Adherence type impacts completion rates of frequent mobile cognitive assessments among older adults with and without cognitive impairment.

Background: Prior to a diagnosis of Alzheimer's disease, many individuals experience cognitive and behavioral fluctuations that are not detected during a single session of traditional neuropsychological assessment. Mobile applications now enable high-frequency cognitive data to be collected remotely, introducing new opportunities and challenges. Emerging evidence suggests cognitively impaired older adults are capable of completing mobile assessments frequently, but no study has observed whether completion rates vary by assessment frequency or adherence type. Methods: Thirty-three older adults were recruited from the Boston University Alzheimer's Disease Research Center (mean age = 73.5 years; 27.3% cognitively impaired; 57.6% female; 81.8% White, 18.2% Black). Participants remotely downloaded and completed the DANA Brain Vital application on their own mobile devices throughout the study. The study schedule included seventeen assessments to be completed over the course of a year. Specific periods during which assessments were expected to be completed were defined as subsegments, while segments consisted of multiple subsegments. The first segment included three subsegments to be completed within one week, the second segment included weekly subsegments and spanned three weeks, and the third and fourth segments included monthly subsegments spanning five and six months, respectively. Three distinct adherence types - subsegment adherence, segment adherence, and cumulative adherence - were examined to determine how completion rates varied depending on assessment frequency and adherence type. Results: Adherence type significantly impacted whether the completion rates declined. When utilizing subsegment adherence, the completion rate significantly declined (p = 0.05) during the fourth segment. However, when considering completion rates from the perspective of segment adherence, a decline in completion rate was not observed. Overall adherence rates increased as adherence parameters were broadened from subsegment adherence (60.6%) to segment adherence (78.8%), to cumulative adherence (90.9%). Conclusions: Older adults, including those with cognitive impairment, are able to complete remote cognitive assessments at a high-frequency, but may not necessarily adhere to prescribed schedules.

Computerized cognitive testing norms in active-duty military personnel: Potential for contamination by psychologically unhealthy individuals.

Normative reference data used for clinical interpretation of neuropsychological testing results are only valid to the extent that the sample they are based on is composed of "normal" individuals. Accordingly, efforts are made to exclude individuals with histories and/or diagnoses that might bias test performance. In this report, we focus on these features in active-duty military personnel because published data on computerized neurocognitive testing norms for this population have not explicitly considered the consequences of neurobehavioral disorders (e.g., PTSD, depression), which are prevalent in this population and known to affect performance on some cognitive assessments. We administered DANA, a mobile, neurocognitive assessment tool, to a large sample of active-duty military personnel and found that scores on self-administered psychological assessments negatively impacted a number of neurocognitive tests. These results suggest that neurobehavioral disorders that are relatively common in this population should be controlled for when establishing normative datasets for neurocognitive outcomes.

Therapeutic robotics for children with disabilities: a case study.

The advancement of technology is having a profound effect on enhancing the lives of children with disabilities. As advances in biomedical technology allow research breakthroughs to continue at a steady pace, more and more is being discovered about the nature of different disorders in children. At the same time, partly due to the continuing rapid rate of advancement (and societal acceptance) of robotics technology, researchers, educators, and therapists are exploring the idea that robots might be used as an effective therapeutic and educational tool. Over the past nine years, AnthroTronix has collaborated extensively with therapists, educators, researchers, parents, and children to uncover the therapeutic and educational benefits of including robotics as part of rehabilitation curriculum for children. As a central part of this effort, the company has worked with its colleagues to develop and refine the CosmoBot system, an interactive robotic toolkit designed to enhance therapy, education, and play for children with disabilities.

Stopping nutrition and hydration technologies: a conflict between traditional Catholic ethics and church authority.

This article focuses on the troubling effects of the secular values of individual freedom and autonomy and their impact on laws regarding suicide and euthanasia. The author argues that in an increasingly secularized culture, death and dying are losing their meaning and are not thought of within a moral framework. The debate regarding the provision of artificial nutrition and hydration is critically considered in light of the history of Catholic morality as well as within the modern healthcare context, and finally with new insight from the recent statements made by the late pope. Drane argues that the pope's insistence on providing artificial nutrition and hydration despite irreversible persistent vegetative states in unconvincing.

