Previous studies have explored the impact of magic tricks on different basic cognitive processes yet there is a need of examining effectiveness of a cognitive training program through magic tricks for children with attention deficit hyperactivity disorder (ADHD). The present study examines the effectiveness and feasibility of the MAGNITIVE program, a manualized intervention for cognitive training through the learning of magic tricks. A total of 11 children with ADHD (from 8 to 12 years) participated in separated groups of two different community settings , and were assessed at pre-treatment, post-treatment, and a 3-month later follow-up in different tasks involving processing speed, sustained attention, selective attention, and mental flexibility. Using non parametric statistical analyses and Reliable Change Index, the results showed that these children receiving MAGNITIVE particularly improved their performance in sustained attention, shifting attention, and mental flexibility, changes were also observed in processing speed performance yet further research is needed in terms of selective attention and inhibition, given the great individual differences within this sample. Changes were maintained when the program was finished. In terms of viability, the study proved a good treatment integrity in different contexts , adherence to the curriculum (attendance and some practice at home), and high levels of engagement satisfaction. In this second clinical trial, MAGNITIVE program appears to be a feasible training program for children with ADHD, as an alternative for medication when possible. Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder whose principal symptoms are hyperactivity, inattention, and impulsivity . ConsideSeveral studies have been conducted in recent years into the effectiveness of non-pharmacological treatments for ADHD . These nStudies have found positive results from training in basic cognitive processes, leading to general improvement in executive functions . FurtherEvidence shows that learning by games and practice using play activities among children can facilitate the internalization of learned strategies and increase motivation . PracticMAGNITIVE, described in detail elsewhere , is a manualized program for cognitive training through the learning of magic tricks. It was developed specifically as a non-pharmacological alternative for children with ADHD.There is currently no manualized program for cognitive training through magic whose effectiveness has been studied on children with ADHD. A study by The first MAGNITIVE pilot study was conducted with seven children between the ages of 8 and 12 diagnosed with ADHD and who were not receiving pharmacological treatment. It consisted of a 10-week session conducted by a therapist who was an expert magician. The results showed significant improvement in processing speed and selective attention as a group. Individually, three of the seven children improved their sustained attention and two of them improved their information processing speed . After tThe principal aim of the present study is to examine the effectiveness and viability  of the MThe final sample consisted of 11 children diagnosed with ADHD from the pediatric ward of the El Escorial Hospital (eight boys and three girls) organized in two community settings . Participation was voluntary. The participants were selected based on the following inclusion criteria: (1) between 8 and 12 years of age; (2) diagnosed with ADHD by their pediatrician and who had high scores at the EDAH Questionnaire  and at a local school (n = 6) attended by the rest of the sample. A post-treatment assessment was conducted in the same week the program concluded (Post), as well as a follow-up evaluation 3 months later (Post-2) using the same tests. All assessments were performed by two research psychologists of the team. A psychotherapist, who is also an experienced magician, delivered the program with a facilitator who assisted with materials and coding integrity of the program.After receiving the approval of the ethics committee, researchers got in touch with parents of patients who met the inclusion criteria and were interested in participating in a non-pharmacological treatment program. The parents were invited to a group information session about the MAGNITIVE program and the objectives of the study. Those interested in the voluntary participation of their children, provided their informed consent and contact details. Appointments were scheduled for an individual pre-treatment psychological assessment of the child and at least one of the parents was also interviewed (Pre). The parents were provided with a questionnaire for their child’s teachers. Parents and teachers reported EDAH scores as a supplementary measure for diagnostic confirmation. The final sample consisted of 11 children organized into two training groups of five and six participants. The treatment was held at the hospital for the first group  was designed for school children (in primary education) diagnosed with ADHD and implemented in small groups (5–6 participants). The program consisted of 10 group-training sessions of 60–75 min, including a break. Each session focused on learning a magic trick or developing the prerequisite skills necessary to perform the trick. The program followed a standardized order, teaching magic tricks of increasing difficulty as the program advanced interspersed with handicraft sessions to create a magician’s costume. The program had dual objectives: to instruct the children to perform magic tricks and to train cognitive abilities through a play activity using various techniques, which scientific studies have associated with improved executive functions . The traThis refers to the degree to which the therapist delivered treatment as intended. A treatment integrity checklist was used to examine the following of the schedule and tasks by the therapist while delivering the program. During each session, the facilitator recorded how many of the session’s objectives were completed. Following A record was kept of the participants’ attendance and the number of hours they practiced at home with the help of a register. Before the beginning of the program, parents were provided with a register on which they were asked to note daily, the amount of time (in minutes) their children practiced magic tricks at home. The parents were not specifically asked to encourage their children to practice. The register was submitted at the end of the program. The study included a weekly calculation of the practice time.In the final evaluation at the end of the program, the children and parents were asked about their satisfaction with the program, using a Likert scale from 1 (not satisfied) to 5 (completely satisfied), evaluating the effect of the program in various aspects: knowledge of magic, entertainment, and use of magic, following of instructions, organization, memory, shifting attention, following the norms and personal comments. The scores varied from 10 to 50. Two items concerning social validation of the program were included. The questionnaire was also submitted to the tutor or teacher of reference of the student.A follow-up session was held 3 months after the program with parents and children to evaluate their performance in psychological tests used to determine the effectiveness of the program.Reading (Reading-FDT) and Counting (Counting-FDT); inhibition through the component of Choosing (Choosing-FDT) and cognitive flexibility/alternating attention through the component Shifting (Shifting-FDT). The reliability coefficients for Spanish samples α = 0.94 (Reading-FDT), α = 0.92 (Counting-FDT), α = 0.86 (Choosing-FDT), and α = 0.90 (Shifting-FDT). The test is very effective in neuropsychological analysis and suggests high intercorrelations between the four components in the test, between 0.66 and 0.93. The results are presented as centile scores, with higher scores indicating better performance.This test FDT;  measuresconcentration performance index (Concentration-D2), selective attention using an omission errors index (Omission-D2), degree of impulsivity using a commission errors index (Commission-D2), and processing speed. This provides a score for Total test effectiveness [taken from the total n° responses (number of characters correctly processed) less the omission and commission errors); the total number of correct answers, as a measure of the work performed as well as the Attention variation index (Variation-D2), which evaluates the stability of work overtime. In most studies, the results of the D2 test have proven highly reliable (r > 0.90). The results are presented as centile scores, with higher scores indicating better performance  environment, the sample was selected by convenience .X2 test (n = 10). Non-parametric tests were used due to the size of the sample. Secondly, non-parametric post hoc tests were conducted to identify exactly when these differences occurred , using Wilcoxon Z-test. Effect size, using Kendall’s W, and statistical power were reported for each significant difference.To evaluate behavioral changes after the treatment, an initial non-parametric analysis was conducted to determine if there were any significant differences between the three moments of evaluation as a whole period: Pre-Post-Post2, by means of the Friedman The clinical significance or magnitude of the individual change was also calculated using the Reliable Change Index RCI; , accordiThe feasibility of the program was determined by evidence that the treatment is acceptable for the target population and may be applied reliably based on the dropout rate, attendance rates, the hours of practice at home, the participant satisfaction questionnaires, and the fidelity of the therapist to the program.Post hoc tests were also conducted using the Wilcoxon Z-test for a two-by-two comparison of the three moments of evaluation: Pre-Post and Post-Post2; to see if changes appear after the program, and last 3 months after. A comparison of the average results of the Pre, Post, and Post 2 (3 months after the end of the program) tests showed statistically significant changes at the three moments of evaluation (Pre-Post-Post2) with moderate effect sizes  in: Coding-WISC, Color Path-Battery of Neuropsychological Assessment for Executive Function in Children (ENFEN), Rings-ENFEN, Total Responses-D2 and Correct Responses-D2, Omission-D2, Effectiveness-D2, Choosing-FDT, and Shifting-FDT. processing speed, the analysis showed significant changes in the three moments as a whole (Pre-Post-Post 2) in Effectiveness-D2 and Total Responses-D2, and changes exclusively in Pre-Post in Counting-FDT and Gray Path-ENFEN. It did not show changes in Reading-FDT nor Coding-WISC.In terms of sustained attention, Concentration-D2 and Coding-WISC both show statistically significant improvements at the three moments, and in Pre-Post, changes remain in Post 2. In selective attention, Omissions-D2 showed significant differences at the three moments. As for shifting attention, the Shifting-FDT test showed statistically significant changes at the three moments, and specifically in Pre-Post; those changes remain in Post-2. Likewise, the change already mentioned at the three moments in Color Path-ENFEN was an evidence of this improvement. The attention variation indexshowed statistically significant changes in all three moments.Regarding attention, there were several sources providing information. As regards inhibition/impulsivity, statistically significant changes were observed in Choosing-FDT both at the three moments (Pre-Post-Post 2) and at the post hoctest (Pre-Post). This was not the case in the calculation of Commission-D2 nor in Interference-ENFEN.With respect to mental flexibility(working memory tasks and short-term memory), there were statistically significant changes at the three moments in Color Path-ENFEN and Ring-ENFEN (p< 0.01), thus confirming, in post hoctests, a Pre-Post change that remains in Post-2 (where there