Assessing Moderate to Vigorous Physical Activity in Older Adults: Validity of a Commercial Activity Tracker

Purpose: Despite the potential for commercial activity devices to promote moderate to vigorous physical activity (MVPA), limited information is available in older adults, a high-priority target population with unique gait dynamics and energy expenditure. The study purpose was to investigate the content validity of the Garmin Vivosmart HR device for step counts and MVPA in adults ≥65 years of age in free-living conditions.Methods: Thirty-five participants (M age= 73.7 (6.3) years) wore Garmin and ActiGraph GT3X+ devices for a minimum of 2 days. Accuracy and intra-person reliability were tested against a hip worn ActiGraph device. Separate analyses were conducted using different accelerometer cut-off values to define MVPA, a population-based threshold (≥2,020 counts/minute) and a recommended threshold for older adults (≥1,013 counts/minute).Results: Overall, the Garmin device overestimated MVPA compared with the hip-worn ActiGraph. However, the difference was small using the lower, age-specific, MVPA cut-off value [median (IQR) daily minutes; 50(85) vs. 32(49), p = 0.35] in contrast to the normative standard (50(85) vs. 7(24), p < 0.001). Regardless of the MVPA cut-off, intraclass correlation showed poor reliability [ICC (95% CI); 0.16(-0.40, 0.55) to 0.35(−0.32, 0.7)] which was supported by Bland-Altman plots. Garmin step count was both accurate (M step difference: 178.0, p = 0.22) and reliable [ICC (95% CI; 0.94) (0.88, 0.97)].Conclusion: Results support the accuracy of a commercial activity device to measure MVPA in older adults but further research in diverse patient populations is needed to determine clinical utility and reliability over time.

The Paternalistic Turn in Behavioral Law and Economics: A Critique

The application of behavioral economics to law and economics has taken a paternalistic turn. Behavioralists believe that the fundamental assumptions regarding individual behavior in standard theory do not reflect reality. If individuals are not “rational” in the standard economic sense, then there will be decisionmaking failures: people cannot be relied upon to make individually optimal decisions and thus to maximize welfare as they see it. This Article is organized as follows. Part One is a prelude and gives context. Part Two discusses the fundamental normative standard in behavioral public policy: true preferences. I then proceed to outline the causes of the divergence between true preferences and actual observed preferences. Part Three analyzes some of the knowledge problems is ascertaining the presence of cognitive and behavioral biases. Part Four presents a case study of the difficulties of behavioral policy analysis in the area of consumer credit. Part Five concludes.

Bringing physical reasoning into statistical practice in climate-change science

The treatment of uncertainty in climate-change science is dominated by the far-reaching influence of the ‘frequentist’ tradition in statistics, which interprets uncertainty in terms of sampling statistics and emphasizes p-values and statistical significance. This is the normative standard in the journals where most climate-change science is published. Yet a sampling distribution is not always meaningful (there is only one planet Earth). Moreover, scientific statements about climate change are hypotheses, and the frequentist tradition has no way of expressing the uncertainty of a hypothesis. As a result, in climate-change science, there is generally a disconnect between physical reasoning and statistical practice. This paper explores how the frequentist statistical methods used in climate-change science can be embedded within the more general framework of probability theory, which is based on very simple logical principles. In this way, the physical reasoning represented in scientific hypotheses, which underpins climate-change science, can be brought into statistical practice in a transparent and logically rigorous way. The principles are illustrated through three examples of controversial scientific topics: the alleged global warming hiatus, Arctic-midlatitude linkages, and extreme event attribution. These examples show how the principles can be applied, in order to develop better scientific practice.“La théorie des probabilités n’est que le bon sens reduit au calcul.” (Pierre-Simon Laplace, Essai Philosophiques sur les Probabilités, 1819).“It is sometimes considered a paradox that the answer depends not only on the observations but on the question; it should be a platitude.” (Harold Jeffreys, Theory of Probability, 1st edition, 1939).

Resilience and permanence of public values: an analysis of administrative contracts in Brazil

This article analyzes the resilience of the public values in the Brazilian public administration’s management models, considering the rules adopted in administrative contracts. This sociological research argues that such public values reflect society’s normative and cultural standards. The study’s theoretical relevance lies in its contribution to understanding the cultural dimension of Brazilian society, recognizing that the law reflects normative standards given the environment in which it is elaborated and enforced. In practice, the study seeks to foster the comprehension of rules, their purposes, and the public ethos that gives identity to the administration. The values attributed to the management models observed in a historical framework were dialogicity, modernization, efficiency, productivity, and professionalization. Finally, administrative contracts are technologies with characteristics of historical models of public management and represent a normative standard that needs improvements.

Breastfeeding in Cystic Fibrosis: A Systematic Review on Prevalence and Potential Benefits

Breastfeeding (BF) is considered the normative standard of feeding for all infants. However, the impact of BF in patients with cystic fibrosis (CF) is not completely defined. Therefore, we conducted a systematic review to evaluate BF prevalence in the CF population and its impact on anthropometric and pulmonary outcomes. We searched MEDLINE, Embase and the Cochrane Library for original articles published in English up to 4 December 2020 that report the prevalence of BF and/or any measure of association between BF and anthropometric or pulmonary outcomes. Nine observational studies were identified (six retrospective cohort studies, one prospective cohort study, one survey and one case–control study within a retrospective cohort). The BF rate in CF patients is lower than that of the healthy population (approximately 50–60% of infants were breastfed at any time). The benefits in anthropometric outcomes of BF for >2 months in this at-risk population are unclear. A few relatively small studies suggest a potential benefit of BF in reducing lung infections, although data are inconsistent. The currently available data are insufficient to draw definite conclusions on the benefits of exclusive BF in anthropometric and pulmonary outcomes in CF. Clinical trials evaluating well-defined BF promotion interventions are needed.

