For multiple-choice tests where no a priori key exists, the initial selection of a key for maximum validity may be made on the basis of the number of persons choosing each alternative and their mean criterion score. The keying formula is derived. Once the initial keying has been done, further precision in keying and item selection may use, in addition, the mean total test score for persons choosing each alternative. Item-selection formulas suggested by Horst and by Gulliksen for maximizing test validity are both in the form of a ratio, an “item-validity index” divided by an “item-reliability index.” The formula derived here is shown to be equivalent to the numerators of these formulas. The expression in the denominators uses the total test score. Although a radical appears in the denominator of Horst's formula and not in the denominator of Gulliksen's formula, both of them select the same items in practice.

In order to raise the predictive efficiency of its college entrance test battery, the Educational Testing Service is working on the development of non-academic measures to supplement the standard aptitude and achievement examinations. A test of difficult number series problems was set up to measure persistence by tempting the students to give up early; the students were informed that some of the problems had no solution, and that full credit would be received by so marking them. This test was tried out and found to have some correlation with grades, while having no correlation with the other tests. Adding this test to the battery showed an appreciable rise in the battery's multiple correlation with grades.

People with mental disorders can receive treatment in the community. Some, however, fall out of services and into the criminal justice system, running the risk of imprisonment and a deteriorating mental health cycle. This editorial describes Mental Health Treatment Requirements (MHTRs), that is court-imposed sentences that enable people in the UK to access treatment in the community and divert them from short custodial sentences. MHTRs have proven successful for people with primary care mental health needs. It remains difficult to secure these sentences for people with secondary care mental health needs. Three new ‘proof of concept’ sites for secondary care MHTRs may help understand barriers and find solutions.

Background: In rural areas, antimicrobial stewardship programs often have limited access to infectious disease (ID) expertise. Videoconference Antimicrobial Stewardship Teams (VASTs) pair rural Veterans Affairs (VA) medical centers with an ID expert to discuss treatment of patients with concerns for infection. In a pilot study, VASTs were effective at improving antimicrobial use. Here, we evaluated 12-month operating costs for staffing for 3 VASTs. Methods: We used the following data to describe 12 months of clinical encounters for 3 VASTs operating from January 2022 – March 2023: the number of VAST sessions completed and clinical encounters; Current Procedural Terminology (CPT) codes associated with clinical encounters; session attendees (by role) and the time spent (percent effort) on VAST-related activities. The annual operating cost was based on the annual salaries and percent effort of VAST attendees. We used these characteristics combined with private-sector and Medicare reimbursements to evaluate the cost of implementation and number of clinical encounters needed to offset those costs (breakeven) for each site. Results: Three VASTs recorded 229 clinical encounters during 117 sessions (Table 1). Based on CPT codes, the approximate revenue per patient was $516.46. Site A, the only site to break even, had the most sessions and clinical encounters as well as the lowest operating costs. For Site B, a slight increase in the clinical encounters, which might be achieved by 3 additional VAST sessions, would help achieve breakeven. For Site C, increasing the number of clinical encounters to 3-4 per session would have helped their VAST break even without requiring a decrease in operating costs. Conclusions: The frequency of VAST sessions, volume of clinical encounters, and low operating costs all contributed the VAST at Site A achieving a financial break-even point within 12 months. Consideration of the potential number of clinical encounters and sessions will help other VASTs achieve financial sustainment, independent of cost-savings related to potential decreases in expenditures for antibiotics and antibiotic-related adverse events. These results also provide insight into possible adoption and diffusion of VAST-like programs in the Medicare hospital setting.

Given how thoroughly the history of quantum physics has been excavated, it might be wondered what these two hefty volumes by a physicist (Duncan) and a historian (Janssen) bring to the table. Aside from their inclusion of a wide range of recent work in this area, including some notable publications by themselves, the answer is twofold: first, as they state explicitly in the preface to the first volume, derivations of the key results are presented ‘at a level that a reader with a command of physics and mathematics comparable to that of an undergraduate in physics should be able to follow without having to take out pencil and paper’ (vol. 1, p. vi). In response to those who might raise Whiggish eyebrows, I shall simply play the ‘you-try-reading-Pascual-Jordan's-groundbreaking-work-in-the-original’ card. As the authors suggest, by using modern notation and streamlining derivations whilst also, they maintain, remaining conceptually faithful to the original sources (ibid.), the book is rendered suitable for classroom use, albeit at the higher undergraduate or graduate levels.