were no significant changes in the absence of the program). On the other hand, statistically significant changes were not observed in Interference-ENFEN nor in the tasks associated with Phonological fluency-ENFEN and Semantic Fluency-ENFEN.Regarding It is also interesting to highlight those tasks where individuals showed clinically significant changes with lower scores, specifically in Choice-FDT , and Interference-ENFEN . However, two participants showed worse results in the Post for Shifting-FDT (1 and 6) and Comission-D2 (4 and 10). Surprisingly, participant 2, one of those showing most improvement in all tests, had the lower score in Total Responses-D2, Total Effectiveness-D2, and Choice-FDT.Regarding the two participants with dyslexia, participant 6 showed worse results in Shifting-FDT and Choice-FDT, but improved Semantic Fluency-ENFEN, while participant 5 showed improvements in Rings-FDT, with statistically worse Post scores only in Choice-FDT.processing speed, were shown by clinically significant improvements in three of the 11 participants in Rings-FDT and one in Total Effectiveness-D2. As for attention, clinically significant improvements appeared in: (1) selective attention, as three participants showed significant improvements in Omissions-D2; (2) sustained attention, with improvement of three participants in Concentration-D2; and (3) shifting attention, not so clearly in this case, as three participants improved significantly at a clinical level for the Color Path-ENFEN and two obtained worse scores after the intervention in Shifting-FDT. However, attention stability of attentionseemed to improve in the performance of four of the 11 participants (Variation-D2). In terms of inhibition and impulsivity, individual patterns were miscellaneous: only one participant improved at a clinical level in Choosing-FDT, whereas four others seemed to do it significantly worse, among them, the two participants diagnosed with dyslexia. Four participants performed significantly lower Commission-D2, but three performed clinically worse in Interference-ENFEN. Regarding the rest of executive functions, three children showed changes in Semantic Fluency-ENFEN and two in Phonological Fluency-ENFEN, but the tests did not allow these differences to be captured in mental flexibility or working memory.In summary, changes in group-mean scores related to The feasibility of the program was calculated based on the integrity of the application by the therapist-magician, the drop-out rate, and the adherence of the participants to the treatment (attendance rate), hours of practice registered by parents and the satisfaction questionnaire completed by the children, parents, and teachers. It was hoped that the changes would persist 3 months later.Regarding the integrity of the treatment over the course of 10 sessions in two groups, overall integrity was 85.7%. For the hospital group, integrity was 91.1%, while at the school integrity was 81.3%. An analysis of the sessions showed than none fell below the 80% cut-off for acceptable treatment integrity. The sessions were conducted within the allotted time (60–75 min), although time was always tighter in the school group. The qualitative evaluation of the therapist indicated greater difficulty in maintaining the pace of sessions imparted at the school as an extracurricular activity.Adherence of the participants to the program included participation in the weekly sessions and hours of practice at home, recorded by the parents. All the participants remained in the program to the end, attending all 10 sessions. The overall rate of attendance  for the 11 participants was 96.36%, seven children attended all the sessions and four children missed only one session. Considering the overall baseline attendance criteria of 70%, this was considered an excellent result for this indicator .With reference to practice at home, four of the 11 children practiced between the sessions at home, observed and recorded by the parents. Of the children who attended sessions at the hospital, only one practiced at home between sessions from 10 to 25 min per week during the first six sessions, stopping practice thereafter. In the school group, three children practiced at home, from 3 to 90 min per week. The variation between the three was enormous. One participant only practiced at home until session 5, while another two managed to dedicate significant amounts of time throughout the course of the program.to do magic tricks after the program, as a significant change, which was confirmed by parents of all the children and having more friendsafter participating in the program, confirmed by the parents of three children. Eight of the children marked 4 (somewhat) for it is easier to follow instruction than before, and they feel able to stay seated more time(conformed by the parents of three children), and seven indicated that they learned to be better organized, have a better memory, and can better follow norms of behavior(coinciding with the response from parents in only two cases). Notably, nine of the children affirmed that they had greatly enjoyed the program, a highly positive result for the therapist-magician. One participant commented on the benefit of now having something to do when bored. Two of the children mentioned the importance of making new friends. Four of the parents commented that their children were highly motivated to attend the sessions and in two cases improvements were reported in academic performance. As for teachers, the three questionnaires which were returned provided little useful information. All the children and parents affirmed that they would recommend the program to others and that the program should receive financial support from social services in order to be available to more children.Regarding the satisfaction questionnaire, of the 10 items dealing with changes in daily life, 69.1% of all responses by the children were 4 or 5 (somewhat or very much), while in the case of parents, similar responses were given 26.4% of the time. In the qualitative analysis, nine children considered the ability The aim of the present study was to evaluate in a second clinical trial in community settings, after conducting a previous pilot study, the effectiveness and feasibility of MAGNITIVE program for groups of children with ADHD; a program based in the implementation of self-instructions and other cognitive-behavioral techniques through the teaching of magic tricks. Under two different types of analysis of treatment effectiveness, findings reveal a significant improvement in these participants regarding cognitive abilities. On the one hand, based on changes in participants’ performance (group mean scores) of different cognitive tasks measuring processing speed, attention processes , mental flexibility and other executive functions such as phonological and semantic fluency. And secondly, as a complementary analysis, RCI changes for each participant were calculated between two moments. Taking the two methodologies into account, this training program particularly increased sustained attention, shifting attention, and mental flexibility of the participants. Processing speed performance significantly changed when the group mean scores were taken. Meanwhile, the impact of this training should be further studied in randomized clinical trials and larger samples, especially in order to clarify its effects in terms of selective attention and inhibition, given the great individual differences within this sample.post hocconfirmed this improvement in Pre-Post, and sometimes also in Post-Post2. It was never the case that for a statistically significant change at the three moments (Pre-Post-Post2), the post hoctests revealed that the change was significant only Post-Post2 without previous significant changes at Pre-Post. Therefore, changes appeared always in the presence of the program, and in any case, could be maintained when the program is finished but, improvements do not occur alone, in the absence of the program. Furthermore, under no circumstances the acquired skills in the presence of the program worsened 3 months later (after the program was finished).In general terms, statistical analysis showed that in all cases where there were significant changes at the three assessed moments (Pre-Post-Post2), the In connection with the improvements in processing speed and sustained attention, the results obtained were consistent with the results in the first pilot study of MAGNITIVE program , and witNo previous interventions were found, reporting improvement in processes such as organization, sequencing, and anticipation with a cognitive-behavioral focus . Some stIn relation to inhibition/impulsivity, there was a statistically significant change in one of the tasks, and clinically significant improvements in some of the participants in different tests associated with inhibition, although other participants showed a significantly worse performance. This cognitive ability seems to be the least benefitted from the program, compared to the rest of abilities. It is worth considering whether the learning of magic tricks does not help in training inhibitory control  or whethThe results in terms of feasibility are promising. Until now, few evidence-based interventions focused on improving cognitive abilities through play activities , which mIn conclusion, following the step-wise model for validating and disseminating interventions , MAGNITIPrevious studies with play activities such as chess games  and compAmong the limitations of the study, the sample recruited was small. Larger samples with a control group of comparison may increase statistical power. The lack of a wait list group or comparison with another training package prevents the direct attribution of the changes to MAGNITIVE program against other unspecified aspects of the program. There is the fact that the same psychotherapist carried out the whole program with two groups , which also reduces the generalization of results. Another limitation refers to the chosen tests to examine changes in inhibition and impulsivity among other cognitive abilities. Practice at home was not requested consistently nor registered in a reliable manner. It would be interesting to analyze the program’s effects if the package includes regulated home tasks within the program or psychoeducational intervention to parents . In addiIn conclusion, this study shows the effectiveness in a second clinical trial of MAGNITIVE, a cognitive training through magic, whose objective is improving deficient cognitive abilities in a group of children with ADHD as part of a play activity. The study is draw from a manualized program as a starting point, which could spread over time, encouraging expertise in performing magic tricks. It has shown an adequate implementation feasibility both in school and hospital environments. MAGNITIVE program is ready to be validated with larger samples in multisite randomized clinical trials.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.This study was reviewed and approved by the Ethics Committee at Universidad Francisco de Vitoria. Written informed consent to participate in this study was provided by the participants’ legal guardian/next of kin.SB and AO contributed to the conception and design of the work, assessed the children, and prepared the first draft of the manuscript with the assistance of IG-F. CM analyzed the data set, wrote the results section, and reviewed the paper draft. SB led the paper draft and revised the last version of the manuscript. All authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


