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.

Desafíos bioéticos en la Transgénesis Animal / Bioethical challenges in animal transgenesis

El término animal transgénico se refiere a un animal cuyo genoma ha sido deliberadamente modificado, se usa la palabra transgénico como una variante animal originada tras la introducción de un gen, o genes, en su genoma. Algunas personas consideran que esta mezcla de material genético entre especies, o la creación de quimeras, que en ocasiones es parte de la estrategia técnica para la obtención de un animal transgénico, altera el concepto de “especie” y es una intervención antinatural que podría interferir en la concepción de lo que hace que un animal sea tal. En respuesta a estos problemas morales se argumenta que en la ingeniería genética no hay mezcla de genomas, sino que únicamente se transfieren uno o dos genes, una pequeña fracción del genoma de la mayoría de las especies receptoras. Además, no se debe olvidar que muchos genes están conservados entre diferentes especies, por lo que la presencia de determinadas secuencias no parece que sea lo determinante a la hora de definir la esencia de una especie. La ciencia ha cedido su lugar y su prestigio a la técnica que pretende ser esencialmente productiva; el planteamiento ético es su uso. Desde un punto de vista global es importante señalar que la utilización de animales modificados genéticamente, cuyo control es constante, está generando importantes beneficios científicos y sanitarios, y que en el futuro puede producir significativas aplicaciones de interés industrial. Pero se recomienda cautela en esas prácticas.(AU)

The term transgenic animal refers to an animal whose genome has been deliberately modified. The word transgenic is used to describe an animal changed due to the introduction of a gene or genes in its genome. Some people consider this mixing of genetic material between species, or the creation of chimeras, to alter the concept “species”. It may also be seen as an unnatural intervention that could interfere in the conception of what define such an animal. In response to the moral problems derived from this scientific practice, it is argued that in most cases there is not a mixture of these engineered genomes, but only an action of transferring only one or two genes from one to the other. Also, perhaps it may be useful to keep into account that many genes are conserved among different species, so that the presence of certain laboratory sequences do not seem to be the determining factor when it comes to defining the essence of a species. Science has been conceding too much prestige to technique, which essentially seeks to be productive, and an ethical approach is different from productivity. From a global point of view it is important to note that the use of genetically modified animals, whose control is constant, is generating significant scientific and health benefits and that this may in the future produce significant applications of industrial interest. However, caution is recommended in this type of practice.(AU)

O termo animal transgênico refere-se a um animal cujo genoma foi modificado deliberadamente. A palavra transgênico é usada para descrever um animal modificado devido à introdução de um gene ou genes em seu genoma. Algumas pessoas consideram que essa mistura de material genético entre espécies ou a criação de quimeras altera o conceito de “espécie”. Ela também pode ser vista como uma intervenção não natural que pode interferir no conceito do que define o animal envolvido. Em resposta aos problemas morais advindos dessa prática científica, sustenta-se que na maioria dos casos não há uma mistura desses genomas de engenharia genética, mas apenas uma ação de transferir só um ou dois genes de um animal a outro. Também, possivelmente pode ser útil levar em conta que muitos genes se conservam entre espécies diferentes, de modo que a presença de certas sequências de laboratório não parece ser o fator vital da determinação quando está em jogo a definição da essência de uma espécie. A ciencia tem concedido demasiado prestígio à técnica, que essencialmente procura ser produtiva, e uma aproximação ética é diferente da produtividade. De um ponto de vista global, é importante observar que o uso de animais geneticamente modificados, cujo controle é constante, está gerando significantes benefícios científicos e para a saúde e que esses desenvolvimentos podem vir no futuro a produzir aplicações relevantes de interesse industrial. Contudo, a prudência é recomendada nesse tipo da prática.(AU)

Planteamientos Bioéticos del Medio Ambiente / Bioethical Proposals regarding the Environment

Existe un punto de partida de actuación ambiental que fue con las Conferencias de Naciones Unidas sobre el Medio ambiente y el Desarrollo, también conocidas como las Cumbres de la Tierra, en 1972. La ética ambiental o ecoética, que a la vez se encuadra dentro de la Bioética global. Potter (1988) habla de “Ética global” es “El estudio sistemático de la conducta humana en el área de las ciencias de la vida y la salud, examinando a la luz de los valores y principios morales”. La relación de la Ecoética y el Medio Ambiente se puede analizar desde el aspecto del modelo bioético principalista, establecido por Beauchamp y Childress en 1994. Los problemas del Medio Ambiente de hoy en día no tienen límites geográficos, como quedó patente por el accidente nuclear de Chernobyl de 1986. La resolución de los problemas ambientales tiene un pilar de la aplicación en la bioética, y ésta a la vez, en la Educación Ambiental; teniendo en cuenta la Carta de Belgrado, realizada en octubre de 1975. El tratado de educación ambiental hacia sociedades sustentables y de responsabilidad global, señala a la educación como un acto político de transformación y como proceso permanente basado en el respeto a todas las formas de vida, con perspectiva holística y pensamiento crítico e innovador.(AU)

