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This paper presents an analysis, based on simulation, of the stability of principal components. Stability is measured by the expectation of the absolute inner product of the sample principal component with the corresponding population component. A multiple regression model to predict stability is devised, calibrated, and tested using simulated Normal data. Results show that the model can provide useful predictions of individual principal component stability when working with correlation matrices. Further, the predictive validity of the model is tested against data simulated from three non-Normal distributions. The model predicted very well even when the data departed from normality, thus giving robustness to the proposed measure. Used in conjunction with other existing rules this measure will help the user in determining interpretability of principal components.
Three new species of Ypresian (early Eocene) Odonata are described: Paradysagrion sosbyaegen. and sp. nov. from the Klondike Mountain Formation at Republic, Washington, United States of America, and Dysagrionites allenbyensissp. nov. and Allenby gen. and sp. A from the Allenby Formation near Princeton, British Columbia, Canada. All three are assigned to the Dysagrionidae and Cephalozygoptera but only tentatively, as key diagnostic morphology is missing from their incomplete fossils. The definition of the collective genus Dysagrionites is broadened to include odonates tentatively assigned to the Dysagrioninae (Dysagrionidae) that are distinct as species but have unclear nominal genus affinity.
In response to the COVID-19 pandemic, we rapidly implemented a plasma coordination center, within two months, to support transfusion for two outpatient randomized controlled trials. The center design was based on an investigational drug services model and a Food and Drug Administration-compliant database to manage blood product inventory and trial safety.
Methods:
A core investigational team adapted a cloud-based platform to randomize patient assignments and track inventory distribution of control plasma and high-titer COVID-19 convalescent plasma of different blood groups from 29 donor collection centers directly to blood banks serving 26 transfusion sites.
Results:
We performed 1,351 transfusions in 16 months. The transparency of the digital inventory at each site was critical to facilitate qualification, randomization, and overnight shipments of blood group-compatible plasma for transfusions into trial participants. While inventory challenges were heightened with COVID-19 convalescent plasma, the cloud-based system, and the flexible approach of the plasma coordination center staff across the blood bank network enabled decentralized procurement and distribution of investigational products to maintain inventory thresholds and overcome local supply chain restraints at the sites.
Conclusion:
The rapid creation of a plasma coordination center for outpatient transfusions is infrequent in the academic setting. Distributing more than 3,100 plasma units to blood banks charged with managing investigational inventory across the U.S. in a decentralized manner posed operational and regulatory challenges while providing opportunities for the plasma coordination center to contribute to research of global importance. This program can serve as a template in subsequent public health emergencies.
This paper presents a comprehensive evaluation of reduced-order models (ROMs) for the determination of pressure coefficient distributions on supersonic and hypersonic bodies. The study investigates the limitations, aerodynamic precision and computational performance associated with various methodologies, ranging from simplistic Newtonian theory-based approaches to more advanced first and second-order shock-expansion theories. Validation is performed by comparing computed results with experimental and computational data for pressure distributions, drag and lift coefficients and centres of pressure for fundamental geometries and authentic vehicle design over a wide range of freestream conditions. The study also includes a comprehensive computational complexity analysis, demonstrating the superiority of finite-element ROM approaches over traditional finite-volume computational fluid dynamics (CFD) simulations. The primary objective of this paper is to scrutinise the extension of these methodological classes to the low supersonic regime. Hence, thermo-chemical reactions within the flow are disregarded, and the ideal gas law is adopted. A value of $\gamma = 1.4$ is chosen for consistency and comparability across the analyses. The proposed ROMs show remarkable potential for reducing high-speed simulation execution times by four orders of magnitude, maintaining accuracy within 20 per cent and as low as 1 per cent. The study unveils three key findings: first, the accuracy degradation of Newtonian-based theories for inclined elements, particularly around 45 degrees, and their reduced dependency on Mach number at large inclination. Secondly, the study presents novel insights into the impact of shock-wave-Mach-wave interactions on pressure distribution calculations, emphasising the Mach number as a crucial metric governing recompression effects. Lastly, the study demonstrates the exceptional accuracy of DeJarnette’s method, providing ${C_P}$ results within 2 per cent for a wide range of conditions, offering an attractive alternative to the Taylor-Maccoll equation.
