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Political philosophy has long worried about the blurred line between politics and entertainment. Plato famously held that democratic politics is highly susceptible to manipulation working t...

Implementation of clinically useful research discoveries in the academic environment is challenged by limited funding for early phase proof-of-concept studies and inadequate expertise in product development and commercialization. To address these limitations, the National Institutes of Health (NIH) established the National Centers for Accelerated Innovations (NCAI) program in 2013. Three centers competed successfully for awards through this mechanism. Here, we present the experience of one such center, the Boston Biomedical Innovation Center (B-BIC), and demonstrate its remarkable success at the translation of innovations to clinical application and commercialization, as well as skills development and education.

As the healthcare system evolves from a centralized, hospital- and office-based model to an emphasis on patient-centric care delivered in decentralized settings from the community and/or home to low resource settings domestically and internationally, some Point-of-Care Technologies (POCT) have become important and others may soon become important in facilitating care. These portable diagnostic and monitoring devices enable moving care closer to the patient. We review recent developments in a national model to accelerate the development of POCT, specifically the Point-of-Care Technology Research Network (POCTRN), comprising a multi-center scientific network supported by a coordinating center. We summarize the history of the Network, and then describe the primary objectives and key activities of the Network and highlight the role of a new coordinating center providing administrative and infrastructure support. POCTRN is committed to building evidence-based best practices for high-quality translation and commercialization in biomedical engineering to maximize clinical impact of Point-of-Care Technologies.

The period known as the “War on Terror” has prompted a revival of interest in the idea of moral dilemmas and the problem of “dirty hands” in public life. Some contend that a policy of targeted killing of terrorist actors is (under specified but not uncommon circumstances) an instance of a dirty-handed moral dilemma – morally required yet morally forbidden, the least evil choice available in the circumstances, but one that nevertheless leaves an indelible moral stain on the character of the person who makes the choice. In this chapter we argue that, while dirty hands situations do exist as a persistent problem of political life, it is generally a mistake to classify policies of target killing (such as the current US policy) as examples of dirty hands. Instead, we maintain, such policies, if justified at all, must ordinarily be justified under the more exacting standards of just war theory and its provisions for justified killing – in particular the requirement that (with limited and defined exceptions) non-combatants be immune from intentional violence. Understanding this distinction both clarifies the significance of dirty hands as a moral phenomenon and also forestalls a set of predictable and all-too-easy appropriations of the concept to domains it was never intended to address.

Commercializing innovations in academic environments is notoriously challenging. Here, we describe the progress of the NIH Centers for Accelerated Innovations program — initiated in 2013 to address these challenges — which we believe could help set a new standard for the early-stage commercialization of biomedical innovations in academic environments.

This study aimed to compare an in-class Seniors on the MOVE (Mature Operators Vehicular Education) interactive multi-session driving curriculum with a self-guided MOVE curriculum for older adults. Using a two group randomized design, we sought to determine if there are between-group differences in older drivers' knowledge and safety behaviors among participants. Forty-four participants with an average age of 79 years (SD=7.1) were randomly assigned to the original MOVE program (SOM-A) or a lower resource (SOM-B) self-guided intervention. SOM-A is a four session program designed to improve older drivers safety knowledge and better understand skills for safer driving. SOM-B is a self-guided program with one required in-class session and one optional session. Subsequent to completion of both curricula, participants were offered CarFit, a comprehensive check of how well a senior driver and their vehicle work together. Baseline, post-intervention and 6-month follow up questionnaires were completed by participants. We found significant differences (p=.01) in the mean driving safety knowledge scores when comparing participants in SOM-A (3.7, SD 2.0) to those in SOM-B (0.87, SD 2.6). With regard to behavioral outcomes, we focused on always wearing a seatbelt, talking with a health care provider about driving ability, and sitting 10-12 inches from the steering wheel. The vast majority of participants reported always wearing their seat belts (SOM-A 100%, SOM-B 92%, p=1.0), and very few reported talking with their doctors (SOM-A Baseline - 0%, Follow up 1 - 0%, p=n/a). Mean behavior change scores for participants sitting 10-12 inches from the steering wheel were significantly more likely among SOM-A (mean=.65, SD=.5) participants than those in SOM-B (mean=.29, SD=.5, p=.01) at first follow-up. Taken together, these findings suggest that the more intensive program is more effective and that driving safety programs focused on behaviors to self evaluate driving abilities continue to be needed to help older drivers remain safer on the road as they age. The involvement of health care providers in such efforts may be an untapped potential. Language: en

