Cooperation is usually explained from an economic perspective focused mainly on the tangible outcomes received by individuals that are also dependent on the behavior of others, with little reference to the actual behaviors used when cooperating. The potential consequences of social dimensions associated with cooperative behaviors are minimized in Skinnerian and game-theory models by means of anonymous subjects that behave individually while physically isolated in separate chambers. When cooperation and non-cooperation occur in the real world, however, they are often associated not only with different outcomes but also with different behaviors. Unlike non-cooperation, cooperative behaviors are usually intrinsically social, influenced by the presence and behaviors of familiar partners. Research is described that addresses whether the social dimensions of cooperative actions go beyond mere description of behaviors to also explain why cooperation occurs. One way to resolve the relative importance of economic and social factors for explanations of cooperation is to measure choice between the options of cooperation and non-cooperation. The economic perspective, linked to models derived from game theory, frames the question as a choice determined by differences in tangible outcomes such as food or money that, in evolutionary terms, are surrogates for gains in fitness. From a behavioral perspective, the choice between cooperation and non-cooperation is also determined by social dimensions associated only with cooperation. The influence of social cooperation on preference was examined by means of two rectangular chambers interconnected by a T-maze. In one chamber, pairs of laboratory rats were reinforced with saccharine solution for coordinating back-and-forth shuttling; in the second chamber, a single animal was reinforced for back-and-forth shuttling performed in isolation. With outcomes equalized between the two options, cooperation was preferred by the majority of subjects. Moreover, variation in the relative rate of reinforcement during cooperation was not a strong predictor of choice whereas the level of intra-pair coordination was positively related to preference. Implications of this result are discussed for both method and theory, including the hypothesis that the preference is influenced by intrinsic reinforcements evoked by cooperating. The consequences for evolutionary fitness would then arise not only from tangible outcomes but from the relationships that develop when cooperating even when immediate and tangible pay-offs are absent, insufficient or sub-optimal. The impact of cooperative relationships on fitness may therefore not occur immediately but in the future, and perhaps in another context, when they influence outcomes that have a significant impact on survival and reproduction.

The current state of physician leadership education consists mainly of executive degree programs designed for midcareer physicians. In 2004, the authors proposed that, by educating medical students in physician leadership and integrating this with a business management or public health degree program, graduates, health care organizations, and communities would benefit sooner. Given the lack of program models to guide program integration and development, the authors began a one-year inquiry to build a model leadership curriculum and integrate leadership education across degree programs. The qualitative inquiry resulted in several linked tasks. First, the authors identified a feasible method for concurrently delivering all three program components (MD degree, Leadership Curriculum, and MBA or MPH degree) during a five-year plan. Second, the authors chose a competency-based educational framework for leadership and then identified, adapted, and validated existing leadership competencies to their context. Third, the authors performed an extensive program alignment to identify existing overlaps and opportunities for integration within and across program components. Fourth, the authors performed a needs analysis to identify educational gaps, subsequently leading to redesigning two courses and to designing three new courses. A description of the Leadership Curriculum is also provided. This inquiry has led to the development of the Boonshoft Physician Leadership Development Program, which provides physician leadership education integrated with medical education and education in business management or public heath. Future program initiatives include developing leadership student assessment tools and testing the link between program activities and short- and long-term outcome measures of program success.

Among older adults, falls are the leading cause of injury-related deaths and emergency department visits, and the incidence of falls in the United States is rising as the number of older Americans increases. Research has shown that falls can be reduced by modifying fall-risk factors using multifactorial interventions implemented in clinical settings. However, the literature indicates that many providers feel that they do not know how to conduct fall-risk assessments or do not have adequate knowledge about fall prevention. To help healthcare providers incorporate older adult fall prevention (i.e., falls risk assessment and treatment) into their clinical practice, the Centers for Disease Control and Prevention’s (CDC) Injury Center has developed the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) tool kit. This study was conducted to identify the practice characteristics and providers’ beliefs, knowledge, and fall-related activities before they received training on how to use the STEADI tool kit. Data were collected as part of a larger State Fall Prevention Project funded by CDC’s Injury Center. Completed questionnaires were returned by 38 medical providers from 11 healthcare practices within a large New York health system. Healthcare providers ranked falls as the lowest priority of five conditions, after diabetes, cardiovascular disease, mental health, and musculoskeletal conditions. Less than 40% of the providers asked most or all of their older patients if they had fallen during the past 12 months. Less than a quarter referred their older patients to physical therapists for balance or gait training, and <20% referred older patients to community-based fall prevention programs. Less than 16% reported they conducted standardized functional assessments with their older patients at least once a year. These results suggest that implementing the STEADI tool kit in clinical settings could address knowledge gaps and provide the necessary tools to help providers incorporate fall-risk assessment and treatment into clinical practice.