The impact of PET image acquisition and reconstruction parameters on SUV measurements or radiomic feature values is widely documented. This scanner effect is detrimental to the design and validation ...of predictive or prognostic models and limits the use of large multicenter cohorts. To reduce the impact of this scanner effect, the ComBat method has been proposed and is now used in various contexts. The purpose of this article is to explain and illustrate the use of ComBat based on practical examples. We also give examples in which the ComBat assumptions are not met and, thus, in which ComBat should not be used.
Most older people wish to age in place, for which functional status or being able to perform activities of daily living (ADLs) is an important precondition. However, along with the substantial growth ...of the (oldest) old, the number of people who develop limitations in ADLs or have functional decline dramatically increases in this part of the population. Therefore, it is important to gain insight into factors that can contribute to developing intervention strategies at older ages. As a first step, this systematic review was conducted to identify risk and protective factors as predictors for developing limitations in ADLs in community-dwelling people aged 75 and over.
Four electronic databases (CINAHL (EBSCO), EMBASE, PsycINFO and PubMed) were searched systematically for potentially relevant studies published between January 1998 and March 2016.
After a careful selection process, 6,910 studies were identified and 25 were included. By far most factors were examined in one study only, and most were considered risk factors. Several factors do not seem to be able to predict the development of limitations in ADLs in people aged 75 years and over, and for some factors ambiguous associations were found. The following risk factors were found in at least two studies: higher age, female gender, diabetes, hypertension, and stroke. A high level of physical activity and being married were protective in multiple studies. Notwithstanding the fact that research in people aged 65 years and over is more extensive, risk and protective factors seem to differ between the 'younger' and 'older' olds.
Only a few risk and protective factors in community-dwelling people aged 75 years and over have been analysed in multiple studies. However, the identified factors could serve both detection and prevention purposes, and implications for future research are given as well.
Background: the 16-item Falls Efficacy Scale-International (FES-I) has been shown to have excellent reliability and construct validity. However, for practical and clinical purposes, a shortened ...version of the FES-I would be useful. Objective: to develop and validate a shortened version of FES-I while preserving good psychometric properties. Design: initial development of a shortened version using data from a UK survey (Short FES-I; n = 704), test of reliability and validity of the Short FES-I using data from a Dutch survey (n = 300). Setting: community samples. Methods: comparison of reliability and validity of the Short FES-I and the FES-I in a random sample of 193 people aged between 70 and 92. Results: the internal and 4-week test–retest reliability of the Short FES-I is excellent (Cronbach's alpha 0.92, intra-class coefficient 0.83) and comparable to the FES-I. The correlation between the Short FES-I and the FES-I is 0.97. Patterns in differences with respect to mean scores according to age, sex, falls history, and overall fear of falling are similar for the Short FES-I and the FES-I. The FES-I had slightly better power to discriminate between groups differentiated by age, sex, falls history, and fear falling, but differences are small. Conclusions: the Short FES-I is a good and feasible measure to assess fear of falling in older persons. However, if researchers or clinicians are particularly interested in the distributions of specific fear of falling-related activities not included in the Short FES-I, the use of the full FES-I is recommended.
Objectives The aim of this paper is to propose a new model of sustainable employability based on the capability approach, encompassing the complexity of contemporary work, and placing particular ...emphasis on work-related values. Methods Having evaluated existing conceptual models of work, health, and employability, we concluded that prevailing models lack an emphasis on important work-related values. Amartya Sen's capability approach (CA) provides a framework that incorporates a focus on values and reflects the complexity of sustainable employability. Results We developed a model of sustainable employability based on the CA. This model can be used as starting point for developing an assessment tool to investigate sustainable employability. Conclusions A fundamental premise of the CA is that work should create value for the organization as well as the worker. This approach challenges researchers, policy-makers, and practitioners to investigate what people find important and valuable - what they would like to achieve in a given (work) context - and moreover to ascertain whether people are able and enabled to do so. According to this approach, it is not only the individual who is responsible for achieving this; the work context is also important. Rather than merely describing relationships between variables, as existing descriptive models often do, the CA depicts a valuable goal: a set of capabilities that constitute valuable work. Moreover, the CA fits well with recent conceptions of health and modern insights into work, in which the individual works towards his or her own goals that s/he has to achieve within the broader goals of the organization.
