know that this necklace is a GPS tracker, as it's designed to look like an appealing necklace. There's a geo-fence alarm function built in to keep your target within a certain range. If they cross the line, you'll get an alert. It supports two-way communication, allowing you to not only listen to audio around the tracker but to talk to the target.
As a short-range tracker, these excel. You get six for the price, meaning you can keep one on your senior parent, one on your pet, and just about anywhere else you need to keep track of something. It's not a long-range tracker, but it does allow you to locate the tracker within a short-range. They excel at keeping an eye on items and people within your vicinity.
The MindMe tracker is a high-quality tracker designed to keep track of people with dementia who wander. It has a simple design and can be carried on a keychain, attached to a belt, or even used as a pendant on a necklace. The battery lasts up to 48 hours and it uses a multi-network SIM to locate people anywhere.
Like the MindMe, the PocketFinder was also designed to keep track of those with dementia. It uses location technologies to monitor individuals using Global GSM wireless networks. It can restore independence to seniors, as you can allow them to do more on their own without fear that they'll get lost, as you can track them using the app.
This keychain personal safety device has no fees or subscriptions, meaning you only pay once. With this device, you loved one can send a few messages with the click of a button. They can let you know that they're okay or send an alert, transmitting their signal to you through an app. There's also a personal panic button built in case of emergencies.
This affordable tracker comes in a multi-pack and you can choose from five different colors. It's designed to track targets short-range, making it perfect for keeping your senior parents safe. If they're prone to wandering, these trackers can alert you if they wander too far away.
The Trax Play is a GPS tracker that comes in two different colors. It can notify you when your senior parent leaves a designed zone, and you can track it through the smartphone app. The tracker itself is durable, water-resistant, and won't break due to intense temperatures. It connects to a 2G T-Mobile network to deliver service.
This real-time GPS tracker can track seniors anywhere they could end up. It has a long range capable of crossing state lines, and the battery can last over a month. The tracker records up to one year of history and comes equipped with many functions, including an alert when your target enters or leaves certain zones.
If you're looking for a budget GPS tracker, you're in luck. This real-time global tracking device is only $12.85. It can track your senior parents, your pets, or even your kids wherever they go using the app. The small size makes it easy to store in a purse or backpack, even discreetly if you need to do so.
The Optimus Tracker is one of the best-reviewed GPS trackers on this list. It includes an iOS and Android app that are quick and deliver immediate location reporting. You can set the device up to send email or text alerts when your target does certain things, like leaving a designated area. The service is $19.95 a month.
With no monthly fee, this GPS tracker pays off in the long run. It requires no data plan and still provides accurate positioning reports within 15 meters. It's able to monitor voices, reporting audio to you through an app. There's a built-in SOS call button too, in case your senior parent has an emergency.
Another JLEKONG GPS tracker with a different design. This version is waterproof and won't be damaged by poor weather conditions. The company offers lifelong technical support and warranty, which is great considering there's no monthly fee. It works alongside the Amber360 app to record the target's position and monitor audio.
This miniature GPS tracker is extremely portable, fitting in the bottom of a purse, bag, or pocket. It provides real-time tracking and an alarm to notify you when it's taken out of a designated area. The tracker can monitor both location and voice and is easy to set up.
With a built-in fall monitor, this GPS tracker was designed with seniors in mind. You can set boundaries using geo-fencing technology and be alerted when the tracked individual leaves a certain zone. The GPS can be accessed through an online portal that uses Google Maps to report the location.