Bioethics and profession of Medicine / Bioethics and the Medical Profession

The present work aims to discuss some crucial contemporary ethical questions the profession of medicine has to face in order for it to be true to its vocation and its very reason of existence. The commodification that has been impimging in all areas of the globalized world and the conservative waves stemming from the attitude of some religious authorities who put abstract principles before people´s well-being (as is the question of abortion) throw the profession of medicine in an unprecedented crisis that can threaten its very survival. A "professional" is by definition one who makes a public promise to do work for others considered crucial to society and because of this all professional of medicine have a serious responsability regarding the oposition to this unjust state of affairs. As every serious responsability requires a serious commitment, the paper urges all medical professionals, both indiviaduality and collectively, to take a unswering responsability of defending the bioethical principles of beneficence and non-maleficence - the very crux of the profession of medicine.

La ética como carácter y la investigación médica / The ethics character and medical research

Con este artículo pretendo volver a llamar la atención hacia la conexión histórica entre el significado originalde la palabra griega ethos y la disciplina de la ética, como el ser interior, el espíritu humano o carácter. La ética de la investigación debe incluir la dimensión interna de la ética, así como incluye las normativas y directrices del comportamiento. La historia de la ética de la investigación nos dice que las transgresiones se han producido no por falta de normas, sino por ignorar la dimensión interna de la ética. Actualmente, los investigadores médicos se ven sometidos a tentaciones de autopromoción, asociadas a narcisismo y avaricia, que les puede llevar a ignorar esta dimensión. Los investigadores de hoy no cederán a las presiones de sus propios intereses, si toman ejemplo del origen de los CaballerosHospitalarios de la Edad Media y de investigadores como Henry K. Beecher.

Natural law, history and politics

The basic philosophical vision and ethical principles of Catholic Natural Law claim universality. Natural Law thinking aspires to objectivity and universality and at the same time is open to the continuing influence fromhistory and politics. The background principles of positive law historically go by the name of Natural Law.Suffering and injustice contribute to a vision both of the structure of human existence and of what we mean byhumane law and ethics. When we confront a cultural crisis, Natural Law, looks not to the past but to the future. Few people today talk of the ethical dimensions of social realities in terms of Natural Law. This is true both in the Church and in the State. In bioethics, the principles rooted in the universal structure of human life have to provide direction and regulations on the playing field of contemporary life and medicine. A liberal Catholic perspective tries to keep in play the universal and the particular aspects of Natural Law reasoning.

Aging and dying: medical and ethical considerations

The idea of writing a chapter on aging seems particularly appropriate. I'm at the right age to address this topic. As I did the preparatory reading and research, I had anunusual experience. For the first time in my life, I felt like an expert. I could judge what people were saying about aging by my own experience. Besides facing aging myself, I work mainly with rural hospitals and nursinghomes and hospice organizations where most of the patients are elderly. Both in my personal life and in my work, I am surrounded by the realities of aging and dying.In a recent book entitled Gray Dawn on the economics and politics of aging, the author, Peter Peterson used a gripping metaphor to describe the challenge of anincreasing aging population. Global aging, he said, is like a massive iceberg which very well could destroy even the most powerful economic vessels in the world. The agingpopulation worldwide, according to this author, threatens human survival and is the most important challenge we face in the 21st century. His iceberg metaphor highlights the danger of global aging and the fact the all human beings are exposed to this danger.

Algunas reflexiones personales sobre la participación de la OPS en temas de bioética / Some personal reflections on PAHO`s involvement with bioethics

Si tenemos que estar conscientes de cómo la investigación influenciará las vidas de los sujetos de investigación, también tenemos que ser críticos respecto de nuestro transfondo de creencias filosóficas y religiosas. Estas pueden o no respaldar nuestro respeto por las personas de otras culturas y hacen posible luchar por la dignidad de las personas vulnerables. Tendremos que enfrentar asuntos prácticos, concretos y específicos en medicina e investigación, pero tendremos que estar conscientes a la vez del trasfondo de creencias y supuestos con los cuales operamos. Tendremos que tener un sentido de quiénes somos y del tipo de mundo sociocultural que queremos para otros seres humanos. Solamente entonces podremos trabajar con los aspectos prácticos de la investigación con sujetos humanos

Medical ethics in Latin America: a new interest and commitment.

Recent visits to five Latin American nations indicate that some medical professionals are eager to increase the role of bioethics in their countries. Conversations with key figures there point up similarities and differences among Latin nations, and between Latin countries and the United States, in their approaches to ethics. Opportunities exist for U.S. bioethicists to help get bioethics teaching and research off the ground in Latin America.