An expert panel wasinvited to develop the integrative learning program based on theneuroplasticity and learning framework. A feasibility test was conducted toevaluate the implementation of the program in two centers after the trainingof personnel who run the program. Verbatim transcripts of case conferenceswere coded, analyzed, and collapsed into themes and sub-themes byconsensus.there was no indication for content modification during the period of programimplementation. Qualitatively, the participating older adults showedimprovement in communications, emotions, connectedness with self and others,and well-being.the integrative learning program was uneventfully implemented with promisingresults. The program is ready for full-scale research on its efficacy inmultiple centers to obtain more robust evidence. In other words, there will be one new case of dementiadiagnosed globally every 3 seconds. The severity of the problem can be seen bytaking China as an example because it has the largest population with dementia inthe world. The prevalence ofsenile dementia (among people aged 65 or above) was rising, from 5% in 2013 to 5.56%in 2017. Taking the Chinese Mainland, Hong Kong, and Taiwan together, it wasreported that the number of people aged 60 or above suffering from dementia was ashigh as 9.48 million in 2018.The estimated measures of prevalence of dementia (estimated population) in northernChina, central China, southern China, western China, Hong Kong, and Taiwan were 5.5%(3.52 million), 5.2% (3.79 million), 4.8% (1.48 million), 7.2% (0.69 million), 7.2%(0.07 million), and 6.0% (0.15 million) respectively. Since China has comparatively quite high dementiaprevalence rate, its huge population size will bring huge number of dementiapatients with heavy burden on the community. In view of this global problem, the WHOhas considered dementia as a global public health priority and taken measures to helpcountries to contain the problem.Caring for the elderly with dementia is a global challenge. About 5% of the world’selders (47 million) suffered from dementia and it was estimated that this will riseto 75 million in 2030 and 132 million by 2050. Dementiaalso has devastating impacts on sufferers’ families and friends. Family members areoften the main caregivers for people with dementia. It is an unpaid andround-the-clock job that causes not only physical and psychological exhaustion, butalso a huge financial burden. It was reported that the loss of wages for beingunpaid caregivers at home was forecasted to increase from $5 billion Canadiandollars in 2008 to $55 billion Canadian dollars in 2038. Besides the wage loss, there are also highintangible costs to caregivers in taking care of people with dementia as stress,fatigue, depression, and anxiety set in.The number of healthy years [disability-adjusted life years (DALY)] lost istremendous as dementia is the fifth leading cause of death globally. It was reportedthat about 28.8 million [95% uncertainty interval (UI) 24.5-34.0] DALYs lost wereattributed to dementia. It was projected this willincrease to US$2 trillion by 2030. Similarly, another study estimated that theannual economic losses caused by dementia in mainland China alone was 83.5-97.4billion Yuan, and the consumption of cognitive related health services reached51.3-59.8 billion Yuan a year.From a societal perspective, the impact of dementia on social healthcare expenditureand demand for nursing services cannot be underestimated as well. As reported, thetotal global expenditure on dementia treatment in 2015 was US$818 billion-10. Up to now no conclusion has been reached and the mostcontroversial debate of all is whether dementia is caused by the dysfunction of theneural circuits in the brainor the malfunction of the cerebrovascular system. Supporters of the dysfunction in the brain’sneural circuits believe that the harmful signals of neuritic plaques and nerve fiberentanglement in certain areas of the brain cause the gradual degradation of thebrain’s cholinergic system, so they are more inclined to use galantamine drugs toenhance the functions of the sufferers’ cholinergic system. On the other hand, for those whobelieve it is the dysfunction in the cerebrovascular system, they believe that highhomocysteine affects the blood vessel systolic reactivity of the cerebral arterywhich in turn leads to cognitive decline and neuro degeneration, so people areadvised to take folic acid and vitamin coenzyme to reduce homocysteinelevels. However, thecurrent pharmacological approach can only delay the progress of the disease. Drugtherapy does not cure dementia,4.The pathogenesis of dementia is complex and scientists are still unraveling its mythsfrom different perspectives, including physiological mechanism of the disease,neurology, behavioral performance, and other associated aspects,6,15. So far, no effective treatment has beenidentified,4.In recent decades, scientists and clinicians have been exploring variousnon-pharmacological treatments for dementia to reduce disability, alleviate and/ormanage behavioral and mental symptoms so as to improve the quality of life of theaffected people and their caregiversAt present most, if not all, care models adopt a biomedical approach to managedementia. Most dementia programs are western medicine oriented, e.g., realityorientation, reminiscence therapy, multisensory stimulation, daily life skillstraining, and music therapy; complementary approach such as inclusion of Chinesemedicinal approach has yet to be adopted.By taking these experiences into consideration, the team attempted to apply theconcept of neuroplasticity and learning to dementia care on the premise that peoplehave the capacity to learn new things through repeated practices. In other words,they can rebuild their capacity gradually through the process of slow streamrehabilitation.-17, whichmeans brain cells can change their structure and functions according to theconditions required. In vivo, studies showed that the physicalbrain structure of mice changed through what they did in their daily experiences inenriched environments. Allbrain cells, including those in damaged brains, have neuroplasticity and especially adult neurons arecapable of neurogenesis. Theadult brains have huge latent plasticity and it is believed that repeated practicecan lead to re-organization of the cerebral networks which can enhance functionalperformance through intense training.Recent studies supported that the brain is plastic. The brain can be rewired just by learning, thinking, andpracticing. One way to achieve the change is to activate learning through goalsetting and practices in a positive mindful manner in the pursuit of rewards whilethe brain is creating new paths-17; and it is always desirable tohave a positive environment for neuroplasticity to emerge and learning to takeplace, when the medial pre-frontal cortex is associated with a healthy, happy, andpositive attitude which can be brought about by coming back to the present momentthrough mindfulness, a way to exercise the pre-frontal cortex-23. To further enhance the change, learning, an applicationof mindfulness, has been shown to increase the flexibility and attention inlearning and thelearners’ connectedness to the surroundings-26.Learning is a process of acquiring skills, knowledge, attitude and values. The“learnt” experiences would mold the brain through neuroplasticity. Thus,neuroplasticity is vital to learning as new neurons are formed in the hippocampusand cerebellum of the adult brain through neurogenesis, and thus, new memories arecreated and older memories may be modifiedTo bridge the knowledge and practice gap in current dementia care, we determined todevelop an integrative learning program based on the concept of neuroplasticity andlearning. It is hoped that the program will help old people with dementia managetheir symptoms using a transdisciplinary approach. We can learn new things  in the presence of innate neuroplasticity. Thelearning can be conducted in combination of group and personal contact. Grouplearning allows interaction and stimulation while person-centered learningaccommodates individual needs. To have learning to occur, we need to repeatedlypractice which optimizes our neural networks based on the neuroplasticity.Therefore, the aim of the study was to develop the integrative learning program forpeople with dementia.This was a methodological study in which an integrative learning program based on theneuroplasticity and learning framework was developed by an expert panel using theDelphi technique, followed by a feasibility test on its implementation using aqualitative approach. Individual interviews with the participants and thematicanalysis of verbatim transcripts were carried out. Ethics approval were obtainedfrom the Research Ethics Committee on Human Subjects of the funding agency beforethe commencement of the study.-30. The panel consisted of 8health professionals including a gerontic care nurse, a registered nurse, anoccupational therapist, a physiotherapist, a Chinese medicine practitioner, amindfulness practitioner, a nutritionist, and a neuroscientist. They all hadmore than 10 years of experience in their own disciplines.Delphi technique was employed to gain consensus in the best possible therapeuticinterventions for old people with dementia among members of the expertpanel. The exchange on each topic terminated whenall experts reached total agreement on their analysis and views were exhausted.Upon completion of each round, a summary was sent to all experts for accuracychecking. With this iterative approach, 12 rounds of exchange were necessitatedto develop the complete integrative learning protocol.A member of our research team explained to the experts individually the purposeof having the panel and the importance of opinion sharing and idea exchange.Subsequent exchanges covered the conceptual framework, needs of people withdementia, components of the program operation and the intervention protocol. Theexperts did not meet but to provide their views through emails or audiorecordings. We organized, collated the views, presented the aggregated viewsiteratively to each expert for considerationTo dispel any unrealistic expectations and facilitate learning, training in goalsetting skills is needed in the integrative learning program. It was agreedamong the experts that people with dementia have different needs andexpectations, and various levels of difficulty and ability to meet them, be itbasic (novice) or advanced (expert). Hence the panel formulated a list ofdevelopmental needs which are necessary and essential for quality living ofpeople with dementia. The goal of development of each need was also identifiedbased on a novice -expert continuum and the conceptual framework ofneuroplasticity and learning .The panel reviewed some common dementia management programs used in localinstitutions. Although these programs have included many contemporary treatmentmodalities, the results were not marked. The panel also commented that thetreatment modalities could have been sufficient but the piece-meal approachmight undermine their efficacy. They concluded that an integrated and structuredmulti-modality approach together with emotion management should be adopted forthe integrative learning program. The multi-modality treatments in the programwere structured sessions that employed physical, cognitive, social, andemotional stimulations to intervene dementia. The modalities selected for theprogram included reality orientation, daily living skills training, reminiscencetherapy, multisensory stimulation, fall prevention program, mindfulnessactivities, Meridian exercise, brain health program  and healtheducation. It was also agreed that case managers, caregivers, and participantswere free to choose these treatments or could be assigned to a treatment regimeon a “mix and match” basis to suit their personality traits for improving theirabilities to meet their own needs.Based on the outcome of the above Delphi exercise, the experts brain-stormed thecontents and details of each, followed by discussions before resolutions weremade by consensus. Consensus was reached for the duration of a standard 3-dayprotocol and 5-day protocol. The 5-day protocol was an extended version of the3-day one, which allowed the participants to practice more in a designated time.. Thoseliving alone, with communication difficulties