A starting point for environmental action was the United Nations Conference on Environment and Development, also known as the Earth Summit in 1972. Environmental ethics, or Ecoethics, fits into general Bioethics. Potter (1988) refers to “Global ethics” as “The systematic study of human behavior in the area of life sciences and health examined in the light of moral values and principles”. The relationship between Ecoethics and the Environment may be analyzed from the point of view of the principialist bioethical model established by Beauchamp and Childress in 1994. Environmental problems today do not have geographical boundaries, as made evident by the Chernobyl nuclear accident in 1986. The resolution of environmental problems has as one of it basis the application of bioethics, based by its turn in environmental education, taking into account the Belgrade Charter, held in October 1975. The Treaty of environmental education towards sustainable societies and global responsibility points to education as a political act of transformation and as an ongoing process based on respect towards all life forms, with a holistic perspective and critical and innovative thinking.(AU)

Um ponto de partida da ação ambiental foi a Conferência das Nações Unidas para o Ambiente e o Desenvolvimento, também conhecido como a Cúpula da Terra, em 1972. A ética ambiental ou Eco-ética é parte da Bioética Global. Potter (1988) se refere à “ética global” como “o estudo sistemático do comportamento humano na área das ciências da vida e da saúde examinados à luz de valores e princípios morais”. A relação entre Ecoética e o Ambiente pode ser analisada do ponto de vista do modelo bioético principialista, estabelecido por Beauchamp e Childress em 1994. Os problemas ambientais hoje não têm limites geográficos, como o tornou evidente o acidente nuclear de Chernobyl, em 1986. A resolução de problemas ambientais tem como uma de suas bases a aplicação da bioética, que se baseia por sua vez na educação ambiental, considerando a Carta de Belgrado, firmada em outubro de 1975. O Tratado da educação ambiental para sociedades sustentáveis e responsabilidade global aponta para a educação como um ato político de transformação e como um processo contínuo baseado no respeito a todas as formas de vida, com uma perspectiva holística e um pensamento crítico e inovador.(AU)

Ecoética en América Latina y el Caribe / Ecoethics in Latin America and the Caribbean

La Ecoética contempla tres aspectos fundamentales: Saber qué es la vida, Cuál es el tipo de calidad que deseamos y Cuál es el sentido de la vida que podemos compartir los seres humanos actuales sin detrimento del hábitat y de las futuras generaciones. El reconocimiento de la vulnerabilidad de la naturaleza, de la pérdida de un medio ambiente sano, ha dado una nueva dimensión a la ética. Hay esenciales problemas en América Latina y el Caribe, como un modelo de desarrollo económico insostenible; una enorme desigualdad en la distribución de la riqueza y un rápido crecimiento demográfico. El principio responsabilidad, es un ensayo de una ética para la civilización tecnológica, habla de un nuevo imperativo ético anteriormente impensable, de un deber de las actuales generaciones hacia las generaciones futuras. Los objetivos como fundamento de valores y principios éticos, se deben centrar, en: fomentar la calidad de vida, cultivar el potencial humano y propiciar la participación de los más desfavorecidos.(AU)

Ecoethics covers three main aspects: knowing what life is, knowing what kind of quality we want and knowing what sense in life can be shared by humans today without harming the habitat and future generations. The recognition of the nature’s vulnerability and losses in a healthy environment has brought a new dimension to ethics. There are serious problems in Latin America and the Caribbean such as a model of unsustainable economic development, a great inequality in wealth distribution and a rapid population growth. The principle of accountability is a test of ethics for the technological civilization and refers to a previously unthinkable new ethical imperative, a duty of present generations to future generations. The objectives, as the basis of ethical values and principles, should focus on: promoting quality of life, cultivating human potential and encouraging the participation of the disadvantaged.(AU)

A Ecoética abrange três aspectos fundamentais: saber o que é a vida, qual o tipo de qualidade que desejamos e qual o sentido da vida que pode ser desfrutado pelos seres humanos de hoje sem prejudicar o habitat e as futuras gerações. O reconhecimento da vulnerabilidade da natureza e da perda de um ambiente saudável trouxe uma nova dimensão à ética. Há sérios problemas na América Latina e no Caribe, como por exemplo, um modelo de desenvolvimento econômico insustentável, uma enorme desigualdade na distribuição da riqueza e um rápido crescimento demográfico. O princípio da responsabilidade é um teste de ética para a civilização tecnológica e se refere a um novo imperativo ético anteriormente impensável, um dever das gerações atuais com gerações futuras. Os objetivos, como base dos valores e princípios éticos, devem centrar-se em: promover a qualidade de vida, cultivar o potencial humano e estimular a participação dos menos favorecidos.(AU)

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.