Objectives
To determine the long‐term effects of three strength and balance exercise interventions on physical performance, fall‐related psychological outcomes, and falls in older people.
Design
A ...single‐blinded, four‐group, randomized controlled trial.
Setting
Community, Germany.
Participants
Community‐dwelling adults aged 70 to 90 who had fallen in the past 6 months or reported fear of falling.
Intervention
After baseline assessment, 280 participants were randomly assigned to the control group (CG; no intervention; n = 80) or one of three strength and balance exercise interventions (the strength and balance group (SBG; strength and balance only; n = 63), the fitness group (FG; strength and balance plus endurance training; n = 64), or the multifaceted group (MG; strength and balance plus fall risk education; n = 73). The interventions consisted of 32 one‐hour group sessions in 16 weeks.
Measurements
Data on physical performance, fall‐related psychological outcomes, and falls were collected for 24 months.
Results
Mixed‐effects regression analyses showed improved short‐ and long‐term (12 and 24 months, respectively) physical performance for the SBG and FG, particularly regarding mobility, balance, and walking speed (P < .05). The improvements in physical performance outcomes were most prominent in the FG. Fall‐related psychological outcomes, number of falls, and injurious falls were not significantly different from in the control group.
Conclusion
Training focusing on strength, balance, and endurance can enhance physical performance for up to 24 months in community‐dwelling older adults. These findings did not translate to improved fall‐related psychological outcomes or reduced incidence of falls. This demonstrates the need for a different approach (e.g., regarding intervention dose and components) to gain intervention benefits in the multiple domains that contribute to independence and well‐being in older adults.
Background: little is known about the prevalence rates and correlates of fear of falling and avoidance of activity due to fear of falling in the general population of community-living older people. ...Objective: to assess prevalence rates and study correlates of fear of falling and avoidance of activity due to fear of falling in this population. Study design and setting: cross-sectional study in 4,031 community-living people aged ≥70 years. Results: fear of falling was reported by 54.3% and associated avoidance of acivity by 379% of our population. Variables independently associated with fear of falling were: higher age (≥80 years: odds ratio (OR) =1.79; 95% confidence interval (CI) =1.49–2.16), female gender (OR = 3.23; 95% CI = 2.76–3.79), poor perceived general health (OR = 6.93; 95% CI = 4.70–10.21) and multiple falls (OR = 5.72; 95% CI = 4.40–7.43). Higher age (≥80 years: OR = 1.92; 95% CI = 1.59–2.32), poor perceived general health (OR = 11.91; 95% CI = 8.38–16.95) and multiple falls (OR = 4.64; 95% CI = 3.73–5.76) were also independently associated with avoidance of activity. Conclusions: fear of falling and avoidance of activities due to fear of falling, were highly prevalent in our sample of community-living older people. Particularly, poor perceived general health showed a strong, independent association with both, fear of falling, and related avoidance of activity. Findings of our study may help health care professionals to identify people eligible for interventions aimed at reducing fear of falling and activity restriction.