Operationalizing multi-site Community Engagement (CE) Studios to inform a research program is valuable for researchers. We describe the process and outcomes of hosting three CE Studios with Community Experts aged 65 years or older with chronic conditions and care partners of older adults. Experts gave feedback about processes for testing the feasibility, efficacy, effectiveness, and implementation of audio recording clinic visits and sharing recordings with patients who have multimorbidity and their care partners.
Methods:
The CE Cores of the Clinical and Translational Science Awards Programs at three academic health science centers created a joint CE Studio guide. Studios were conducted iteratively by site. Following receipt of the final reports, responses were compared to find themes, similarities, and differences on four topics in addition to overall commentary: Recruitment and Retention, Study Protocol, Study Reminders and Frequency, and Recording Technology.
Results:
Eighteen older adults and care partners in three states provided valuable feedback to inform multi-site trials. Feedback influenced multiple aspects of trials in process or subsequently funded. Experts provided critique on the wording of study invitations, information sheets, and reminders to engage in study procedures. Experts were concerned for participants being disappointed by randomization to a control arm and advised how investigators should prepare to address that.
Conclusions:
Multi-site CE Studios should be consecutive, so each team can learn from the previous teams. Using the CES Toolkit ensures that final reports were easily comparable and utilized to develop a research program that now includes three federally funded clinical trials.
Policy specialization in the U.S. Congress benefits the institution collectively and members individually. Yet members of Congress (MCs) are insufficiently specialized to optimize lawmaking success (Volden and Wiseman 2020). In this paper, we demonstrate the increasing propensity of MCs to generalize legislatively is driven largely by an expansion of MC legislative agendas in business domains. We then offer and test an explanation for this trend whereby business’s increasing demand for congressional attention (Drutman 2015) has outpaced the supply of congressional capacity to serve business needs (Crossen, Furnas, LaPira, and Burgat 2020; McKay 2022). This unmet demand incentivizes MCs to expand their business portfolio, which results in increased campaign contributions from business political action committees (PACs). We provide evidence consistent with this theory, showing that under conditions of access scarcity, MCs benefit financially (in terms of increased business PAC contributions) by broadening the number of business domains they are active in legislatively.
Postural orthostatic tachycardia syndrome is a debilitating disorder. We compared paediatric patients with this dysautonomia presenting with and without peak upright heart rate > 100 beats per minute.
Materials and Methods:
Subjects were drawn from the Postural Orthostatic Tachycardia Syndrome Program database of the Children’s Hospital of Philadelphia diagnosed between 2007 and 2018. Subjects were aged 12–18 years at diagnosis with demographic data, supine and peak heart rate from 10-minute stand, symptoms, and family history. Patients were divided into “low heart rate” (peak less than 100 beats/minute) and “high heart rate” (peak at least 100 beats/minute) groups.
Results:
In total, 729 subjects were included (low heart rate group: 131 patients, high heart rate group: 598 patients). The low heart rate group had later age at diagnosis (16.1 versus 15.7, p = 0.0027). Median heart rate increase was 32 beats/minute in the low heart rate group versus 40 beats/minute in the high heart rate group (p < 0.00001). Excluding palpitations and tachypalpitations, there were no differences in symptom type or frequency between groups.
Discussion:
Paediatric patients meeting heart rate criteria for postural orthostatic tachycardia syndrome but without peak heart rate > 100 demonstrate no difference in symptom type or frequency versus those who meet both criteria. Differences observed reached statistical significance due to population size but are not clinically meaningful. This suggests that increased heart rate, but not necessarily tachycardia, is seen in these patients, supporting previous findings suggesting maximal heart rate is not a major determinant of symptom prevalence in paediatric postural orthostatic tachycardia syndrome.
Diagnosis of acute ischemia typically relies on evidence of ischemic lesions on magnetic resonance imaging (MRI), a limited diagnostic resource. We aimed to determine associations of clinical variables and acute infarcts on MRI in patients with suspected low-risk transient ischemic attack (TIA) and minor stroke and to assess their predictive ability.
Methods:
We conducted a post-hoc analysis of the Diagnosis of Uncertain-Origin Benign Transient Neurological Symptoms (DOUBT) study, a prospective, multicenter cohort study investigating the frequency of acute infarcts in patients with low-risk neurological symptoms. Primary outcome parameter was defined as diffusion-weighted imaging (DWI)-positive lesions on MRI. Logistic regression analysis was performed to evaluate associations of clinical characteristics with MRI-DWI-positivity. Model performance was evaluated by Harrel’s c-statistic.