Equality and Justice in Medicine: a paradigm of Uncertainty / Equidad y Justicia en Medicina: un paradigma de Incerteza

Equity in the sense of equal access to mainline contemporary medicine is recognized as one of today’s greatest challenges: economically, politically, and morally. The treatments of contemporary medicine are either unavailable or too expensive for most sick persons in the world. There is an experience of inequity and injustice which is extensive and can be turned into a motor for revolution if left unaddressed. The distribution of health-care services to all persons on the same standard is both an ideal and a driving force to change in society. In Natural Law Theory, equity and justice are principles revealed in human responses to reality. Human beings, even children, demand equity and justice. Health care systems attempt to put these principles into concrete services, but none do so adequately or to the satisfaction of all. This situation creates the challenge of equity and justice in high-tech medicine. Different medical service models are looked at and compared. Challenging circumstances to achieving equity and justice in health care are considered. Finally, the challenge created by a war metaphor and an industrial metaphor, both of which operate in contemporary medicine, is examined. Ideals like equity and justice are never fully concretized but remain important for driving needed changes in health-care systems.(AU)

A equidade no sentido do acesso igual à medicina contemporânea elitista é reconhecida como um dos grandes desafios de hoje: econômico, político e moral. Os tratamentos da medicina contemporânea são estão disponíveis ou são demasiado caros para a maioria das pessoas doentes no mundo. Há uma ampla experiência de desigualdade e injustiça que pode ser transformada em um ímpeto para a revolução caso não seja resolvida. A oferta de serviços médicos a todas as pessoas no mesmo padrão é um ideal e uma força motriz para mudar na sociedade. Na teoria do direito natural, a equidade e a justiça são princípios revelados em respostas humanas à realidade. Todos os seres humanos, inclusive as crianças, demandam equidade e justiça. Os sistemas sanitários tentam traduzir esses princípios em serviços concretos, mas nenhum o faz adequadamente ou para a satisfação de todos. Essa situação cria o desafio da equidade e da justiça na medicina de alta tecnologia. Os diferentes modelos de serviço médico são examinados e comparados. São também consideradas as circunstâncias desafiadoras para alcançar a equidade e a justiça nos cuidados médicos. Por fim, o desafio criado por uma metáfora da guerra e uma metáfora industrial, ambos em operação na medicina contemporânea, são examinados. Ideais como a equidade e a justiça nunca são inteiramente concretizados, mas permanecem sendo importantes para realizar mudanças necessárias nos sistemas de cuidados médicos.(AU)

La equidad en el sentido de la igualdad de acceso a la medicina contemporánea tradicional se reconoce como uno de los desafíos más grandes de hoy: económico, político y moral. Los tratamientos de la medicina contemporánea son inasequibles o demasiado costosos para la mayoría de las personas enfermas en el mundo. Hay una experiencia de inequidad y de injusticia que es extensa y se puede convertir en motor para la revolución si no se la resuelve. La distribución de los servicios de cuidado médico a todas las personas en el mismo estándar es un ideal y una fuerza impulsora como para cambiar la sociedad. En la teoría del derecho natural, la equidad y la justicia son principios reveladores en respuestas humanas a la realidad. Seres humanos, incluso niños, demandan equidad y justicia. Los sistemas sanitarios intentan convertir estos principios en servicios concretos, pero ninguno los hace adecuados o a la satisfacción de todos. Esta situación crea el desafío de la equidad y de la justicia en la medicina de alta tecnología. Se examinan y se comparan diversos modelos del servicio médico. Se consideran las circunstancias desafiadoras como para alcanzar la equidad y la justicia en los cuidados médicos. Por fin, se examina el desafío creado por una metáfora de la guerra y una metáfora industrial, que funcionan en la medicina contemporánea. Ideales como la equidad y la justicia nunca se concretizan pero siguen siendo de todo importantes para conducir cambios necesarios en los sistemas de cuidados médicos.(AU)