like language barriers, deafness,dysphasia and/or severe dysarthria, recently participated in another dementiaprogram, with known history of psychotic illnesses such as schizophrenic,psychiatric, or with organic brain diseases such as brain tumors were excluded.All participants continued with their daily routines and medications during theresearch period. Consents were obtained from both the eligible older people andtheir relatives.The feasibility test which lasted for 6 months was held in community care centersrun by the same non-profit organization (NPO) and their routine and careprovided were the same across their centers. The centers were located indifferent districts where residents were in public housing. Two centers wererandomly drawn from the NPO by drawing lots. Eligible older people with dementiafrom the centers were recruited by convenience sampling. The inclusion criteriawere people aged 65 or above, members of the community care centers, diagnosedwith dementia and mild cognition impairment Qualitative data were based on the verbatim transcripts of the monthly caseconferences. The verbatim transcripts of the case conferences were used forthematic analysis. These verbatim records were transcribed and coded for contentanalysis, based on the conceptual framework of the integrative learning program.A research assistant first identified words/segments in each transcript and thencondensed them into meaningful units. Two members of our research teamabstracted all the condensed meaning units into subthemes which weresubsequently verified by three external experts.The result of the integrative learning program which was reported above for easyreference. The protocol developed from the program was closely followed by the casemanagers and there was no indication for change throughout the implementationperiod.The demographic data showed no significant differences in gender and age between the2 centers. But there were statistically significant differences in educational level(p = 0.006) and duration of dementia (p = 0.001) between the 2 centers .A total of twelve verbatim records were collected, six from each center. To protectprivacy of those not in the study, the team only studied those information relatedto the participants. With reference to the conceptual framework, communication andwell-being were related to neuroplasticity and learning, and life skills reflectedneuroplasticity while connectedness reflected mindful learning. The participants showed obvious behavioral change which provided an insightfulperspective on the effects of the program qualitatively. At the early stages of theprogram, some participants often left early or frequently asked to go to thebathroom and this situation improved significantly after they had been in contactwith the case manager several times. Most participants were able to participate ingroup activities throughout the process and were happy to cooperate with alltraining activities. This behavioral change supports that people with dementia havethe ability or the desire for self-improvement.The participants over the 6-month period were increasingly more willing tocommunicate with others, not only with family members, but also with the casemanagers, their peers, and the institutional staff. Moreover, they began to use awider range of oral expression skills with more vocabularies. This was in line withthe idea advocated by UK’s National Health Service to encourage people withcognitive dysfunction to communicate with others as much as possible in order toslow down the impact of dementia. All participants in the 3-day and 5-day programsshowed greater confidence in expressing themselves, using eye contacts, givingfacial expressions, and raising their voice volume when answering questions.After the integrative learning program intervention, most of the participants in thetwo centers were more confident, more reactive, and had an increased range ofactions when doing lower limb exercises. Their willingness to participate intraining activities and follow instructions had also improved over time. Similarly,their functional performance  was reported to haveimproved. The team believes that if this “guidance or encouragement” is not allowed,it affects the overall assessment of functional performance because “guidance orencouragement” is what this group of older people need.A number of factors lowered the participation rates of some participants, whichaffected the results. For instance, some participants were unable to join someactivities due to infection that required isolation. During an influenza outbreak inthe program period, some group activities were restricted and, as a result, theaffected participants could only attend personal practice sessions instead. In orderto complete all sessions as scheduled, the actual participation time of thoseaffected participants had to be shortened and therefore, could have influenced theirperformance in the program.At the early stages of the intervention, the participants showed difficulty incontrolling their temper. Their emotional expressions, somehow, drew the attentionof the case managers (selected from therapists) who, on reflection, allowed them tomake timely adjustments to related activities to better suit the participants’needs. As time went on, laughter in the function room gradually increased, and mostof the participants began to express their pleasure and preference in the running ofthe activities, and established a trusting therapeutic relationship with the casemanagers and a good rapport was developed between the two parties.The increase in the participants’ pleasure could also be reflected in the verbatim.In the reminiscence sessions, the participants were gradually more willing to sharedetails of their past with others, like recalling where they came from, how theyspent their childhood, what their favorite food was, what things impressed themmost, and so on, prompting them to start thinking for themselves and being aware oftheir own quest for a better life. The reminiscence therapy was very effective in anevent before the Mid-Autumn festival. The participants were very eager to guess theprices of a variety of mooncakes. Some initiated to compare the prices with those intheir old days and to evaluate whether the mooncakes were worth buying. In addition,some participants even took initiative to share the old practice of making monthlyinstalments to “Moon Cake Club” due to the low wages in the past, the fading out of“Moon Cake Club” etc.Most of the participants became more active and interactive in the activities, andsome out of their own volition began to greet and talk to the case managers, callout the case managers by name correctly, and gradually engage in some dailyconversations, which did not occur in the early part of the intervention.The integrative learning program focused on enhancing the participants’ abilities toimplement whole-person care so as to enable institutional caregivers to better meettheir needs. It was set up to use physical, cognitive, social, and emotionalinterventions, as well as some repetitive intervention plans. The repetitiveintervention plans focused on developing the elderly’s sense of familiarity,security, and abilities in order to increase their participation, learning anddevelopment in all their functional areas. Case managers were sensitive to anypossible plateau effects that participants might have and, thus, changed theintensity or type of activity components in the affected training sessions.. Also, it is crucial that the case managers,caregivers and the old people have the same understanding of the old people’s“self”. This common understanding helps formulate mutually acceptable goals. In thismodel, people with dementia were the active members in the center of care, whileteam members shared the roles and responsibilities of caregiving. Transdisciplinarycare adopted an approach where case managers were chosen from a team of nurses,occupational therapists, physiotherapists, TCM physicians, western doctors, and painmanagement specialists basing on care needs.The program emphasizes self-determination, goal setting and sense of control. Theteam believes that people must have an understanding of their “self” before they canmanage their dementia. The self of a person is manifested in the form of behaviorswhich evolve from interactions of different personality traits. In the case of theold people, these personality traits would have been shaped to a large extent bytheir life experiences and have been quite solidly grounded. Their understanding oftheir self is reflected through their behaviors. Therefore, the key to providinggood care to people with dementia is to have a shared understanding of mutuallyacceptable goals among the case managers, caregivers and the old people concerned.This shared understanding means everyone needs to take an active role in theprogram, not just the recipients of care - the old peopleGiven the positive experience that we had in this methodological study, we havecommitted to actively conduct a multi-center trials to fine-tune the implementationof this transdisciplinary care program so as to benefit more people with dementia.More importantly, this study opens an alternative perspective in dementia care forresearchers and those with dementia and their carers.This methodological study revealed the feasibility of an integrative approach in thecare of old people with dementia. Dementia is considered as a global epidemic withhuge potential costs. It is stereotyped by its progressive and irreversible impactson individual’s health and wellbeing. The preliminary work reported in this paperhas shed light on the possibility of rehabilitating old people with dementia throughthe integrative learning program developed from the theories of neuroplasticity andlearning. Some positive effects of the program reflected from the results of theobservations and judgments of the therapists were evidenced in case conferences.Given this is only a feasibility testing, the research team considered more robustand full scale evaluation of the program necessary and essential for betteracceptance. The integrative program may exemplify the contributions of nursing tomeet health needs where the demand is growing using a nurse-led model of care.


African Americans (AA) are less likely than White Americans to complete advance care plans or end-of-life treatment documents. They face significantly greater risk of Alzheimer’s Disease, a silent epidemic for this population, and other dementias. The healthcare system’s lack of dementia support for AAs contributes to disparate care. A four-session caregiver group education program was conducted on advance care planning for AA dementia family providers. The program was based on Kolb’s Experiential Learning Model and initially found effective in an R01 study using in-person delivery by a professional. The present pilot assessed feasibility of delivering the program in a self-directed multimedia format without professional facilitation, using Session 1 on tube feeding decisions as the test session. Twenty-six AA dementia caregivers completed the session in groups of 5 to 8 at a church equipped with a large TV screen. On-screen prompts guided navigation through the program which included recorded lecture, slides, short videos on decision-making, and group discussions. Using quantitative and qualitative methods, pre-and post-survey instruments were administered and interviews conducted. Usability ratings averaged 84%. Knowledge and self-efficacy gains exceeded those of the R01, with a 35% increase in correct responses on knowledge items, versus 18% for the R01 subjects; and increase in perceived decisional self-efficacy of 31% versus 30% for the R01 subjects. Qualitative feedback was universally positive. These findings confirm the feasibility of the self-guided multimedia approach to delivery of the program. A large RCT is planned which, if successful, will support wide dissemination to AA caregivers in need.