Geoarchaeological research as part of the AHRC funded Living with Monuments (LwM) project investigated the upper Kennet river system across the Avebury World Heritage landscape. The results demonstrate that in the early–mid-Holocene (c. 9500–1000 bc) there was very low erosion of disturbed soils into the floodplain, with floodplain deposits confined to a naturally forming bedload fluvial deposit aggrading in a shallow channel of inter-linked deeper pools. At the time of the Neolithic monument building in the 4th–early 3rd millennium bc, the river was wide and shallow with areas of presumed braid plain. Between c. 4000 and 1000 bc, a human induced signature of soil erosion became a minor component of fluvial sedimentation in the Kennet palaeo-channel but it was small scale and localised. This strongly suggests that there is little evidence of widespread woodland removal associated with Neolithic farming and monument building, despite the evidently large timber requirements for Neolithic sites like the West Kennet palisade enclosures. Consequently, there was relatively light human disturbance of the hinterland and valley slopes over the longue durée until the later Bronze Age/Early Iron Age, with a predominance of pasture over arable land. Rather than large Neolithic monument complexes being constructed within woodland clearings, representing ancestral and sacred spaces, the substantially much more open landscape provided a suitable landscape with areas of sarsen spreads potentially easily visible. During the period c. 3000–1000 bc, the sediment load within the channel slowly increased with alluvial deposition of increasingly humic silty clays across the valley floor. However, this only represents small-scale landscape disturbance. It is from the Late Bronze Age–Early Iron Age when the anthropogenic signal of human driven alluviation becomes dominant and overtakes the bedload fluvial signal across the floodplain, with localised colluvial deposits on the floodplain margins. Subsequently, the alluvial archive describes more extensive human impact across this landscape, including the disturbance of loessic-rich soils in the catchment. The deposition of floodplain wide alluvium continues throughout the Roman, medieval, and post-medieval periods, correlating with the development of a low-flow, single channel, with alluvial sediments describing a decreasing energy in the depositional environment.

Correction of dietary calcium and protein undernutrition using milk, yoghurt, and cheese in older adults in aged care homes is associated with reduced fractures and falls(1). As these foods contain potentially atherogenic fats, we aimed to determine whether these dietary changes adversely affect serum lipid profiles. Sixty aged care homes in Australia were randomised to intervention (n = 30 milk, yoghurt, and cheese enriched menu) or control (n = 30 regular menu) for 2 years. A sample of 159 intervention and 86 control residents (median age 87.8 years) had dietary intakes recorded using plate waste analysis and fasting serum lipids measured at baseline and 12 months. Diagnosis of cardiovascular disease and use of relevant medications were determined from medical records. Data were analysed using mixed effects linear regression model adjusting for clustering (aged care home) and other confounders. Intervention increased daily dairy servings from 1.9 ± 1.0 to 3.5 ± 1.4 (p<0.001) while controls continued daily intakes of £ 2 servings daily (1.7 ± 1.0 to 2.0 ± 1.0 (p<0.05). No group differences were observed for serum total cholesterol/high-density lipoprotein-C (TC/HDL-C) ratio, Apoprotein B/Apoprotein A (ApoB/ApoA) ratio, low-density lipoprotein-C (LDL-C), non-HDL-C, or triglycerides (TGs) at baseline and 12 months. Among older adults in aged care homes, correcting insufficiency in the daily intake of calcium and protein using milk, yoghurt and cheese does not alter serum lipid levels, suggesting that this is a suitable intervention for reducing the risk of falls and fractures.

Occurrence of cryptosporidiosis has been associated with weather conditions in many settings internationally. We explored statistical clusters of human cryptosporidiosis and their relationship with severe weather events in New Zealand (NZ). Notified cases of cryptosporidiosis from 1997 to 2015 were obtained from the national surveillance system. Retrospective space–time permutation was used to identify statistical clusters. Cluster data were compared to severe weather events in a national database. SaTScan analysis detected 38 statistically significant cryptosporidiosis clusters. Around a third (34.2%, 13/38) of these clusters showed temporal and spatial alignment with severe weather events. Of these, nearly half (46.2%, 6/13) occurred in the spring. Only five (38%, 5/13) of these clusters corresponded to a previously reported cryptosporidiosis outbreak. This study provides additional evidence that severe weather events may contribute to the development of some cryptosporidiosis clusters. Further research on this association is needed as rainfall intensity is projected to rise in NZ due to climate change. The findings also provide further arguments for upgrading the quality of drinking water sources to minimize contamination with pathogens from runoff from livestock agriculture.