Continuing need for an ethics of virtue and character

En salud, tan importantes como las normas y políticas y, aún más, son las características éticas de su atención que, en definitiva, establecen la diferencia de la atención humana en salud. No son las regulaciones ni las leyes que existan para determinadas conductas y comportamientos las que generan una actitud tierna y generosa hacia los adultos mayores enfermos. Solamente profesionales con esa disposición pueden responder adecuadamente a sus necesidades. Si ellos no lo hacen y actúan de la manera tradicional con que procede el personal sanitario, los bioeticistas perderán la verdadera dimensión del sentido humano propio de la bioética médica que, tal como las demás disciplinas, tiene particularidades propias de acuerdo con sus diferentes tendencias y tradiciones culturales. Dado el incremento de la expectativa de vida de la población humana, particularmente en el mundo desarrollado y en desarrollo, mayor es la necesidad de características especiales de la atención en salud a los adultos que envejecen, lo cual significa contar con una acción mancomunada de los bioeticistas, independientemente de sus convicciones políticas y antecedentes culturales, centrada en responder adecuadamente a las necesidades de salud propias de los adultos mayores. Con esta concepción este artículo centra su interpretación en las necesidades propias del adulto mayor para referirse a las mejores conductas bioéticas para atenderlas prioritariamente con profundo sentido humano. Entender las necesidades humanas de la población mayor que de manda atención su salud, con la sensibilidad que requiere su estado emocional y afectivo, brinda a los médicos la oportunidad de que su actuación retorne a la ética clásica.(AU)

As important as rules and policies are, ultimately it is ethical character which makes the difference. Not rules, nor regulations, not even laws requiring this or that behavior will generate a humane response to this new population of the elderly infirmed. Only medical professionals with character traits developed in response to patient needs will make the needed difference. If they do not attend to the classical tradition in ethics which focuses attention on the character of health care workers, bioethicists will miss an important dimension of contemporary medical Bioethics, like every international discipline has its variations, cultural styles, particular concerns, unique perspectives. Once the problem of an increasingly aging population is recognized everywhere in the developed world, then a particular style of medical care delivery is called for. This demand unites bioethicists, no matter their political or cultural background differences, in bringing the attention of medical care givers to the needs of aging patients. This article focuses attention on aging patient's needs, and the best bioethical measures to meet these needs in a humane way. Meeting this new population's medical needs provides an opportunity for medical professionals to reconnect with classical medicals ethics.(AU)

Bioethics in the Americas: north and south. A personal story

Se trata de un relato respecto a la historia y desarrollo, primero de la Ética Médica y luego de la Bioética en Estados Unidos, España y Latinoamérica, a través de su participación personal como estudiante, investigador, profesor y colaborador de la creación de programas y proyectos de integración de la Bioética a los currículos universitarios, en sus Facultades de Medicina y a otras instituciones y organizaciones de salud en Latinoamérica. El relato se extiende desde sus experiencias en la Universidad Gregoriana de Roma, en su formación filosófica y teológica, luego en España en sus estudios de Maestría y Doctorado y sus aprendizajes con el Profesor Lain Entralgo, para concluir con su vinculación a universidades norteamericanas y a la OPS en su Programa Regional de Bioética. En toda esta trayectoria su apreciación crítica a los regímenes bajo el poder del marxismo, nazismo, y franquismo; así como a la controversia ética en los Estados Unidos respecto a los conflictos de los confines de la vida, la contracepción y el aborto e, igualmente, al surgimiento de organizaciones de Bioética en los Estados Unidos como el Hasting Center y el Kennedy Institute for the Study of Human Reproducción and Bioethics con su contribución a la investigación y educación en Bioética.(AU)

This relates to the history and progress, first of the Medicine’s Ethics and later of Bioethics in United States, Spain and then Latino America, through to his personal participation as an student, investigator, professor and collaborator of the creation of programs and projects for the integration of the Bioethics to the university’s curriculum in their Medicine faculties and to other institutions and organizations of health care in Latin America. This narration extends from his experiences in the Gregorian University of Roma, in his Philosophical and theological formation, then in Spain in his studies for his Master´s degree in Spanish, Doctoral degree in philosophy and studies with the Professor Lain Entralgo, which helped him to appreciate ethical issues en medical practice, before there was a discipline called bioethics, then to conclude with his vinculum with north American universities and the OPS in its regional of bioethics Program. During all his trajectory, his critic appreciation of the regimes under the power of Marxism , Nazism and Franksim ( period of General Franco). Also of the ethical controversy in the United States in respect to the conflicts of the confines of life, the contraception and the abortion and equally to the formation of Bioethics Organizations in the United States such as the Husting Center and the Kennedy Institute for the Study of Human Reproductions and Bioethics with his contribution to the investigation and education en Bioethics.(AU)

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.