SHED-IT: Recharge trial, conducted in 125 men with depressive symptoms and overweight or obesity, tested the efficacy of a gender-tailored eHealth program with integrated mental health support. The aims of this study were to examine the perceptions of men who received the SHED-IT: Recharge intervention in relation to recruitment, satisfaction with the program, and suggestions to improve the program. Individual semi-structured interviews were conducted in a random sub-sample, stratified by baseline depression and weight status  age 49.6 years (11.6), PHQ−9 score 9.0 (3.7), BMI 32.5 kg/m2 (4.6)). Transcripts were analyzed using an inductive process by an independent qualitative researcher. Four themes emerged, namely, (i) specific circumstances determined men’s motivation to enroll, (ii) unique opportunity to implement sustained physical and mental health changes compared to previous experiences, (iii) salience of the program elements, and (iv) further opportunities that build accountability could help maintain focus. Gender-tailored, self-directed lifestyle interventions incorporating mental health support are acceptable and satisfying for men experiencing depressive symptoms. These findings provide important insights for future self-guided lifestyle interventions for men with poor physical and mental health.Despite increasing rates of co-morbid depression and obesity, few interventions target both conditions simultaneously, particularly in men. The  Depression and obesity are highly prevalent, chronic health conditions that affect a substantial number of men worldwide ,2. EvideLifestyle programs integrating specific mental health support can reduce weight and depressive symptoms concurrently , but mosSHED-IT : Recharge randomized controlled trial (RCT). This study evaluated the efficacy of a 3-month gender-tailored, eHealth program comprising behavioral lifestyle advice with targeted mental health support to improve the physical and mental health of men with overweight or obesity and low mood. The program was completely self-guided and included printed materials  alongside online components . All materials were gender-tailored to appeal to men’s preferences  [SHED-IT: Recharge group maintained significant intervention improvements at 6 months follow-up for depressive symptoms  units, 95% CI = −4.0, −0.7, p < 0.01, d = 0.5) and weight . Small-to-medium intervention effects were also detected for several health behaviors , energy intake (kJ)) and cognitive outcomes   [To address the growing number of men living with both depression and overweight or obesity, we recently conducted the ry mode) . Detailery mode) , secondary mode) , and medry mode)  have bee0.3–0.5) .SHED-IT: Recharge trial in relation to recruitment, satisfaction with program content and delivery components, and suggestions for how the SHED-IT: Recharge program could be improved.Despite these positive findings, a comprehensive process evaluation of the trial, has not yet been conducted. To guide further program developments and provide insights for new programs, it is important to seek feedback from participating men about the design and delivery of the intervention, as well as their experiences in the trial ,29. WithSHED-IT: Recharge RCT and findings of the study outcomes have been reported elsewhere [n = 62; control, n = 63) participated in a parallel-group RCT comparing an intervention to a self-assessment, wait-list control group. Assessments were held in September 2019 (baseline), December 2019 , and March 2020  at the University of Newcastle, Australia. All measures were collected by trained research assistants who were blinded to group allocation. The trial was approved by the University of Newcastle Human Research Ethics Committee and registered with the Australian New Zealand Clinical Trials Registry (ACTRN12619001209189). All men provided written informed consent prior to enrolment. The study design, conduct and reporting adhered to the CONSORT guidelines [A comprehensive description of the lsewhere ,26,27. Bidelines .SHED-IT: Recharge program was based on the rigorously evaluated SHED-IT Weight Loss Program for Men, which provides evidence-based strategies for men to lose weight through practical lifestyle changes [SHED-IT interventions, the current program was gender-tailored to appeal to men [SHED-IT: Recharge program was designed to appeal to men by providing efficient access, privacy, and autonomy [The 3-month self-directed  changes ,32,33,34 changes . Consistl to men . For insl to men ,17,36. Fl to men , which mautonomy ,24. Thisautonomy . SHED-IT Weight Loss Program for Men program was modified to specifically focus on improving both physical and mental health simultaneously. This included adapting previously recommended health advice , adding new behavioral recommendations  linked to depression [Handbook, which contained information on men’s health, weight loss, goal setting, and tips to improve key behaviors . Men were also given a logbook, where they completed key setup tasks , set and reviewed goals, mapped their weight loss, worked through online activities , and documented their progress through the program . The study website hosted introductory materials  and a series of 10−15 min resistance training workout videos. These weekly pre-recorded sessions guided men through a sequence of bodyweight resistance exercises  that were designed to be achievable (exercise variations to make it relevant for the different fitness levels), challenging (difficulty increased weekly), and practical (completed anywhere). As a novel component, targeted mental health intervention through a sequence of online mental fitness modules using cognitive behavioral techniques  was also integrated due to its effectiveness for improving depressive symptoms [MyFitnessPal website or app, which contains a database of food items  that can be logged to provide individual feedback in relation to weight loss goals . Men also received weekly text messages to emphasize key strategies from the program or to direct them to the latest mental fitness or resistance training workout.Given the current study targeted men with low mood, the previous pression ,39, and pression . An extepression . In briesymptoms . These sSHED-IT: Recharge program [This study used descriptive qualitative methods to gain a comprehensive understanding of the experiences of men who participated in the  program . Individ program  and some program . Using t program . This prSHED-IT: Recharge RCT if they were aged 18−70 years, had a body mass index (BMI) in the overweight or obesity range (BMI 25−42 kg/m2), and reported at least mild depressive symptoms over the previous two weeks (PHQ-9 score ≥5) [SHED-IT: Recharge RCT from the Hunter Region of NSW, Australia, between August and September 2019, predominately through traditional news mediums and targeted Facebook advertising. Men were eligible to participate in the core ≥5) . For incange BMI −42 kg/m2n = 49) and 74% of the entire intervention group (n = 62). We determined that 20 men would provide a sufficient representation of the different subgroups of men in the study. It was achievable in relation to logistical and budget constraints and aligned with sample sizes used in other papers of this nature [n = 5); (ii) obesity/mild depression (n = 5); (iii) overweight/moderate-to-severe depression (n = 4); and (iv) overweight/mild depression (n = 5). The following measures were collected at baseline in the RCT through online surveys and in-person assessments. Depressive symptoms were measured using the PHQ-9 depression scale, which has established validity as a diagnostic measure of depressive disorders in both clinical and community samples [Overall, 46 intervention participants provided consent to a post-program interview. This represented 94% of men in the intervention group who attended the 6-month follow-up assessment  tests for categorical variables. All variables were checked for plausibility and missing values. Data are presented as mean (SD) for continuous variables and counts (percentages) for categorical variables. Using IBM SPSS Statistics version 25 , baseline characteristics of men who were interviewed versus men not interviewed were compared using independent Audio and video recorded interviews were conducted using the online Zoom Video Communications Inc. (Zoom) conferencing program; however, only the audio recordings were sent for transcription. Interviews were independently transcribed verbatim, with men de-identified prior to analysis. Analyses were conducted using Nvivo 11  by author V.H., who is an experienced qualitative researcher and was not involved in any other aspect of the trial. A thematic analysis technique as described by Braun and Clarke  was chosp > 0.05).SHED-IT: Recharge program. Four themes emerged: (i) specific circumstances determined men’s motivation to enroll, (ii) unique opportunity to implement sustained physical and mental health changes compared to previous experiences, (iii) salience of the program elements, and (iv) further opportunities that build accountability could help maintain focus. The related sub-themes are listed in 2), and PHQ-9 score provided in brackets. The average interview duration was 43 min (ranging from 21 to 73 min). Thematic analysis of the interviews revealed a range of themes representing men’s perceptions and experiences of the SHED-IT: Recharge trial was due to long-term dissatisfaction with their weight, including frustration with fluctuating weight loss/regain experienced because of previous weight loss attempts. Many talked of a growing difficulty in maintaining an ideal weight as they aged due to perceived lack of physical activity, fitness, or health problems.For many participants, the motivation to join the My weight gained quickly, and I found it very difficult to get the motivation to change my eating and drinking habits and get back into that groove of exercise which I found so easy before. So, I was hoping that would be a kick-start for me.2, PHQ-9 score: 13)  experiences with profit-making weight loss programs that relied on “selling a product”. Related to this was the altruistic motivation of being in a “research program” by which participants could ultimately “help others”. The aimed specifically at men. Approximately one-third of participants were motivated to enroll, upon learning that the program was It really appealed to me because it was a men’s program. That’s one of the things that’s clear about men’s health, is that there’s not a great deal of programs that people comfortably know about out there. And so, a lot of people, I believe, they just simply carry on because they don’t really know how to access it. And I liked the idea that it was also focused on the way that men think. It didn’t necessarily have to be run by men, but it was more comfortable. There’s nothing worse than trying to go to a place or join a program where it’s primarily women that are doing it.2, PHQ-9 score: 6)    , consulted with dietitians or personal trainers, while a few others talked of self-driven attempts at weight loss.Many men commented on the potential for The disappointing thing is for me I’ve been going to a gym on and off for 20 years and the