Little is known about the health status of adults living in continuing care retirement communities (CCRC). Using matched-case control, 458 adults from the Health and Retirement Study (HRS) or a CCRC-based sample were compared on total comorbidity, self-rated health, home health services use, and hospitalizations. At year 2, the CCRC sample reported more comorbidities (96%) but significantly better self-rated health (96% good/excellent) than the HRS sample (93% comorbidity, 73% good/excellent; p < .01). There were no significant differences in frequency of home health use or hospitalization. Living in a CCRC appears to be associated with higher self-ratings of health in this sample.

Our research explores the correlates of spiritual experiences over a 2-year period in a sample of older adults (N = 164; mean age 81.9 years) living in a continuing care retirement community. Utilizing responses to the Daily Spiritual Experiences Scale, scores were analyzed for changes over time and for their hypothesized moderating effect in the relationship between chronic illness impact and markers of psychological well-being (as measured by the Geriatric Depression and Life Satisfaction scales). Repeated measures ANOVA indicated a significant decline (P

The humanist movement of the Northern Renaissance—often called ‘Christian humanism’ or ‘Erasmian humanism’ (after its most famous member, Desiderius Erasmus)—had a lasting impact on many areas of European intellectual and cultural life. This paper reviews the contribution of Erasmus and his circle to the theory and practice of education. After first outlining the main features of the Erasmian humanist tradition more generally, the paper then explores in greater detail two specific works on education by Erasmus himself—his treatises on The education of a Christian prince (1515) and his later work On the education of children (1529). The paper then investigates Thomas More’s Utopia (1516), perhaps the most enduring literary achievement of Erasmian humanism, showing how Utopia displays the educational philosophy of the movement in such a way as to bring out its larger implications for moral and political theory and practice. Finally, the paper briefly considers the contemporary legacy of the tradition of Era...

It has been estimated that up to 45% of men in the United States have low bone density. Yet, only a few studies have examined men's knowledge of bone health and disease. Men's knowledge of sex-specific issues related to osteoporosis is especially not well understood. We surveyed 1535 community-dwelling men with a mean age of 79yr. The assessed risk factors included a current diagnosis of low bone mass, positive history for fracture, recent level of physical activity, and current medications with the potential to affect bone health. Knowledge about male risk factors for osteoporosis was also assessed, including the effects of advancing age, frame size, fracture risk, calcium and Vitamin D supplementation, low testosterone level, and treatment for prostate cancer. Within this sample, only 11% of the men reported a current diagnosis of low bone mass, whereas 11% reported a prior hip fracture. Only 5% of the sample reported taking some type of Food and Drug Administration–approved medication for osteoporosis. In the aggregate, the participating men answered only 39% of the 6 male osteoporosis-knowledge questions correctly. It is imperative that bone health promotion campaigns that have educated many women effectively now expand their focus to advance the bone health of men also.

OBJECTIVES: To model the incremental cost-utility of seven interventions reported as effective for preventing falls in older adults. DESIGN: Mathematical epidemiological model populated by data based on direct clinical experience and a critical review of the literature. SETTING: Model represents population level interventions. PARTICIPANTS: No human subjects were involved in the study. MEASUREMENTS: The last Cochrane database review and meta-analyses of randomized controlled trials categorized effective fall-prevention interventions into seven groups: medical management (withdrawal) of psychotropics, group tai chi, vitamin D supplementation, muscle and balance exercises, home modifications, multifactorial individualized programs for all elderly people, and multifactorial individualized treatments for high-risk frail elderly people. Fall-related hip fracture incidence was obtained from the literature. Salary figures for health professionals were based on Bureau of Labor Statistics data. Using an integrated healthcare system perspective, healthcare costs were estimated based on practice and studies on falls in older adults. Base case incremental cost utility ratios were calculated, and probabilistic sensitivity analyses were conducted. RESULTS: Medical management of psychotropics and group tai chi were the least-costly, most-effective options, but they were also the least studied. Excluding these interventions, the least-expensive, most-effective options are vitamin D supplementation and home modifications. Vitamin D supplementation costs less than home modifications, but home modifications cost only $14,794/quality-adjusted life year (QALY) gained more than vitamin D. In probabilistic sensitivity analyses excluding management of psychotropics and tai chi, home modification is most likely to have the highest economic benefit when QALYs are valued at $50,000 or $100,000. CONCLUSION: Of single interventions studied, management of psychotropics and tai chi reduces costs the most. Of more-studied interventions, home modifications provide the best value. These results must be interpreted in the context of the multifactorial nature of falls. Language: en