The impact of metallicity on the mass-loss rate from red giant branch (RGB) stars is studied through its effect on the parameters of horizontal branch (HB) stars. The scaling factors from Reimers and ...Schröder and Cuntz are used to measure the efficiency of RGB mass-loss for typical stars in 56 well-studied Galactic globular clusters (GCs). The median values among clusters are, respectively,
$\eta _{\rm R} = 0.477 \pm 0.070 ^{+0.050}_{-0.062}$
and
$\eta _{\rm SC} = 0.172 \pm 0.024 ^{+0.018}_{-0.023}$
(standard deviation and systematic uncertainties, respectively). Over a factor of 200 in iron abundance, η varies by ≲30 per cent, thus mass-loss mechanisms on the RGB have very little metallicity dependence. Any remaining dependence is within the current systematic uncertainties on cluster ages and evolution models. The low standard deviation of η among clusters (≈14 per cent) contrasts with the variety of HB morphologies. Since η incorporates cluster age, this suggests that age accounts for the majority of the ‘second parameter problem’, and that a Reimers-like law provides a good mass-loss model. The remaining spread in η correlates with cluster mass and density, suggesting helium enrichment provides the third parameter explaining HB morphology of GCs. We close by discussing asymptotic giant branch (AGB) mass-loss, finding that the AGB tip luminosity is better reproduced and η has less metallicity dependence if GCs are more co-eval than generally thought.
The intensive polychemotherapy regimen eBEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone in escalated doses) is very active in patients with ...advanced-stage Hodgkin's lymphoma, albeit at the expense of severe toxicities. Individual patients might be cured with less burdensome therapy. We investigated whether metabolic response determined by PET after two cycles of standard regimen eBEACOPP (PET-2) would allow adaption of treatment intensity, increasing it for PET-2-positive patients and reducing it for PET-2-negative patients.
In this open-label, randomised, parallel-group phase 3 trial, we recruited patients aged 18–60 years with newly diagnosed, advanced-stage Hodgkin's lymphoma in 301 hospitals and private practices in Germany, Switzerland, Austria, the Netherlands, and the Czech Republic. After central review of PET-2, patients were assigned (1:1) to one of two parallel treatment groups on the basis of their PET-2 result. Patients with positive PET-2 were randomised to receive six additional cycles of either standard eBEACOPP (8 × eBEACOPP in total) or eBEACOPP with rituximab (8 × R-eBEACOPP). Those with negative PET-2 were randomised between standard treatment with six additional cycles of eBEACOPP (8 × eBEACOPP) or experimental treatment with two additional cycles (4 × eBEACOPP). A protocol amendment in June, 2011, introduced a reduction of standard therapy to 6 × eBEACOPP; after this point, patients with positive PET-2 were no longer randomised and were all assigned to receive 6 × eBEACOPP and patients with negative PET-2 were randomly assigned to 6 × eBEACOPP (standard) or 4 × eBEACOPP (experimental). Randomisation was done centrally using the minimisation method including a random component, stratified according to centre, age (<45 vs ≥45 years), stage (IIB, IIIA vs IIIB, IV), international prognostic score (0–2 vs 3–7), and sex. eBEACOPP was given as previously described; rituximab was given intravenously at a dose of 375 mg/m2 (maximum total dose 700 mg). The primary objectives were to show superiority of the experimental treatment in the PET-2-positive cohort, and to show non-inferiority of the experimental treatment in the PET-2-negative cohort in terms of the primary endpoint, progression-free survival. We defined non-inferiority as an absolute difference of 6% in the 5-year progression-free survival estimates. Primary analyses in the PET-2-negative cohort were per protocol; all other analyses were by intention to treat. This trial was registered with ClinicalTrials.gov, number NCT00515554.