results were good, but I never sustained them because I hadn’t put two and two together.2, PHQ-9 score: 11)                      personal and progress information sent via phone/text. One participant felt that the use of additional questions and prompts would have increased accountability and engagement. If it’s a question about “Did you record your food today?” or “Did you get enough sleep last night?”, or “Have you done your activities” or “This is your day to step on the scales reminder” might just be the push that I needed to be held accountable.2, PHQ-9 score: 8)   to facilitate weight loss [SHED-IT Weight Loss process evaluations, which have also emphasized the program may offer a cost-effective and convenient approach to help men achieve weight loss at a population level [Men’s perceptions revealed they were very satisfied with the ght loss ,54. Althght loss , this suon level ,36. Impoon level .SHED-IT: Recharge, the need for increased social support was raised by a subgroup of men. A future study may compare an online intervention with and without the social connectedness element to test whether this results in a greater impact for treating depression . Of interest, a recent qualitative study exploring mental health promotion in the workplace reported men perceived social cohesion as particularly meaningful for “having each other’s backs” [Although the men valued the self-directed format of s backs” . While es backs” ,24,36, cs backs” .To our knowledge, this is the first qualitative study to explore men’s perceptions of a gender-tailored lifestyle program targeting both the physical and mental health of men. In particular, these data provide a rich understanding evaluating the experiences of men living with both low mood and overweight or obesity who are widely acknowledged as an underrepresented subgroup in the psychological and weight loss literature ,52. ThisIn conclusion, the current process evaluation revealed that although men are traditionally hard to engage in both weight loss and depression research ,9, they


If faculty placement in the American academic hierarchy is by merit, then it correlates with scholarly productivity at all career stages. Recently developed data-collection methods and bibliometric measures test this proposition in a cross-sectional sample of US academic archaeologists. Precocity—productivity near the point of initial hire—fails to distinguish faculty in MA- and PhD-granting programs or among ranked subsets of PhD programs. Over longer careers, on average archaeologists in PhD-granting programs outperform colleagues in lower programs, as do those in higher-ranked compared to lower-ranked PhD programs, all in the practical absence of mobility via recruitment to higher placement. Yet differences by program level lie mostly in the tails of productivity distributions; overlap between program levels is high, and many in lower-degree programs outperform many PhD-program faculty even when controlling for career length. Results implicate cumulative advantage to explain the pattern and suggest particularism as its cause. If American universities attract students and faculty in quality commensurate with their standing, then the perceived stature of institutions corresponds to the abilities of those who populate them. Regarding undergraduates, this thesis is a form of guilt or glory by affiliation that engages unexamined assumptions . In its simplest form, guilt-or-glory logic for faculty is an extension of the logic regarding students. If students succeeded on merit in an apparently competitive selection process then so too must have their professors. But what evidence supports the corollary logic that faculty merit sorts among institutions by real or imagined natural level?universalism denotes the meritocratic ideal, particularism the many factors that can compromise the meritocratic ideal  soNo single study can disentangle the complex causality of cumulative advantage. Like others , 11, thiIt tests three corollary theses of universalism: first, that initial hire is meritocratic, and second, that productivity patterns consistently across the institutional hierarchy of American higher education as a product of merit. But initial hire must be imperfect in any hierarchy; as a result, some productive scholars may first be recruited to lower levels, some less productive ones to higher levels. Whatever the latter’s fate, universalism requires for the former later movement to the higher positions they merit. Therefore, the study tests a third universalist thesis: that, for those initially placed poorly, sustained scholarly productivity is rewarded by mobility, i.e. recruitment to higher position in the university hierarchy.To disentangle the roles of universalism and particularism in cumulative advantage requires independent measures of institutional standing and scholarly merit. To distinguish cause and effect, merit at or near hire must be measured separately from cumulative career merit, to permit analysis of the former’s relationship to placement. It also requires a sample of faculty, measures of their productivity, and analysis of the correlation between individual faculty merit and institutional placement.Whatever institutional hierarchy that students and the public at large perceive may not correspond well to faculty perceptions. In archaeology and elsewhere, by the 1970s “Graduate education emerged as the most prestigeful form of training” , 223). B3. B22], The methodology of most institutional rankings is questionable , 27. ThiFor forty years or more, the National Research Council (NRC) has produced roughly decadel rankings or evaluations of doctoral programs by major discipline in US universities. Of course, no ranking is perfect, but this one is sponsored by a reputable non-profit research organization populated by academics that neither markets services to the subjects it evaluates nor depends upon revenues from sales of its ranking. Its methodology, while arguable, is fully reported. Yet NRC rankings engage two complications for this study. First, they are confined to doctoral programs, excluding faculty in MA and BA programs where nearly half of academic archaeologists work; there are no comprehensive rankings of all American universities and programs. Second, North America is unusual in global context because archaeology here is encapsulated within anthropology. Rankings discussed below are always of larger anthropology departments.phds.org’s 2011 NRC rankings included 84 anthropology programs, of which specialized ones without relevance to archaeology  were omitted. Older rankings of anthropology programs somewhat correlate with 2011 NRC results  but havArchaeologists are a minority in most anthropology departments ; most diAnthroGuide 2016–2017 ).To measure precocity, a second PoP search for each sampled individual was confined to the period that began four years before the PhD year and ended two years after it, reasoning that most graduate-study publication is likely to occur in the last four years before earning the doctorate. But hires also may be influenced by promise of imminent scholarly production , so this interval was extended to two years past the PhD on the assumption that most scholarly promise would materialize by then.h, g, and hIann were recorded as prec_h, prec_g and prec_hIann, respectively. Unfortunately, PoP cannot compute these indices over just the search interval . Therefore, cumulative measures like h and g pertain to the individual’s entire career rather than the restricted search interval. Thus, if an archaeologist published three journal articles and one book chapter during the limited search interval that ended a decade or more ago, most or all probably were cited at least four times since then. If so, precocity measures approximate publication counts which, anyway, also should differ on average between young faculty hired into different program levels. Conversely, hIann values often were high for recent PhDs, whose productivity over the restricted search interval compared to senior colleagues was much nearer their career totals. As a result, relatively productive junior scholars apportion cumulative bibliographic measures over a shorter interval  that yields high values.Relevant measures of Analysis was conducted in SPSS™, statistical power calculations in powerandsamplesize.com. Number of archaeologists by department is low and right-skewed for BA and PhD programs, approximately normal for MA ones. Mean number of archaeologists per department rises by a factor roughly of two from BA through MA to PhD programs. Many archaeologists are widely scattered in ones and twos, mostly in BA programs, fewer in slightly larger MA ones. More archaeologists work in relatively few but large PhD programs.2 = 4.9 p = .09; ANOVA F = 2.7 p = .07) only because mean longevity in MA programs (= 16.1 years) is considerably lower than in BA (= 20.8) and PhD (= 22.3) programs. There are no significant differences in the distribution of professorial rank  by degree program  although the assistant rank is slightly overrepresented in MA programs , or in pooled BA/MA versus PhD program . In sum, there are no clear seniority differences by program level; differences between them in scholarly productivity owe to other factors.Comparison between program levels or NRC ranks must consider the possible complicating factor of difference in career length or rank. A crude measure of career length is the difference between sample year, 2017, and year of PhD award . Obviously, this is an imperfect estimate of years-as-professor, but any error introduced is assumed to be minor. Pattern in on this measure is nearly significant . Ih and prec_g). They also correlate significantly with their equivalent career measures, at much lower values . Precocity gauges scholarly records near point-of-hire, so tests the first universalist corollary: differential initial placement by merit. prec_h and prec_g pattern consistently by degree program, although mean differences are modest; prec_hIann does not pattern consistently; the MA-program mean exceeds the PhD mean . Statistical power relates to Type II errors; all significant variable differences exceeded the acceptable power level of 0.80. Differences in precocity measures lie mostly between archaeologists in BA versus higher programs. Results fail to attain significance when comparing archaeologists in MA and PhD programs .Precocity measures correlate strongly and significantly with one another  productivity of hires from higher-ranked institutions may explain via universalism the hiring patterns otherwise attributed to particularist networks , 9, if sPrecocity bibliometric indices do not sort archaeologists clearly by degree program .All bibliographic indices differ significantly across degree programs , Fig 2 . Nevertheless, measures’ ranges do not sort clearly by program level, but overlap considerably; many BA- and MA-program archaeologists are as productive as most PhD-program ones. Universalism’s second corollary—merit-sorting by hierarchical level—is supported statistically but with exceptions difficult to accommodate to the ideal.Thus, archaeologists in BA and MA programs form a single subsample for comparison