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ObjectivesTo assess the association between working patterns and vitamin D status in men and women and to determine the potential influence of related lifestyle and socioeconomic factors.MethodsThe authors used data from the 1958 British birth cohort (aged 45 years) and 6154 participants, who were in full-time work, were included in current analyses. Vitamin D status was measured by circulating concentrations of 25-hydroxyvitamin D (25(OH)D). Information on working patterns and lifestyle factors was obtained using a structured questionnaire administered at 45 years.ResultsManual social class was strongly associated with vitamin D-related lifestyle factors, with those in manual classes not only spending more time outdoors, but also spending more time watching TV/using PC, consuming less supplements and oily fish. Associations between working patterns and vitamin D-related lifestyles were less clear: night work was not strongly associated with lifestyles in either gender, while working hours were associated with time spent outside, PC/TV leisure time and use of supplements in men but not in women. In men, working patterns were not associated with lower 25(OH)D concentrations. In women, 25(OH)D concentrations were 8% lower (95% CI 15% to 2%) in night workers compared with others, while women working less than 35 h/week had 5% higher concentrations of 25(OH)D (95% CI 1% to 8%) compared with those working 35–40 h/week after adjustment for season, social class and body mass index (BMI).ConclusionsWomen working nights and longer hours may be vulnerable to deficits in vitamin D status and associated health hazards.

The flipped classroom (FC) andragogy purports an improvement of critical thinking and problem-solving skills in students. This literature review explores fourteen research studies and discusses outcome measures reported on the effectiveness of using this teaching modality. Students described the learning activities during the classroom meeting times as valuable and indicated the interaction and engagement were beneficial to their learning. Many students opined an increased comprehension of the subject matter. Overall, the FC required more work on the part of the students and the faculty, and the majority of students preferred the traditional classroom (TC) passive method of learning over the FC active learning andragogy as a result of the substantial time commitment required for preparation necessitated by the FC. Five of the fourteen studies evaluated student learning outcome measures; four studies showed an improvement in the FC environment compared to the TC and one reported the FC was at least as effective as the TC. Further studies with quantifiable outcome measures are required to determine the effectiveness of a FC on critical thinking and problem-solving skills of nursing students. •Flipped classroom demonstrated increased knowledge for some students.•Faculty observed enhanced learning and critical thinking in some students.•Further studies with quantifiable outcome measures are recommended.

According to the IRF PPS final rule, the reimbursement rate updates for fiscal year (FY) 2018 are estimated to increase payment to IRFs by $75 million, and the quality reporting revisions are projected to reduce costs for IRFs by $2.6 million. Because of section 411(b) of the Medicare Access and CHIP Reauthorization Act (MACRA), the market basket update must be a one percent increase regardless of forecasting calculations. Beginning in FY 2016, section K was added to the IRF-PAI, which allows the assessor to actually check more than one option for the patient's intake status instead of choosing only regular food, modified food consistency/supervision, or tube/ parenteral feeding. Because the question is duplicative, it was decided to remove the voluntary Item 27, swallowing status, since the same information is actually in Section K. CMS also stated in their response to comments that, should additional information about the patient's swallowing status be necessary, it should be documented in the patient's health record.

[...]there is always an exception. Because the root operation Change (2) can only have an External approach, the Other Device option can be found in all tables for the root operation Change in the Medical and Surgical Section. The revisions in the Head and Facial Bones body system deal primarily with the removal of laterality from the frontal bone, occipital bone, sphenoid bone, and the maxilla. Nose has been revised to nasal mucosa and soft tissue in the Ear, Nose, Sinus body system, and laterality has been removed from the diaphragm in the Respiratory System.