Results:
In 1028 patients, age (Odds Ratio (OR) 1.03, 95% Confidence Interval (CI) 1.01–1.05), motor (OR 2.18, 95%CI 1.27–3.65) or speech symptoms (OR 2.53, 95%CI 1.28–4.80), and no previous identical event (OR 1.75, 95%CI 1.07–2.99) were positively associated with MRI-DWI-positivity. Female sex (OR 0.47, 95%CI 0.32–0.68), dizziness and gait instability (OR 0.34, 95%CI 0.14–0.69), normal exam (OR 0.55, 95%CI 0.35–0.85) and resolved symptoms (OR 0.49, 95%CI 0.30–0.78) were negatively associated. Symptom duration and any additional symptoms/symptom combinations were not associated. Predictive ability of the model was moderate (c-statistic 0.72, 95%CI 0.69–0.77).
Conclusion:
Detailed clinical information is helpful in assessing the risk of ischemia in patients with low-risk neurological events, but a predictive model had only moderate discriminative ability. Patients with clinically suspected low-risk TIA or minor stroke require MRI to confirm the diagnosis of cerebral ischemia.
Knowledge of sex differences in risk factors for posttraumatic stress disorder (PTSD) can contribute to the development of refined preventive interventions. Therefore, the aim of this study was to examine if women and men differ in their vulnerability to risk factors for PTSD.
Methods
As part of the longitudinal AURORA study, 2924 patients seeking emergency department (ED) treatment in the acute aftermath of trauma provided self-report assessments of pre- peri- and post-traumatic risk factors, as well as 3-month PTSD severity. We systematically examined sex-dependent effects of 16 risk factors that have previously been hypothesized to show different associations with PTSD severity in women and men.
Results
Women reported higher PTSD severity at 3-months post-trauma. Z-score comparisons indicated that for five of the 16 examined risk factors the association with 3-month PTSD severity was stronger in men than in women. In multivariable models, interaction effects with sex were observed for pre-traumatic anxiety symptoms, and acute dissociative symptoms; both showed stronger associations with PTSD in men than in women. Subgroup analyses suggested trauma type-conditional effects.
Conclusions
Our findings indicate mechanisms to which men might be particularly vulnerable, demonstrating that known PTSD risk factors might behave differently in women and men. Analyses did not identify any risk factors to which women were more vulnerable than men, pointing toward further mechanisms to explain women's higher PTSD risk. Our study illustrates the need for a more systematic examination of sex differences in contributors to PTSD severity after trauma, which may inform refined preventive interventions.
The heat capacities of kaolinite (7 to 380 K) and of dimethyl sulfoxide (DMSO) intercalated kaolinite (20 to 310 K) were measured by adiabatically shielded calorimetry. The third law entropy of kaolinite, S298, is 200.9 ± 0.5 J·mol−1K−1.
The “melting point” of the DMSO in the intercalate, 288.0 ± 0.2 K, is 3.7 K lower than that of pure DMSO, 291.67 K. The heat capacity of DMSO in the intercalate above 290 K is approximately 5.2 J·mol−1·K−1 smaller than that of pure liquid DMSO at the same temperature.
The adsorption of arsenate (As(V)) on kaolinite, montmorillonite and illite was investigated at varying pH and competing anion concentration while holding As(V) concentration (6.7 × 10−7M), clay suspension density (2.5 g L−1) and ionic strength (0.1 M NaCl) constant. The effects of 2 concentrations of phosphate (P) or molybdate (Mo) (6.7 × 10−7 and 6.7 × 10−6M) on As(V) adsorption envelopes (adsorption vs. pH) gave evidence for direct competitive adsorption (in the case of As(V) + P) and possibly site-specific non-competitive adsorption (As(V) + Mo). Distinct As(V) adsorption maxima occurred at approximately pH 5.0 for kaolinite, 6.0 for montmorillonite and 6.5 for illite, and ranged from 0.15 to 0.22 mmol As(V) kg−1. When both As(V) and P were present at equimolar concentrations (6.7 × 10−7M), As(V) adsorption decreased slightly, whereas As(V) adsorption substantially decreased in binary As(V)/P systems when the P concentration was 6.7 × 10−6M, which was 10 times greater than As(V). The presence of Mo at equimolar (6.7 × 10−7 M) and 10 times greater (6.7 × 10−6M) concentrations than As(V) caused only slight decreases in As(V) adsorption because the Mo adsorption maximum occurred at pH < 4. The constant capacitance surface complexation model was applied to As(V) and P adsorption data and was used to predict As(V) adsorption at varying P concentrations. The model gave reasonable descriptions of As(V) adsorption on the 3 clay minerals at varying pH and in the presence of a competing oxyanion (P), indicating that surface complexation modeling may be useful in predicting As(V) adsorption in soils.