Collective forward-looking responsibility of patient advocacy organizations: conceptual and ethical analysis

Background Patient advocacy organizations (PAOs) have an increasing influence on health policy and biomedical research, therefore, questions about the specific character of their responsibility arise: Can PAOs bear moral responsibility and, if so, to whom are they responsible, for what and on which normative basis? Although the concept of responsibility in healthcare is strongly discussed, PAOs particularly have rarely been systematically analyzed as morally responsible agents. The aim of the current paper is to analyze the character of PAOs’ responsibility to provide guidance to themselves and to other stakeholders in healthcare. Methods Responsibility is presented as a concept with four reference points: (1) The subject, (2) the object, (3) the addressee and (4) the underlying normative standard. This four-point relationship is applied to PAOs and the dimensions of collectivity and prospectivity are analyzed in each reference point. Results Understood as collectives, PAOs are, in principle, capable of intentionality and able to act and, thus, fulfill one prerequisite for the attribution of moral responsibility. Given their common mission to represent those affected, PAOs can be seen as responsible for patients’ representation and advocacy, primarily towards a certain group but secondarily in a broader social context. Various legal and political statements and the bioethical principles of justice, beneficence and empowerment can be used as a normative basis for attributing responsibility to PAOs. Conclusions The understanding of responsibility as a four-point relation incorporating collective and forward-looking dimensions helps one to understand the PAOs’ roles and responsibilities better. The analysis, thus, provides a basis for the debate about PAOs’ contribution and cooperation in the healthcare sector.

The Soul of the American University Revisited

The Soul of the American University Revisited traces the role of Protestantism in shaping American higher education from the founding of Harvard in the 1630s to the present. It offers a critical analysis of the changing ways in which Protestantism intersected with collegiate life, intellectual inquiry, and broader cultural developments. In accounts that have been edited and somewhat abridged for this second edition, it looks at pace-setting colleges and universities as they coped with modern society, post-Darwinian science, new secular philosophies, and increasing diversity in American life. Until the mid-twentieth century most leading American schools remained nominally Protestant, but their Protestantism was typically of a liberal variety that emphasized the broad ethical ideals of the Western and Judeo-Christian heritage. After the attacks in the 1960s on the “WASP” privilege, the vestiges of that establishment in higher education were soon largely dismantled. By the late twentieth century exclusive secular viewpoints were often considered the normative standard in higher education. Originally published in 1994 as The Soul of the American University, this new edition carries the story into the twenty-first-century culture. In the disarray and diversity of the intellectual life of this arguably “postsecular” age there is increasing room in the academy for varieties of intellectually responsible religious viewpoints. Indeed, as a concluding chapter recounts, more traditionalist Christian scholars and institutions, Protestant as well as Catholic, have developed substantially in recent decades.

Business, Human Rights and Climate Due Diligence: Understanding the Responsibility of Banks

Under the 2011 UN Guiding Principles on Business and Human Rights (UNGPs), banks, like all businesses, have a responsibility to respect human rights and to carry out human rights due diligence. Although climate due diligence is not explicitly included in the UNGPs, tackling an enterprise’s direct and indirect climate change impacts is arguably a dimension of the corporate responsibility to respect human rights and should form part of the human rights due diligence process. At present, it is unclear how such responsibility applies to banks, whose contribution to climate change is mostly indirect. This article addresses the research question: how should the law be interpreted to form a coherent climate due diligence standard for banks? To address it, the article first maps out the climate responsibility of banks under international soft law standards and assesses privately developed guidance. It then elucidates the emerging concept of climate due diligence, reading climate change responsibilities into the now well-established corporate responsibility to respect human rights as authoritatively elaborated in the UNGPs. Finally, it explains how such normative standard applies to banks and unpacks the key elements that a bank’s climate due diligence process should include.

Childbearing vs. clinical trial participation: is it one or the other?

Recent advances have shed light on the importance of early therapeutic intervention for neurodegenerative diseases. Primary prevention trials present a potential disease-modifying strategy for pre-symptomatic patients of autosomal dominant neurodegenerative diseases (ADND), such as early onset familial Alzheimer’s disease (AD) and Huntington’s disease (HD). As trials target earlier disease stages, however, prospective participants face new ethical and logistical challenges, namely childbearing and reproductive health decisions. Since pregnancy is an exclusion criteria for such trials, participants of reproductive age must choose between participating in research and having a family. Such decisions carry significant burdens for ADND patients that if left unaddressed could impact patient well-being and the field as whole. We use our perspective as scientists, advocates, and ADND family members to highlight current shortcomings in the field regarding trial participation and family planning issues for ADND patients and call for the establishment of a normative standard to address these concerns.

Is Gay Tourism More Than Tourism? A Case Study of Puerto Vallarta, MX

The reasons gay men seek out gay travel destinations has been well established in the literature. However, less research has been published on the consequences of that travel on the destinations themselves and the effect of gay tourism on the LGBTQ+ community as a whole. I use ethnographic research in Puerto Vallarta, Mexico, a popular international gay tourist destinations for American and Canadian gay men. I focus on how gay destinations are constructed as sites where members of the gay community can experience acceptance and inclusion and I ask the following questions, is this acceptance and inclusion dependent upon consumption? Are the tourist site and expectations for behavior in those sites oppressively normal? That is, does the site create a normative standard of behavior for gay tourists? Furthermore, while gay tourists may experience inclusion and a level of acceptance, how does gay tourism affect the destination site itself? Is this acceptance and inclusion problematized by larger systems of inequality such as class, gender, and race? Lastly, as members of a historically oppressed group, does and should gay tourism rise above its commodification to produce just, equitable relationships within and beyond the LGBTQ+ community including the environment?