to archaeologists in PhD programs. So grouped, productivity still patterns by degree program , signifiIn career measures, pairwise comparison distinguishes PhD-program archaeologists as more productive on average, despite the absence of clear differences in corresponding precocity measures between PhD and MA programs. If productivity were primarily an individual quality, then the absence of difference in precocity measures by degree program should persist in career ones. It does not.h are right-skewed, particularly at the PhD level  and BA/MA-program archaeologists whose h<2, clearly those not committed to scholarship . To prevent the few PhD archaeologists whose h<2 (n = 3) to affect results, they too were omitted. Overall, this treatment omits one subset’s top quartile and its extreme lower tail, the other’s approximate bottom quartile .Productivity skewness is typical of many scholarly fields e.g., , 6, 11)., 11.6, 1vel e.g. . Yet with K-W χ2 = 2.63 p = .269; g K-W χ2 = 2.61 p = .271; hIann K-W χ2 = 1.52 p = .221; for combined BA/MA versus PhD h U = 1005.0 p = .231; g U = 963.5 p = .135; hIann U = 1194.5 p = .766; again, parametric ANOVA F and Student’s t yields similar conclusions). For brevity, h and g upper quartile of BA/MA affiliates (n = 15) to all PhD affiliates (n = 74), the former’s h, g, and hIann means all exceed PhD means, insignificantly .Here, differences are insignificant   low-achieving bottom quartile of BA/MA archaeologists are excluded, productivity differences fade to insignificance. For the great majority of academic archaeologists—the trimmed sample, about three-quarters of each subset—difference in placement by program level does not correspond to difference in scholarly productivity. Nor do productivity differences extend to the upper range of BA/MA affiliates, whose top h and g are cumulative career measures that justify subdivision of the dataset. This was accomplished first, by coarsely defining a subsample of archaeologists whose PhD year was earlier than 2002. This subsample is of professional age of 15+ years.As above, faculty rank is distributed similarly among program levels; there are no significant differences in seniority or inferred longevity by program. Nevertheless, h K-W χ2 = 4.9 p = .09; g K-W χ2 = 4.3 p = .12; hIann K-W χ2 = 5.5 p = .07). In career measures, differences between PhD and lower programs persist in this subsample . Again, therefore, BA and MA groups were combined for comparison to the PhD subsample. Again, the latter significantly exceed the former . Again, however, the trimmed subsample yields different results. In career measures, differences by program level fade . Also, MA-program means exceeds PhD means, as does h for the BA/MA group.Precocity measures calculated in the senior subsample do not differ by degree program , the BA/MA hIann mean is slightly higher in the 2007–2017 cohort, and all BA/MA means exceed PhD ones in the oldest cohort.The sample can be subdivided even more finely by defining cohorts whose professional age ranges from 0 to 10, 11–20 and 20+  , or cumulative measures nor, as above, of academic rank. The only salient factor to explain productivity differences is degree program. That difference does not exist before initial hire but correlates with later productivity. The trimmed sample, however, mostly fails to distinguish archaeologists’ productivity by program level, locating differences chiefly at the tails of their respective distributions. Accordingly, for about three-quarters of the sample there are no significant productivity differences by program level, suggesting both great productivity overlap between program levels and the absence of consistent universal factors to explain affiliation. Finally, the top h quartile of BA/MA affiliates statistically is indistinguishable from PhD affiliates.Career measures Data also can be interrogated for the relationship between merit and placement among PhD-program archaeologists, accomplished using NRC program rankings. Reported results are from analysis of individual default rankings compiled by NRC .h U = 313.0 p = .09; prec_g U = 299.5 p = .06; prec_hIann U = 376.5 p = .47) . Difference, particularly in prec_g, owes to a positive outlier in the bottom-half group that U and t weight differently. There is at best equivocal support for distinguishing between upper and lower NRC halves in prec_h and prec_g; prec_hIann does not differ by NRC halves.Distinguishing archaeologists in the top and bottom halves of the NRC rankings yields insignificant results for precocity measures in nonparametric (prec_p = .47) ; Fig 8 ah U = 277 p = .03; g U = 281.0 p = .03; but hIann U = 347.5 p = .26; Student’s t gave comparable results; power level for h and g>0.80 but only = 0.63 for hIann). As in comparison by degree programs, subdivision of PhD programs by NRC rank reveals no difference in precocity measures but significant ones in career h and g. . The fourth (lowest) quartile’s means on all precocity variables exceed the third’s value. Results are not significant in h (K-W χ2 = 7.5 p = .06) but are in g (K-W χ2 = 9.2 p = .03); hIann did not pattern consistently by quartile (K-W χ2 = 4.3 p = .23)  . ParametAs in comparison by degree program, there are no significant differences in precocity measures by halves or quartiles of NRC rank. Again, faculty of equal original productivity are recruited to programs of differing rank. Some differences emerge in career measures, often but not always by ascending NRC rank groups. Again, therefore, differences arise after hire.A possible explanation for higher career-merit measures in PhD programs is mobility–recruitment to higher position after initial hire. On evidence here, junior scholars may be difficult to distinguish, but perhaps more productive scholars at lower ranks eventually are recruited to higher ones. Yet for a generation or more mobility has been notoriously constrained by academic archaeology’s poor labor market, described euphemistically as “small, highly competitive”  remained at the same institution in 2017. Of the remaining nine, only four had moved to an institution possessing a higher degree program. One moved from an Ivy League BA program to a PhD program elsewhere, and one evidently was a trailing spouse. That leaves two of 44 (1.5%) who rose independently from a lower to an unequivocally higher placement. Movement at this rate amounts to rare exceptions who prove the rule. Mobility and the recruitment to higher placement that it might produce is rare in academic archaeology. Universalism’s third corollary is not supported.h and hIann only) yields a matrix of affiliation for testing a status-mobility hypothesis of meritocratic allocation  to the design of the study”.  Again, this is supposition, in this case more involved even than invoking the mere supposition that novelty, etc., are rewarded at hire. I can’t disprove it any more than I—or even #6, come to think of it--can prove a negative.But consider that if #6’s scenario holds, then there should be significant difference in faculty proportions by professorial rank. If poor scholars are being hired (unwisely) by lower-ranked universities that later experience a form of buyer’s remorse by  refusing them tenure, then faculty in lower program levels are being replaced more often. Therefore, that part of my sample should be skewed toward lower professorial rank, higher program levels toward higher professorial ranks. No such pattern is found in my data, as ms. lines 704-15 reported. On the contrary, proportions of professorial rank by program level are similar. I have evidence, not supposition, to support this conclusion. Thus, the study does not, as #6 charges, “select upon the longevity of career,” because career length does not differ by program level or NRC subsample. The re-revised ms. makes that point against #6’s supposition. Actually, against #6 I might suppose that the process s/he describes might play out more often in PhD programs. If so, then those, not lower, programs should skew toward younger faculty and lower professorial ranks. Again, however, there is no such pattern in the evidence. Reluctantly, I am forced to add a new section (re-revised ms. lines 794-819) merely to refute this dubious argument. I confess that the logic it sets forth is tortured, but only because it mirrors #6’s supposition in that respect.Finally on this point, #6 again sees ambiguity, this time in what I mean by “mobility.” This point merely repeats his/her criticism of the abstract, addressed above. Point 3.Point 3 reduces to #6’s Point 1. Once more, there is free supposition. I do not necessarily agree that capabilities are any more poorly measured in the precocity interval than the later career one. I agree that those talents are measured “by long-term productivity” only if controlling for the effects not just of time but the setting—here, program level—in which that time is spent. Indeed, that is the heart of the matter. If we take productivity measures at face value, without considering the conditions under which academics labor in order to earn them, then we elevate universalism to unassailable article of faith. That’s like taking annual income at face value as a measure of merit without distinguishing between we who earn our own and the fortunate few who inherited fortunes. At that point we can, as #6 does, argue by predilection rather than be evidence. If by such dubious logic #6 means that savvy hiring committees see the je ne sais quoi that precocity measures fail to measure but that career measures can , then I must request an explanation. How is it that career measures capture that ineffable essence while precocity measures do not? You can’t have it both ways. If you like bibliometric measures over the entire career, you can’t dismiss those that are compiled over the precocity interval, nor how they pattern relative to career measures, merely because they are inconvenient to your preconceptions. Lines 113-24 address objections the nature of #6’s, and before s/he even expressed them. I must call to #6’s attention something already stated in the ms.: “Invoking such unobservable factors against a particularist conclusion at once renders it difficult to prove and its universalist alternative difficult to refute.”Trace out #6’s logic. If the evidence supports universalism, then the universalist conclusion must be reached. If the evidence opposes it, then the universalist conclusion still must be reached, in this case by free supposition that invents convenient causes for the patterns in evidence that are inconsistent with it. This is not merely transparently unfair but a tautology. However the evidence patterns or free supposition claims, it supports #6’s predetermined conclusion.In #6’s mind, what evidence is necessary to support a qualified conclusion of particularism? His/her standards are highly unpersuasive, returning us to nothing better than the Coles’ “’real-life experiments…difficult to perform’” (ms. lines 110-11). Difficult indeed; nothing short of impossible, as the Coles themselves suggested.Against #6.I document a clear pattern: no productivity differences in the precocity interval, but emerging in later career. Then, following a considerable body