Objectives: To examine the impact of Musculoskeletal Disorder (MSD) pain on work productivity in Long-Term Caregivers. Methods: An eight item work productivity impairment scale specific to MSD pain was constructed, evaluated and used as part of a telephone survey of LTCaregivers health. Results: The productivity impairment scale demonstrated good reliability and validity. The fifty-six of 71 caregivers (79%) reporting work-related MSD pain endorsed, on average > three of eight items in the impairment scale. Only two variables predicted productivity impairment: 1) pain frequency and 2) frequency of resident lifts and transfers. Conclusions: Specifically linking MSD pain from manual resident lifting to impaired work productivity may provide employers with additional visible impact of manual lifting beyond compensation costs alone, and thus promote adoption of safer lifting practices.

This article considers the question of whether and to what degree citizens are responsible collectively for the actions of their state. In contrast to current accounts of collective responsibility, which focus on causality or affect as means for transmitting responsibility, the article develops an alternative account, the ‘authorized state’ model. This model, drawn from core intuitions of the social contract tradition, sees collective responsibility as being transmitted through the state as the agent or representative of its citizens. Having developed this model as an ideal type, the article then assesses under what circumstances the model is most applicable. The article finally applies the model to the US war in Iraq to assess the collective responsibility of US citizens for the outcomes of that war.

Carex arkansana (L.H. Bailey) L.H. Bailey, Arkansas sedge (CYPERACEAE)— City of Alexandria: Seasonally-wet meadow east of S. Quaker Lane below Duke Street (Rt. 236) and north of the railroad tracks, 2 June 2005, R.H. Simmons 2531 (City of Alexandria herbarium [coa], Virginia Department of Conservation and Recreation, Division of Natural Heritage herbarium [dnh], MICH, Maryland Department of Natural ResourcesAnnapolis herbarium [tawes], and US). Significance. This is the first record of Carex arkansana in Virginia. Its native range extends from Texas north to Kansas and east to Arkansas, Missouri, and Illinois where it occurs in moist prairies, low open areas, and woodland glades (Ball 2002). The Virginia site is just east of the location of the old Seminary Station (a place name on a number of old labels at US in the D.C. and Vicinity Collection) and was a major railroad stockyard and fruit-packing station until the late 20th century. This species undoubtedly became established at this site, eventually forming a nearly impenetrable turf with numerous other carices, when the railroad tracks were removed and seed material from imported hay was graded into the soil.

Lifelong learning programs continue to grow in span and scope. Few studies, however, have investigated how older adults themselves participate in group learning. The central question explored in our study was as follows: Does gender play a role in group dynamics for older adults? Two groups of volunteers (age 62 to 96 years) enrolled in a 16-week discussion group. Groups were videotaped and turns at talk were counted. Results revealed that although men were the minority, they accounted for a substantial proportion of the turns at talk for both groups. Further research on lifelong learning is needed to understand how gender dynamics may affect older learners.

This study examined the effect of Tai Chi Chuan (TC) on lower extremity strength and balance and confidence in performing daily activities. Residents (n = 77) living independently in a continuing care retirement community were randomized to early or late TC instructional groups. The late group served as the control for the first 20 weeks. Measures of strength, balance, and confidence were assessed at baseline, 10, 20, and 40 weeks. There were no statistically significant differences between the groups at baseline in mean number of chronic illnesses, medications, falls, and activities of daily living. Repeated-measures analyses revealed significant improvement for the early and late groups during their respective periods of TC instruction, but not otherwise. Confidence ratings were unaffected. The early group's improvement at 20 weeks regressed to the mean baseline score by 40 weeks, suggesting that continued exercise is necessary to maintain gains in strength and balance.