Nursing home residents may be particularly vulnerable to coronavirus disease 2019 (COVID-19). Therefore, a question is when and how often nursing homes should test staff for COVID-19 and how this may change as severe acute respiratory coronavirus virus 2 (SARS-CoV-2) evolves.
Design:
We developed an agent-based model representing a typical nursing home, COVID-19 spread, and its health and economic outcomes to determine the clinical and economic value of various screening and isolation strategies and how it may change under various circumstances.
Results:
Under winter 2023–2024 SARS-CoV-2 omicron variant conditions, symptom-based antigen testing averted 4.5 COVID-19 cases compared to no testing, saving $191 in direct medical costs. Testing implementation costs far outweighed these savings, resulting in net costs of $990 from the Centers for Medicare & Medicaid Services perspective, $1,545 from the third-party payer perspective, and $57,155 from the societal perspective. Testing did not return sufficient positive health effects to make it cost-effective [$50,000 per quality-adjusted life-year (QALY) threshold], but it exceeded this threshold in ≥59% of simulation trials. Testing remained cost-ineffective when routinely testing staff and varying face mask compliance, vaccine efficacy, and booster coverage. However, all antigen testing strategies became cost-effective (≤$31,906 per QALY) or cost saving (saving ≤$18,372) when the severe outcome risk was ≥3 times higher than that of current omicron variants.
Conclusions:
SARS-CoV-2 testing costs outweighed benefits under winter 2023–2024 conditions; however, testing became cost-effective with increasingly severe clinical outcomes. Cost-effectiveness can change as the epidemic evolves because it depends on clinical severity and other intervention use. Thus, nursing home administrators and policy makers should monitor and evaluate viral virulence and other interventions over time.
While mentors can learn general strategies for effective mentoring, existing mentorship curricula do not comprehensively address how to support marginalized mentees, including LGBTQIA+ mentees. After identifying best mentoring practices and existing evidence-based curricula, we adapted these to create the Harvard Sexual and Gender Minority Health Mentoring Program. The primary goal was to address the needs of underrepresented health professionals in two overlapping groups: (1) LGBTQIA+ mentees and (2) any mentees focused on LGBTQIA+ health. An inaugural cohort (N = 12) of early-, mid-, and late-career faculty piloted this curriculum in spring 2022 during six 90-minute sessions. We evaluated the program using confidential surveys after each session and at the program’s conclusion as well as with focus groups. Faculty were highly satisfied with the program and reported skill gains and behavioral changes. Our findings suggest this novel curriculum can effectively prepare mentors to support mentees with identities different from their own; the whole curriculum, or parts, could be integrated into other trainings to enhance inclusive mentoring. Our adaptations are also a model for how mentorship curricula can be tailored to a particular focus (i.e., LGBTQIA+ health). Ideally, such mentor trainings can help create more inclusive environments throughout academic medicine.
We examine the fossil weaver ants (Formicidae, Formicine, Oecophyllini) of the early Eocene Okanagan Highlands fossil localities of British Columbia, Canada and Washington, United States of America, naming Eoecophylla quilchenensisn. gen.etsp. from Quilchena (British Columbia), formally transferring Camponotites kraussei Dlussky and Rasnitsyn (Republic, Washington) to the genus Oecophylla Smith, F., and describing but not naming a worker (McAbee, British Columbia), treated as Oecophyllinisp. A. These are the oldest known Oecophyllini (Oecophylla + Eoecophylla) and Oecophylla. Forewing vein stubs of E. quilchenensis and its well-developed hind wing vein M are plesiomorphies; this M is unique within the subfamily, suggesting Oecophyllini is sister to other Formicine. The head shape of O. kraussein. comb. indicates a close relationship to Oecophylla longiceps Dlussky from Eocene Messel, Germany. The ant Titanomyrma Archibald et al. is also known from the Okanagan Highlands and Messel, consistent with Late Cretaceous/early Paleogene intercontinental dispersal. We discuss possible host plants and trophobionts of these ants. Although Okanagan Highlands localities were cooler than the Paleotropical range of modern Oecophylla, their presence there might be explained by mild winters without significant frost.
