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      Situated Precision Healthcare in the Smart Medical Home: Bringing NASA’s Research Strategy down to Earth

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          Abstract

          This special issue is ambitious in that it calls for strategic transformation in research on Alzheimer’s Disease (AD) and related dementias, including innovation in both research design and value delivery, through lifestyle interventions that implicitly relate to a much broader range of comorbidities and diseases of aging. One response to this challenge is to venture beyond the boundaries of research that supports the healthcare industry. Toward this end, we introduce opportunities for research translation and knowledge transfer from NASA to the healthcare industry. Our intent is to show how NASA’s approach to research can guide innovation for a smart medical home, most notably for AD and other diseases of aging. The article is organized in four major sections: (a) aggregating fragmented research communities; (b) lifestyle interventions in the medical home; (c) multiscale computational modeling and analysis; and (d) lifespan approach to precision brain health. We provide novel motivations and transformative paths to a diversity of specific lines of research, across communities, that would be difficult to discover in common methods of networking within research communities and even through sophisticated bibliographic methods. We thus reveal how knowledge transfer between the public and private sector can stimulate development of broader scientific communities and achieve a more coherent strategic approach to integration and development of a diversity of capabilities including but not limited to technology.

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          A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial.

          Modifiable vascular and lifestyle-related risk factors have been associated with dementia risk in observational studies. In the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER), a proof-of-concept randomised controlled trial, we aimed to assess a multidomain approach to prevent cognitive decline in at-risk elderly people from the general population. In a double-blind randomised controlled trial we enrolled individuals aged 60-77 years recruited from previous national surveys. Inclusion criteria were CAIDE (Cardiovascular Risk Factors, Aging and Dementia) Dementia Risk Score of at least 6 points and cognition at mean level or slightly lower than expected for age. We randomly assigned participants in a 1:1 ratio to a 2 year multidomain intervention (diet, exercise, cognitive training, vascular risk monitoring), or a control group (general health advice). Computer-generated allocation was done in blocks of four (two individuals randomly allocated to each group) at each site. Group allocation was not actively disclosed to participants and outcome assessors were masked to group allocation. The primary outcome was change in cognition as measured through comprehensive neuropsychological test battery (NTB) Z score. Analysis was by modified intention to treat (all participants with at least one post-baseline observation). This trial is registered at ClinicalTrials.gov, number NCT01041989. Between Sept 7, 2009, and Nov 24, 2011, we screened 2654 individuals and randomly assigned 1260 to the intervention group (n=631) or control group (n=629). 591 (94%) participants in the intervention group and 599 (95%) in the control group had at least one post-baseline assessment and were included in the modified intention-to-treat analysis. Estimated mean change in NTB total Z score at 2 years was 0·20 (SE 0·02, SD 0·51) in the intervention group and 0·16 (0·01, 0·51) in the control group. Between-group difference in the change of NTB total score per year was 0·022 (95% CI 0·002-0·042, p=0·030). 153 (12%) individuals dropped out overall. Adverse events occurred in 46 (7%) participants in the intervention group compared with six (1%) participants in the control group; the most common adverse event was musculoskeletal pain (32 [5%] individuals for intervention vs no individuals for control). Findings from this large, long-term, randomised controlled trial suggest that a multidomain intervention could improve or maintain cognitive functioning in at-risk elderly people from the general population. Academy of Finland, La Carita Foundation, Alzheimer Association, Alzheimer's Research and Prevention Foundation, Juho Vainio Foundation, Novo Nordisk Foundation, Finnish Social Insurance Institution, Ministry of Education and Culture, Salama bint Hamdan Al Nahyan Foundation, Axa Research Fund, EVO funding for University Hospitals of Kuopio, Oulu, and Turku and for Seinäjoki Central Hospital and Oulu City Hospital, Swedish Research Council, Swedish Research Council for Health, Working Life and Welfare, and af Jochnick Foundation. Copyright © 2015 Elsevier Ltd. All rights reserved.
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            The answer is 17 years, what is the question: understanding time lags in translational research