The first part of this manuscript is an introduction to systems engineering and how it may be applied to health care and point of care testing (POCT). Systems engineering is an interdisciplinary field that seeks to better understand and manage changes in complex systems and projects as whole. Systems are sets of interconnected elements which interact with each other, are dynamic, change over time and are subject to complex behaviors. The second part of this paper reports on the results of the National Institute of Biomedical Imaging and Bioengineering (NIBIB) workshop exploring the future of point of care testing and technologies and the recognition that these new technologies do not exist in isolation. That they exist within ecosystems of other technologies and systems; and these systems influence their likelihood of success or failure and their effectiveness. In this workshop, a diverse group of individuals from around the country, from disciplines ranging from clinical care, engineering, regulatory affairs and many others to members of the three major National Institutes of Health (NIH) funded efforts in the areas the Centers for POCT for sexually transmitted disease, POCT for the future of Cancer Care, POCT primary care research network, gathered together for a modified deep dive workshop exploring the current state of the art, mapping probable future directions and developing longer term goals. The invitees were broken up into 4 thematic groups: Home, Outpatient, Public/shared space and Rural/global. Each group proceeded to explore the problem and solution space for point of care tests and technology within their theme. While each thematic area had specific challenges, many commonalities also emerged. This effort thus helped create a conceptual framework for POCT as well as identifying many of the challenges for POCT going forward. Four main dimensions were identified as defining the functional space for both point of care testing and treatment, these are: Time, Location, Interpretation and Tempo. A framework is presented in this paper. There were several current and future challenges identified through the workshop. These broadly fall into the categories of technology development and implementation. More specifically these are in the areas of: 1) Design, 2) Patient driven demand and technology, 3) Information Characteristics and Presentation, 4) Health Information Systems, 5) Connectivity, 6) Workflow and implementation, 7) Maintenance/Cost, and 8) Quality Control. Definitions of these challenge areas and recommendations to address them are provided.

Sixty-seven older adults were assessed using multiple validated tools. The current study aimed to identify high-, medium-, and low-risk impairment among older drivers and to explore high-risk drivers’ reactions to being told their results. Of 67 adults screened from a convenience sample of older drivers, nine high-risk participants, four completed in-depth follow-up qualitative interviews. The quantitative assessment algorithm identified 13% as high risk, 30% as medium risk, and 57% as low risk, and only Trails B distinguished the medium- and high-risk impairment groups. Although the assessment tests did not predict future crash involvement over a 7-month period, four participants in the medium- and high-risk impairment categories had been involved in a crash during the 5 years prior to the study compared with none of those who screened low risk. Only three participants (1 high risk) voluntarily surrendered their driver’s licenses after the assessment, and one participant in the in-depth interviews reported that the assessment influenced the decision to stop driving. There may be some benefit in using driving record history and assessment results to determine driving risk impairment level. However, more research is needed to determine the best combination of tools to predict risk level. How to best communicate risk levels remains to be determined, although results from the older drivers in this study underscore the need for great sensitivity when identifying areas of concern about driving ability.

The virtue of mercy is widely admired, but is now marginalized in contemporary public life. Yet for centuries it held a secure place in western public discourse without implying a necessary contradiction with justice. Alex Tuckness and John M. Parrish ask how and why this changed. Examining Christian and non-Christian ancient traditions, along with Kantian and utilitarian strains of thought, they offer a persuasive account of how our perception of mercy has been transformed by Enlightenment conceptions of impartiality and equality that place justice and mercy in tension. Understanding the logic of this decline, they argue, will make it possible to promote and defend a more robust role for mercy in public life. Their study ranges from Homer to the late Enlightenment and from ancient tragedies to medieval theologies to contemporary philosophical texts, and will be valuable to readers in political philosophy, political theory, and the philosophy of law.

In a letter to Erasmus dated 3 September 1516, Thomas More wrote: ‘I am sending you my “Nowhere”, which is nowhere well written’. More's use of the Latin word ‘nusquam’ in this sentence (not ‘Utopia’, as one might have expected) made explicit what would have been apparent to any reader of the book with a knowledge of Greek: that the island of Utopia which the character Raphael Hythloday describes is ‘nowhere’. The name ‘Utopia’, those readers would have known, was a compound of the Greek adverb ‘ou’, meaning ‘not’, with the noun ‘topos’, or ‘place’. The non-existence of Utopia operates throughout the work as a joke with at least two dimensions. On one level, the story Hythloday tells is ostensibly presented as fact, whereas humanist readers with a knowledge of Greek would have known it to be fiction. But additionally, Hythloday's argument (against the objections to communism voiced by ‘More’) that communal living really does work in Utopia is ironically undercut by the fact that Utopia is nowhere at all. Why More should choose to make this second joke is in a way the most fundamental question for the interpretation of Utopia, for if we do not understand why More thinks it is important that the commonwealth Hythloday describes is ‘nowhere’, we will not be able to understand what More is doing in the work as a whole.

