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Background: The Movement Disorder Society Unified Parkinson Disease Rating Scale (MDS-UDPRS) is a commonly used tool to measure Parkinson disease (PD) progression. Longitudinal changes in MDS-UPDRS scores in de novo PD have not been established.
Methods: 362 participants from the Parkinson's Progression Markers Initiative, a multicenter longitudinal cohort study of de novo PD, were included. Longitudinal progression of MDS-UPDRS total and subscale scores were modeled using mixed model regression.
Conclusions: The expected average progression of MDS-UPDRS scores in de novo PD from this study can assist in clinical monitoring and provide comparative data for detection of disease modification in treatment trials.
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In identifying and cultivating effective leaders, organizations often employ diverse metrics to assess success. In its commitment to evaluating and defining success in its personnel, the U.S. Army has historically placed significant emphasis on physical fitness assessment scores.
Emphasis on ACFT scores inadvertently overshadows other critical qualities essential for effective leadership. The Army Leadership Requirements Model (ALRM) defines specific attributes and competencies, which align with Army operational needs and pertinence to individuals at all levels of leadership (Department of the Army, 2019a).
For example, individuals with strong character qualities make decisions that coincide with operational requirements and fulfill leader expectations regardless of what level they serve. To that point, physical fitness has little to do holistically when it comes to their leadership role within their organizations based on the ALRM.
Physical fitness is a factor of presence, which is an Army leader attribute (Department of the Army, 2019a). By aligning promotions and leadership selections predominantly with ACFT scores, the Army risks undervaluing other attributes outlined in the ALRM.
Overemphasis on ACFT scores creates an ethical dilemma of prioritizing leadership qualities and physical fitness proficiency. The impact hinders deserving Soldier selection and fails to align with the diverse physical demands of combat roles.
The current final ACFT score calculation process for individuals who take alternate events predisposes these Soldiers to have lower scores. The Army measures Soldiers on a pass-or-fail scale for alternate ACFT events and grants a 60 point maximum for passing the event (Department of the Army, 2019b). If Soldiers take two alternate events for the ACFT and achieve the maximum score for the other four events, they could realistically get only 520 points.
The impact of overemphasizing ACFT scores extends beyond promotion, affecting Soldiers across various Military Occupational Specialties (MOS). An independent review revealed inconsistencies in passing rates, with certain MOSs facing disadvantages due to their specific physical requirements (RAND Corporation, 2022).
For example, an infantryman would in most cases have a higher ACFT score than a recruiter. In fact, the independent report concluded that Practical Nursing Specialists and Culinary Specialists assessed with a 72% overall ACFT pass rate, which falls at the bottom ten of all regular Army MOSs (RAND Corporation, 2022).
Additionally, the minimum thresholds for some ACFT events contradict the established physical requirements for specific MOSs, creating an ethical dilemma for Soldiers who must meet conflicting standards. The Culinary Specialty requires individuals to vertically lift 25 pounds while wearing 80 pounds of gear, regardless of gender (MilSuite, 2023). However, the deadlift ACFT event requires males to vertically lift 140 pounds and females to lift 120 pounds to achieve a minimum score (United States Army, n.d.).
The weight needed to achieve a minimum score on the deadlift event for either gender far exceeds 25 pounds with 80 pounds of gear worn. Furthermore, Soldiers would have to vertically lift more than their MOS must physically do during combat operations to gain more than a minimum score. These factors negatively affect Soldier combat readiness and future leader selection throughout the force.
A critical examination of the ACFT scoring system exposes inconsistencies in the data collected during the diagnostic period. The Army collected evidence offering mixed and incompatible results to substantiate logical reasons for implementing some of the events, such as the plank, which has no clear correlation to combat performance (RAND Corporation, 2022).
Col. Nicholas Gist, director of the Department of Physical Education, suggests MOS physical demands are immaterial, and that being physically active five to six days a week would assist Soldiers to achieve maximum ACFT performance (Bartelt, 2020). This reasonably supports the root cause of influenced biases on ACFT scores, which negatively affects promotions and incorrect leader placement.
Physical Fitness accounts for only 15% of the total promotion points available for Soldiers seeking advancement to sergeant and staff sergeant (Department of the Army, 2019b). Therefore, emphasis on physical fitness scores causes an incorrect placement of future individual talent in organizational leadership roles.
The fact is that the ACFT replaced the APFT as the official test to measure physical fitness. However, the Army established that higher physical fitness scores correlate to a higher propensity for promotion potential, which reinforces adverse impacts derived from the root causes.
The Army uses three ethical lenses to identify potential ethical dilemmas or validate ethical considerations within available courses of action, such as rules, outcomes, and virtues (Department of the Army, 2020).
For instance, leaders use ethical lenses to determine if a recommendation contradicts with virtues established within the Army Values or if the outcome results in ethical obscurity, preventing the best course of action. It is essential to apply ethical lenses to the two recommended changes.
Making these changes produces an ethically sound outcome that aligns with current MOS physical demands, regardless of gender, with the physical demands they would realistically endure during combat operations.
Second, removing the ACFT score from promotion boards would promote a more comprehensive candidate evaluation, aligning with the Army's People First Strategy and fostering a positive organizational culture.
This article explored the need for a positive shift to ensure quality Soldiers are fairly selected for promotion and leadership positions. It examined the challenge and ramifications of aligning promotions and leadership selections with ACFT scores, balancing ethical leadership and physical proficiency, addressing disparities and misalignments, root cause analysis, and proposed two ethical solutions.
In its commitment to evaluating and defining success in its personnel, the U.S. Army should adopt a gender-neutral ACFT based on MOS-specific physical demands that uses a pass-or-fail measurement and should remove the ACFT score from promotion boards to promote a more comprehensive candidate evaluation and foster a positive organizational culture.
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I'm creating a site where all of the users have a score that is updated everyday. I can easily create rankings from this score, however I'd like to be able to create a "Hot" list of the week or month, etc..
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