American politics has become sharply polarized. Partisan deadlock has prevented the addressing of critical public policy issues. A prime example is Congress’s inability to pass campaign finance legislation. Corporations spend unlimited amounts of company funds to promote management’s preferred candidates without disclosure. The distortive effects of large unaccountable corporate political expenditures are evident, and the opportunity for corrupting our politics is clear. In addition, large undisclosed corporate contributions pose a threat to a well-functioning marketplace and democracy. This chapter addresses the challenge of addressing corporate political spending through the informal, non-state suasion and advocacy of the nonprofit Center for Political Accountability. CPA is a case study in successful private ordering, prompting S&P 500 companies to disclose corporate political spending; develop policies that will ensure good compliance and governance; adopt codes of conduct to reflect and inspire pro-accountability behavior; and successfully compete with other firms for best disclosure and accountability practices.
Stress and depression have a reciprocal relationship, but the neural underpinnings of this reciprocity are unclear. We investigated neuroimaging phenotypes that facilitate the reciprocity between stress and depressive symptoms.
Methods
In total, 22 195 participants (52.0% females) from the population-based UK Biobank study completed two visits (initial visit: 2006–2010, age = 55.0 ± 7.5 [40–70] years; second visit: 2014–2019; age = 62.7 ± 7.5 [44–80] years). Structural equation modeling was used to examine the longitudinal relationship between self-report stressful life events (SLEs) and depressive symptoms. Cross-sectional data were used to examine the overlap between neuroimaging correlates of SLEs and depressive symptoms on the second visit among 138 multimodal imaging phenotypes.
Results
Longitudinal data were consistent with significant bidirectional causal relationship between SLEs and depressive symptoms. In cross-sectional analyses, SLEs were significantly associated with lower bilateral nucleus accumbal volume and lower fractional anisotropy of the forceps major. Depressive symptoms were significantly associated with extensive white matter hyperintensities, thinner cortex, lower subcortical volume, and white matter microstructural deficits, mainly in corticostriatal-limbic structures. Lower bilateral nucleus accumbal volume were the only imaging phenotypes with overlapping effects of depressive symptoms and SLEs (B = −0.032 to −0.023, p = 0.006–0.034). Depressive symptoms and SLEs significantly partially mediated the effects of each other on left and right nucleus accumbens volume (proportion of effects mediated = 12.7–14.3%, p < 0.001−p = 0.008). For the left nucleus accumbens, post-hoc seed-based analysis showed lower resting-state functional connectivity with the left orbitofrontal cortex (cluster size = 83 voxels, p = 5.4 × 10−5) in participants with high v. no SLEs.
Conclusions
The nucleus accumbens may play a key role in the reciprocity between stress and depressive symptoms.
National validation of claims-based surveillance for surgical-site infections (SSIs) following colon surgery and abdominal hysterectomy.
Design:
Retrospective cohort study.
Setting:
US hospitals selected for data validation by Centers for Medicare & Medicaid Services (CMS).
Participants:
The study included 550 hospitals performing colon surgery and 458 hospitals performing abdominal hysterectomy in federal fiscal year 2013.
Methods:
We requested 1,200 medical records from hospitals selected for validation as part of the CMS Hospital Inpatient Quality Reporting program. For colon surgery, we sampled 60% with a billing code suggestive of SSI during their index admission and/or readmission within 30 days and 40% who were readmitted without one of these codes. For abdominal hysterectomy, we included all patients with an SSI code during their index admission, all patients readmitted within 30 days, and a sample of those with a prolonged surgical admission (length of stay > 7 days). We calculated sensitivity and positive predictive value for the different groups.
Results:
We identified 142 colon-surgery SSIs (46 superficial SSIs and 96 deep and organ-space SSIs) and 127 abdominal-hysterectomy SSIs (58 superficial SSIs and 69 deep and organ-space SSIs). Extrapolating to the full CMS data validation cohort, we estimated an SSI rate of 8.3% for colon surgery and 3.0% for abdominal hysterectomy. Our colon-surgery surveillance codes identified 93% of SSIs, with 1 SSI identified for every 2.6 patients reviewed. Our abdominal-hysterectomy surveillance codes identified 73% of SSIs, with 1 SSI identified for every 1.6 patients reviewed.
Conclusions:
Using claims to target record review for SSI validation performed well in a national sample.