Age-related memory decline affects a large proportion of older adults. Cognitive training, physical exercise, and other lifestyle habits may help to minimize self-perception of memory loss and a decline in objective memory performance.The purpose of this study was to determine whether a 6-week educational program on memory training, physical activity, stress reduction, and healthy diet led to improved memory performance in older adults.A convenience sample of 115 participants (mean age: 80.9 [SD: 6.0 years]) was recruited from two continuing care retirement communities. The intervention consisted of 60-minute classes held twice weekly with 15-20 participants per class. Testing of both objective and subjective cognitive performance occurred at baseline, preintervention, and postintervention. Objective cognitive measures evaluated changes in five domains: immediate verbal memory, delayed verbal memory, retention of verbal information, memory recognition, and verbal fluency. A standardized metamemory instrument assessed four domains of memory self-awareness: frequency and severity of forgetting, retrospective functioning, and mnemonics use.The intervention program resulted in significant improvements on objective measures of memory, including recognition of word pairs (t([114]) = 3.62, p0.001) and retention of verbal information from list learning (t([114]) = 2.98, p0.01). No improvement was found for verbal fluency. Regarding subjective memory measures, the retrospective functioning score increased significantly following the intervention (t([114]) = 4.54, p0.0001), indicating perception of a better memory.These findings indicate that a 6-week healthy lifestyle program can improve both encoding and recalling of new verbal information, as well as self-perception of memory ability in older adults residing in continuing care retirement communities.

Despite the prevalence of training parents in the use of child behavior management strategies, relatively little investigate attention has been devoted to promoting acquisition of parent observational and recording skills. In this study, we examined the efficacy of a brief curriculum designed to teach parents how to observe and record targeted child behaviors systematically. Subsequent to instruction, each of six participating parents demonstrated, in an analogue context, higher levels of both occurrence and nonoccurrence agreement, based upon their recordings of child behavior, when compared with those of a panel of experienced professionals. Agreement of parental recordings with those of professionals typically increased to a predetermined mastery criterion and stabilized subsequent to training, relative to a high degree of variability during baseline. Results are discussed in terms of directions for further refinement of the curriculum and additional study of its impact.

Pediatricians who serve children with developmental disabilities would be well advised to study and practice applied behavior analysis. Within a behavior analytic framework, the pediatrician views the child's aberrant performance as being a constellation of behavioral excesses and skill deficits that serve a functional purpose, rather than as being a symptom of some underlying illness or intrapsychic mechanism. The pediatrician can counsel the child, parents, and teachers to rearrange their environment, with an emphasis on how they can behave differently toward one another in specific situations, so as to alter the target behavior. When the child's problem behaviors are relatively severe or intractable, the pediatrician can refer the patient and family to a behavior specialist while continuing to support efforts to improve the child's overall health and adjustment.

OBJECTIVE: To evaluate CarFit, an educational program designed to promote optimal alignment of driver with vehicle. METHODS: A driving activity survey was sent to 727 randomly selected participants living in retirement communities. Drivers (n=195) were assigned randomly to CarFit intervention (n=83, M age=78.1) or Comparison (n=112, M age=79.6) groups. After 6months, participants completed a post-test of driving activity and CarFit recommendations. RESULTS: Nonconsenting drivers were older and participated in fewer driving activities. CarFit participation was moderate (71%) with 86% of the participants receiving recommendations. 60% followed the recommendations at the 6-month re-evaluation). The CarFit (67.6%) and Comparison (59.3%) groups reported at least one type of self-regulation of driving activity at baseline. There was no significant change in the driving behaviors at the six-month follow-up. CONCLUSION: CarFit was able to detect addressable opportunities that may contribute to the safety of older drivers. IMPACT ON INDUSTRY: CarFit recommendations may need stronger reinforcement in order to be enacted by a participant. Language: en