Between May 14, 2008, and July 18, 2014, we recruited 2101 patients, of whom 137 were found ineligible before randomisation and a further 19 were found ineligible after randomisation. Among 434 randomised patients (217 per arm) with positive PET-2, 5-year progression-free survival was 89·7% (95% CI 85·4–94·0) with eBEACOPP and 88·1% (83·5–92·7) with R-eBEACOPP (log-rank p=0·46). Patients with negative PET-2 randomly assigned to either 8 × eBEACOPP or 6 × eBEACOPP (n=504) or 4 × eBEACOPP (n=501) had 5-year progression-free survival of 90·8% (95% CI 87·9–93·7) and 92·2% (89·4–95·0), respectively (difference 1·4%, 95% CI −2·7 to 5·4). 4 × eBEACOPP was associated with fewer severe infections (40 8% of 498 vs 75 15% of 502) and organ toxicities (38 8% of 498 vs 91 18% of 502) than were 8 × eBEACOPP or 6 × eBEACOPP in PET-2-negative patients. Ten treatment-related deaths occurred: four in the PET-2-positive cohort (one <1% in the 8 × eBEACOPP group, three 1% in the 8 × R-eBEACOPP group) and six in the PET-2-negative group (six 1% in the 8 × eBEACOPP or 6 × eBEACOPP group).
The favourable outcome of patients treated with eBEACOPP could not be improved by adding rituximab after positive PET-2. PET-2 negativity allows reduction to only four cycles of eBEACOPP without loss of tumour control. PET-2-guided eBEACOPP provides outstanding efficacy for all patients and increases overall survival by reducing treatment-related risks for patients with negative PET-2. We recommend this PET-2-guided treatment strategy for patients with advanced-stage Hodgkin's lymphoma.
Deutsche Krebshilfe, Swiss State Secretariat for Education and Research, and Roche Pharma AG.
To test whether StandingTall, a home based, e-health balance exercise programme delivered through an app, could provide an effective, self-managed fall prevention programme for community dwelling ...older people.
Assessor blinded, randomised controlled trial.
Older people living independently in the community in Sydney, Australia.
503 people aged 70 years and older who were independent in activities of daily living, without cognitive impairment, progressive neurological disease, or any other unstable or acute medical condition precluding exercise.
Participants were block randomised to an intervention group (two hours of StandingTall per week and health education; n=254) or a control group (health education; n=249) for two years.
The primary outcomes were the rate of falls (number of falls per person year) and the proportion of people who had a fall over 12 months. Secondary outcomes were the number of people who had a fall and the number who had an injurious fall (resulting in any injury or requiring medical care), adherence, mood, health related quality of life, and activity levels over 24 months; and balance and mobility outcomes over 12 months.
The fall rates were not statistically different in the two groups after the first 12 months (0.60 falls per year (standard deviation 1.05) in the intervention group; 0.76 (1.25) in the control group; incidence rate ratio 0.84, 95% confidence interval 0.62 to 1.13, P=0.071). Additionally, the proportion of people who fell was not statistically different at 12 months (34.6% in intervention group, 40.2% in control group; relative risk 0.90, 95% confidence interval 0.67 to 1.20, P=0.461). However, the intervention group had a 16% lower rate of falls over 24 months compared with the control group (incidence rate ratio 0.84, 95% confidence interval 0.72 to 0.98, P=0.027). Both groups had a similar proportion of people who fell over 24 months (relative risk 0.87, 95% confidence interval 0.68 to 1.10, P=0.239), but the proportion of people who had an injurious fall over 24 months was 20% lower in the intervention group compared with the control group (relative risk 0.80, 95% confidence interval 0.66 to 0.98, P=0.031). In the intervention group, 68.1% and 52.0% of participants exercised for a median of 114.0 min/week (interquartile range 53.5) after 12 months and 120.4 min/week (38.6) after 24 months, respectively. Groups remained similar in mood and activity levels. The intervention group had a 0.03 (95% confidence interval 0.01 to 0.06) improvement on the EQ-5D-5L (EuroQol five dimension five level) utility score at six months, and an improvement in standing balance of 11 s (95% confidence interval 2 to 19 s) at six months and 10 s (1 to 19 s) at 12 months. No serious training related adverse events occurred.
The StandingTall balance exercise programme did not significantly affect the primary outcomes of this study. However, the programme significantly reduced the rate of falls and the number of injurious falls over two years, with similar but not statistically significant effects at 12 months. E-health exercise programmes could provide promising scalable fall prevention strategies.
ACTRN12615000138583.
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