Several hypotheses may explain the association between substance use, posttraumatic stress disorder (PTSD), and depression. However, few studies have utilized a large multisite dataset to understand this complex relationship. Our study assessed the relationship between alcohol and cannabis use trajectories and PTSD and depression symptoms across 3 months in recently trauma-exposed civilians.
Methods
In total, 1618 (1037 female) participants provided self-report data on past 30-day alcohol and cannabis use and PTSD and depression symptoms during their emergency department (baseline) visit. We reassessed participant's substance use and clinical symptoms 2, 8, and 12 weeks posttrauma. Latent class mixture modeling determined alcohol and cannabis use trajectories in the sample. Changes in PTSD and depression symptoms were assessed across alcohol and cannabis use trajectories via a mixed-model repeated-measures analysis of variance.
Results
Three trajectory classes (low, high, increasing use) provided the best model fit for alcohol and cannabis use. The low alcohol use class exhibited lower PTSD symptoms at baseline than the high use class; the low cannabis use class exhibited lower PTSD and depression symptoms at baseline than the high and increasing use classes; these symptoms greatly increased at week 8 and declined at week 12. Participants who already use alcohol and cannabis exhibited greater PTSD and depression symptoms at baseline that increased at week 8 with a decrease in symptoms at week 12.
Conclusions
Our findings suggest that alcohol and cannabis use trajectories are associated with the intensity of posttrauma psychopathology. These findings could potentially inform the timing of therapeutic strategies.
The Cambrian (Miaolingian; Wuliuan) Spence Shale Lagerstätte of northern Utah and southern Idaho is one of the most diverse Burgess Shale-type deposits of Laurentia. It yields a diverse fauna consisting of abundant biomineralized and locally abundant soft-bodied fossils, along a range of environments from shallow-water carbonates to deep-shelf dark shales. Panarthropods are the dominant component throughout the deposit, both in time and space, but whereas the trilobites and agnostoids are abundant, most of the soft-bodied taxa are only known from very few specimens. Additionally, the knowledge of soft-bodied panarthropods is currently largely limited to locations in the Wellsville Mountains of northeastern Utah. This contribution describes 21 new soft-bodied panarthropods from six locations, including the first occurrences of soft-bodied panarthropods in the High-Creek, Smithfield Creek, Spence Gulch, and Two-Mile Canyon localities. Additionally, we report the presence of bradoriids— i.e., Branchiocaris pretiosa Resser, 1929, Perspicaris? dilatus Robison and Richards, 1981, Naraoia? sp. indet., Thelxiope cf. T. palaeothalassia Simonetta and Delle Cave, 1975, and Tuzoia guntheri Robison and Richards, 1981—for the first time from the Spence Shale Lagerstätte; the first reported occurrence outside of the Burgess Shale for Thelxiope cf. T. palaeothalassia; and the first Wuliuan occurrence of Tuzoia guntheri. We also report on a new hurdiid carapace element and additional specimens of Buccaspinea cooperi? Pates et al., 2021, Dioxycaris argenta Walcott, 1886, Hurdia sp. indet., and Tuzoia retifera Walcott, 1912. This new material improves our understanding of the panarthropod fauna of the Spence Shale Lagerstätte and substantially increases our understanding of the distribution of the described taxa in time and space.
Classic psycholinguistics seeks universal language mechanisms for all people, emphasizing the “modal” listener: hearing, neurotypical, monolingual, and young adults. Applied psycholinguistics then characterizes differences in terms of their deviation from the modal. This mirrors naturalist philosophies of health which presume a normal function, with illness as a deviation. In contrast, normative positions argue that illness is partially culturally derived. It occurs when a person cannot meet socio-culturally defined goals, separating differences in biology (disease) from socio-cultural function (illness). We synthesize this with mechanistic functionalist views in which language emerges from diverse lower-level mechanisms with no one-to-one mapping to function (termed the functional mechanistic normative approach). This challenges primarily psychometric approaches—which are culturally defined—suggesting a process-based approach may yield more insight. We illustrate this with work on word recognition across multiple domains: cochlear implant users, children, language disorders, L2 learners, and aging. This work investigates each group’s solutions to the problem of word recognition as interesting in its own right. Variation in the process is value-neutral, and psychometric measures complement this, reflecting fit with cultural expectations (disease vs. illness). By examining variation in processing across people with a variety of skills and goals, we arrive at deeper insight into fundamental principles.