of earlier research that ms. lines 139-140 cite, I suggest a cause: higher support for research combined with Matthew effects that benefit those hired into PhD programs. The suggested causes correspond to the pattern documented. These are factors the nature of which Merton cited  as sources of particularism. Therefore, I believe that the result is both documented and significant, and suggest that it is consistent with particularism. To rescue his/her contrary logic, #6 cites no—none, not an iota of--supporting literature or evidence, and instead merely indulges in free supposition. Mindful of ms. lines 107-124, I am entitled to turn #6’s logic—and #1’s—against them:1. If hiring were truly meritorious, we should see a clear difference in precocity scores by program level at placement. We do not.2. If hiring were truly meritorious, we should see a strong correlation between bibliometric measures in precocity and career-long intervals. We do not.3. If hiring were truly meritorious, we should see little if any overlap between program levels that is visible in career productivity measures. Instead, considerable overlap is evident, as the abstract--which #6 parsed laboriously on editorial grounds but did not acknowledge--clearly states.4. Anyone who feels free to suppose freely to the contrary has commensurate obligations. One option is to argue by free supposition as did #6, but only acknowledging that his/her objections are speculative, not grounded. Another is to offer either evidence, not mere supposition, to the contrary, or at least to suggest positive, constructive ways independently to test at once one’s own suppositions and perhaps contrary views. It has been years, but I once read Popper. How, in the least way, is #6’s contrary view falsifiable? If it is not, then how does it deserve serious regard, and what defense does any legitimate argument like mine have against it? Anyone can say “Yes, but….” #6 must prove that I’m wrong, or at least offer grounded, perhaps even constructive, criticisms, not merely freely suppose that I might be wrong, and thereby further suppose that s/he refuted my argument or even so much as offered constructive criticisms. The currency of academic criticism is documented, fair, argument and evidence, not free supposition.Beyond the ms.’s empirical and analytical contributions, lines 986-1013 and 1105-26 qualify results, suggest other kinds of evidence that might support or refute my tentative conclusion, and advocate research to collect and analyze such evidence. They demonstrate my willingness both to be proven wrong and to constructively suggest lines of research, not to freely suppose in armchair fashion.Free supposition is no basis for a fair professional review.Attachmentresponse v2.docxSubmitted filename: Click here for additional data file. 12 Oct 2021Merit and placement in the American faculty hierarchy: Cumulative advantage in archaeologyPONE-D-21-11471R1Dear Dr. Shott,We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. 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For more information, please contact Kind regards,Radu IovitaAcademic EditorPLOS ONEAdditional Editor Comments :After discussions with the Chief Editor, we came to the agreement that your revisions and rebuttals of the reviewer comments were sufficient to guarantee that your submission fulfilled the publication criteria without sending it out for another round of reviews. We also agreed that, should others find your article or its findings objectionable, these objections should take the form of a separate article, rather than be lost in the process of peer review. Reviewers' comments: 20 Oct 2021PONE-D-21-11471R1 Merit and placement in the American faculty hierarchy: Cumulative advantage in archaeology Dear Dr. Shott:I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! 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Although most research universities offer investigators help in obtaining patents for inventions, investigators generally have few resources for scaling up non-patentable innovations, such as health behavior change interventions. In 2017, the dissemination and implementation (D & I) team at the University of Wisconsin’s Clinical and Translational Science Award (CTSA) created the Evidence-to-Implementation (E2I) award to encourage the scale-up of proven, non-patentable health interventions. The award was intended to give investigators financial support and business expertise to prepare evidence-based interventions for scale-up.The D & I team adapted a set of criteria named Critical Factors Assessment, which has proven effective in predicting the success of entrepreneurial ventures outside the health care environment, to use as review criteria for the program. In March 2018 and February 2020, multidisciplinary panels assessed proposals using a review process loosely based on the one used by the NIH for grant proposals, replacing the traditional NIH scoring criteria with the eight predictive factors included in Critical Factors Assessment.two applications in 2018 and three applications in 2020 earned awards. Funding has ended for the first two awardees, and both innovations have advanced successfully.Late-stage translation, though often overlooked by the academic community, is essential to maximizing the overall impact of the science generated by CTSAs. The Evidence-to-implementation award provides a working model for supporting late-stage translation within a CTSA environment. The University of Wisconsin – Madison (UW) is one of the nation’s 61 NIH-funded Clinical and Translational Science Award (CTSA) grantees. The name of the grantee at UW is the Institute for Clinical and Translational Research (ICTR). The goal of ICTR is to create an environment at UW that facilitates the conduct of research that improves human health. Some research conducted at UW results in patentable products, such as drugs and devices, and the UW – like almost all research universities – has robust technology transfer infrastructure in place to help researchers apply for patents on their inventions and create new businesses . But UW – again like most research universities – has less infrastructure to support scaling up non-patentable interventions  that have been shown to improve public health, representing a potential evidence-to-practice gap to be closed.purveyor is “an individual or group of individuals representing a program or practice who actively work to implement that practice or program with fidelity and good effect.”  and to other groups, our proposals to surgical societies or to health systems. We’re so used to presenting it as research, but it’s a different angle.In May 2019, an outside evaluator collected feedback from the first two awardees about the value of the D & I services they had received. Awardees were asked about the quality of the services they had received, their confidence that their interventions would be successfully implemented and disseminated, and suggestions they had for improving the E2I grant mechanism. Both awardees were enthusiastic about the help they received from the D & I Launchpad related to business concepts and models, marketing, budgeting, and legal issues. An interview with Tai Chi Prime principal investigator Betty Chewning is here: Both awardees expressed confidence that their interventions will continue to be scaled up, though both recognize hurdles. Both awardees had suggestions for improving the E2I award process, such as lengthening the time between the pre-proposal and final proposal and clearly defining the roles of the D & I Launchpad team and principal investigators as proposals are developed. These suggestions were implemented during the second round of E2I awards.The first two awardees of E2I awards are continuing to scale up their innovations as of this writing, three years after they received their E2I awards, a significant milestone given that approximately 95% of new ventures fail in the market.  Both PIsThe E2I process will evolve over time, as it already has between its first and second rounds. For instance, we learned that we need to play more of a consultative role to potential grantees in the application process rather than playing an active role in application development; we evolved a much closer relationship with our University’s office of industrial relations, in recognition of the need to engage early with issues around potential conflicts of interest; and we included metrics around diversity in terms of the end users served by awardees. Nevertheless, the program’s essential elements are theoretically and empirically grounded, fill an important gap at research universities, were identified in response to what worked and did not work in a previous award program, and apply an approach to forecasting the success of entrepreneurial ventures that has demonstrated predictive validity.  We see tEvery research university has policies regarding conflicts of interest, establishing commercial enterprises (for-profit or non-profit), and working with third parties to disseminate interventions developed at the institution. These policies may also include rules regarding what type of funding was used to develop the intervention . The D&I Launchpad team works closely with offices on campus regarding potential conflicts of interest. We have processes in place, like mandatory investigator consultations with the Office of Industry Engagement, to review work plans. To initiate similar programs at other CTSAs, close collaboration with conflict-of-interest entities is critical.A program like the E2I award requires substantial funding. At UW, ICTR leaders recognized the need to focus effort on helping investigators scale up their non-patentable innovations. They channeled investment into the infrastructure required to support a robust D&I presence, including earmarking funds for the E2I award from the Wisconsin Partnership Program, an entity established in 2004 through an endowment gift from Blue Cross and Blue Shield United of Wisconsin’s conversion to a stock insurance corporation. To replicate a program like the E2I program, CTSA leaders will need to: (1) Prioritize the need to support D&I activities like the E2I program and (2) Be resourceful in procuring funds to support the program. Finally, the E2I program is an infrastructure development stage, with the first two applications funded by the program just reaching maturity at manuscript submission. Though empirically based, it is too early to tell if the Critical Factors Assessment approach adapted for the E2I program can accurately predict the future success or failure of programs funded through the award.We are currently conducting an environmental scan of CTSAs nationwide to identify programs similar to the E2I award. Collaboration among CTSAs offering similar programs could help maximize the impact of research supported by CTSAs by building inertia around late-stage translation and an evidence base around factors that ease or slow scale-up. Awardees are required to provide program outcomes for a period of three years. Specific metrics are customized to each program and are loosely based on the Reach, Effectiveness, Adoption, Implementation, Maintenance framework.  Impact m