            This study aimed to review the literature describing and quantifying time lags in the health research translation process. Papers were included in the review if they quantified time lags in the development of health interventions. The study identified 23 papers. Few were comparable as different studies use different measures, of different things, at different time points. We concluded that the current state of knowledge of time lags is of limited use to those responsible for R&D and knowledge transfer who face difficulties in knowing what they should or can do to reduce time lags. This effectively ‘blindfolds’ investment decisions and risks wasting effort. The study concludes that understanding lags first requires agreeing models, definitions and measures, which can be applied in practice. A second task would be to develop a process by which to gather these data.
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              Character Strengths and Virtues : A Handbook and Classification

              "Character" has become a front-and-center topic in contemporary discourse, but this term does not have a fixed meaning. Character may be simply defined by what someone does not do, but a more active and thorough definition is necessary, one that addresses certain vital questions. Is character a singular characteristic of an individual, or is it composed of different aspects? Does character--however we define it--exist in degrees, or is it simply something one happens to have? How can character be developed? Can it be learned? Relatedly, can it be taught, and who might be the most effective teacher? What roles are played by family, schools, the media, religion, and the larger culture? This groundbreaking handbook of character strengths and virtues is the first progress report from a prestigious group of researchers who have undertaken the systematic classification and measurement of widely valued positive traits. They approach good character in terms of separate<br>strengths-authenticity, persistence, kindness, gratitude, hope, humor, and so on-each of which exists in degrees. <p>Character Strengths and Virtues classifies twenty-four specific strengths under six broad virtues that consistently emerge across history and culture: wisdom, courage, humanity, justice, temperance, and transcendence. Each strength is thoroughly examined in its own chapter, with special attention to its meaning, explanation, measurement, causes, correlates, consequences, and development across the life span, as well as to strategies for its deliberate cultivation. This book demands the attention of anyone interested in psychology and what it can teach about the good life.<br>
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                Author and article information

                Journal
                101748959
                48687
                Adv Geriatr Med Res
                Advances in geriatric medicine and research
                11 August 2022
                2020
                29 June 2020
                18 August 2022
                : 2
                : 3
                : e200017
                Affiliations
                [1 ]Nascent Science Technology LLC, Boston, MA 02108, USA
                [2 ]Department of Neurology and Alzheimer’s Disease Center, Boston University School of Medicine, Boston, MA 02118, USA
                [3 ]Framingham Heart Study, National Heart, Lung, and Blood Institute, Boston, MA 01702, USA
                [4 ]Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA
                [5 ]Department of Anatomy Neurobiology, Boston University School of Medicine, Boston, MA 02118, USA
                [6 ]School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA 01003, USA
                [7 ]Center for Personalized Health Monitoring, University of Massachusetts, Amherst, MA 01003, USA
                [8 ]Netrias LLC, Cambridge, MA 02142, USA
                Author notes

                AUTHOR CONTRIBUTIONS

                GR conceived the content of this manuscript based on independent collaboration with each of the co-authors over several years. The manuscript highlights cited work in NASA that is addressed in considerably more detail in several unpublished monographs delivered to NASA from 2016 to 2019. GR wrote the paper with input from RA on alternative paradigms for epidemiological research in situated precision health of elderly persons in a smart medical home, from RVE on experimental research for personalized health monitoring and lifestyle interventions for disorders of aging, and from ME on the intersection of bioinformatics and machine learning to accelerate medical scientific discovery. The collaborative content of the paper was envisioned by all the authors in a joint panel presentation entitled Situated Precision Health in Extraordinarily Closed Environments in a workshop, Spaces in Space: Optimizing Behavioral Health Cognitive Performance in Confined Environments, offered by the Translational Research Institute for Space Health (TRISH) and the MIT Media Laboratory’s Space Exploration Initiative, February 7, 2019.

                [* ]Correspondence: Gary Riccio, griccio@ 123456nascent3.com .
                Article
                NIHMS1608533
                10.20900/agmr20200017
                9387332
                2e4a5e8a-8117-47dd-84d6-781cea8b4bd7

                This is an open access article distributed under the terms and conditions of Creative Commons Attribution 4.0 International License.

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                Categories
                Article

                aging,digital biomarkers,systems medicine,precision health,isolation,confinement

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