The purpose of this study was to validate the six-item Men’s Osteoporosis Knowledge Quiz (MOKQ). The MOKQ asks questions about risk factors that are pertinent to men, such as the risk for developing low bone mass related to hormone treatment for prostate cancer and the importance of testosterone for bone mass. A survey was sent to 242 men with a mean age of 83.2 years. The mean number of questions answered correctly in response to the six-item MOKQ was 2.37. Convergent validity was examined by correlating the score achieved on the MOKQ with the score achieved on the total Facts on Osteoporosis Quiz. The Pearson correlation coefficient for the MOKQ and the Facts on Osteoporosis Quiz was r = .76. Reliability was demonstrated by computing a Cronbach’s alpha for the MOKQ ( r = .72). The MOKQ was found to have adequate reliability and validity in assessing older men’s knowledge about osteoporosis.

To model the incremental cost-utility of seven interventions reported as effective for preventing falls in older adults.Mathematical epidemiological model populated by data based on direct clinical experience and a critical review of the literature.Model represents population level interventions.No human subjects were involved in the study. MEASUREMENS: The last Cochrane database review and meta-analyses of randomized controlled trials categorized effective fall-prevention interventions into seven groups: medical management (withdrawal) of psychotropics, group tai chi, vitamin D supplementation, muscle and balance exercises, home modifications, multifactorial individualized programs for all elderly people, and multifactorial individualized treatments for high-risk frail elderly people. Fall-related hip fracture incidence was obtained from the literature. Salary figures for health professionals were based on Bureau of Labor Statistics data. Using an integrated healthcare system perspective, healthcare costs were estimated based on practice and studies on falls in older adults. Base case incremental cost utility ratios were calculated, and probabilistic sensitivity analyses were conducted.Medical management of psychotropics and group tai chi were the least-costly, most-effective options, but they were also the least studied. Excluding these interventions, the least-expensive, most-effective options are vitamin D supplementation and home modifications. Vitamin D supplementation costs less than home modifications, but home modifications cost only $14,794/quality-adjusted life year (QALY) gained more than vitamin D. In probabilistic sensitivity analyses excluding management of psychotropics and tai chi, home modification is most likely to have the highest economic benefit when QALYs are valued at $50,000 or $100,000.Of single interventions studied, management of psychotropics and tai chi reduces costs the most. Of more-studied interventions, home modifications provide the best value. These results must be interpreted in the context of the multifactorial nature of falls.

Children referred to child management clinics frequently exhibit noncompliance with adult requests. Using a counterbalanced ABAC design, the authors examined the relative efficacy of guided compliance versus time out as a method of promoting child adherence to adult requests. Time out effected larger increases in percentage compliance among four of five participating children.

Purpose Assess the validity of our previously published multidimensional concept of Successful Aging that integrates physiological, psychological, and sociological domains of health. Design Three distinctly different populations were used to assess the discriminant and predictive validity. Methods Data included 1438 women age 65 and older who participated in the Women's Health and Aging Studies I and II (WHAS-I and WHAS-II) and 302 participants in a continuing care retirement community (CCRC) study. Outcome measures included ADL and IADL function, self-reported health status, and number of hospitalizations. Results Within the CCRC, the Successful Aging construct discriminated participants with regard to ADL and IADL function and self-reported health status. In both WHAS-I and WHAS- II samples, the construct predicted functional ADL and IADL change over time, and in WHAS-I, it predicted hospitalizations. Implications The Successful Aging construct appears valid and warrants further research and refinement among the general population.

How do the hard facts of political responsibility shape and constrain the demands of ethical life? That question lies at the heart of the problem of 'dirty hands' in public life. Those who exercise political power often feel they must act in ways that would otherwise be considered immoral: indeed, paradoxically, they sometimes feel that it would be immoral of them not to perform or condone such acts as killing or lying. John Parrish offers a wide-ranging account of how this important philosophical problem emerged and developed, tracing it - and its proposed solutions - from ancient Greece through the Enlightenment. His central argument is that many of our most familiar concepts and institutions - from Augustine's interiorised ethics, to Hobbes's sovereign state, to Adam Smith's 'invisible hand', understanding of the modern commercial economy - were designed partly as responses to the ethical problem of dirty hands in public life.