Are they ‘worth their weight in gold’? Sport for older adults: benefits and barriers of their participation for sporting organisations

The ageing global population has led to an increased focus on health for older adults. However, older adults have not been a specific priority for some sporting organisations (SOs). Thus, there is an emerging opportunity for this age group to be considered within international sport policy. The aim of this study was to understand the benefits and barriers that SOs encounter when engaging older adults. Eight focus group interviews (n = 49) were held with representatives of Australian national sporting organisations (NSOs), and older adults who were either sport club or non-sport club members. The socioecological model domains, interpersonal, organisational and policy, were used as a framework for thematic analysis, and organisational capacity building concepts were utilised to explain the findings. Common perceived benefits included interpersonal benefits (intergenerational opportunities and role models) and organisational benefits (volunteering, financial contributions and maximised facility usage) for engaging older adults. Common perceived barriers included interpersonal barriers (competing priorities and perceived societal expectations), organisational barriers (lack of appropriate playing opportunities, lack of facility access and lack of club capacity) and policy barriers (strategic organisational focus on children and elite sport and risk management). Whilst participation in sport is not common for older adults, their involvement can be invaluable for sport clubs. It is not anticipated that any policy focus on older adults will significantly increase active participation for this age group. However, any increase in older adults’ sport participation either through actively playing, supporting family and friends and/or volunteering will contribute to the positive health of individuals, sport clubs and the community.Peer reviewedFinal Accepted Versio

Fracture model with variable range of interaction

We introduce a fiber bundle model where the interaction among fibers is modeled by an adjustable stress-transfer function which can interpolate between the two limiting cases of load redistribution, the global and the local load sharing schemes. By varying the range of interaction several features of the model are numerically studied and a crossover from mean field to short range behavior is obtained. The properties of the two regimes and the emergence of the crossover in between are explored by numerically studying the dependence of the ultimate strength of the material on the system size, the distribution of avalanches of breakings, and of the cluster sizes of broken fibers. Finally, we analyze the moments of the cluster size distributions to accurately determine the value at which the crossover is observed.Comment: 8 pages, 8 figures. Two columns revtex format. Final version to be published in Phys. Rev.

Bipartite Mixed States of Infinite-Dimensional Systems are Generically Nonseparable

Given a bipartite quantum system represented by a tensor product of two Hilbert spaces, we give an elementary argument showing that if either component space is infinite-dimensional, then the set of nonseparable density operators is trace-norm dense in the set of all density operators (and the separable density operators nowhere dense). This result complements recent detailed investigations of separability, which show that when both component Hilbert spaces are finite-dimensional, there is a separable neighborhood (perhaps very small for large dimensions) of the maximally mixed state.Comment: 5 pages, RevTe

The Gaugino Code

Gauginos might play a crucial role in the search for supersymmetry at the Large Hadron Collider (LHC). Mass predictions for gauginos are rather robust and often related to the values of the gauge couplings. We analyse the ratios of gaugino masses in the LHC energy range for various schemes of supersymmetry breakdown and mediation. Three distinct mass patterns emerge.Comment: 42 pages, Latex; a discussion of deflected anomaly mediation added, references adde

Metastable Vacua in Flux Compactifications and Their Phenomenology

In the context of flux compactifications, metastable vacua with a small positive cosmological constant are obtained by combining a sector where supersymmetry is broken dynamically with the sector responsible for moduli stabilization, which is known as the F-uplifting. We analyze this procedure in a model-independent way and study phenomenological properties of the resulting vacua.Comment: 21 pages, 19 figures; v2: matches version published in JHE

Development and validation of a simplified thoracolumbar spine fracture classification system

STUDY DESIGN : Development and validation of fracture classification system. OBJECTIVE: To develop and validate a Simplified Classification System (SCS) for Thoraco-Lumbar (TL) fractures (SCS – TL fractures). SETTING : Tertiary Spinal Injuries Centre, New Delhi, India METHODS : Based on the International Spinal Cord Society Spine Trauma Study Group (ISCoS STSG, n = 23) experts’ clinical consensus conducted by the senior author and on his own experience, the Denis classification for TL fractures was modified to develop a SCS-TL fractures that could guide the management. After Face and Content validation, Construct validation was done in two stages. First stage analyzed if management of 30 cases of TL fractures, as suggested by the SCS - TL fractures and ISCoS STSG (n = 9) as well as other (n = 5) experts, matched. Second stage was a one year prospective study analyzing if the management suggested matched the management actually carried out by different spine surgeons (n = 10) working at a single institution. RESULTS : In the first stage there was 100% agreement for management (conservative or surgical) as proposed by experts and that suggested by the proposed classification for TL fractures whereas for surgical approach there was 88% agreement. In the second stage, there was 100% agreement for the management as well as surgical approach as carried out at our centre and that proposed by the SCS for TL fractures. CONCLUSIONS : The proposed SCS-TL fractures helps in classifying and in decision making for management of TL fractures. The next phase of validation would involve multicentric reliability studies and prospective application of the SCS- TL fractures.https://www.nature.com/schj2022Orthopaedic Surger

Hospital variation and outcomes after repeat hepatic resection for colorectal liver metastases:a nationwide cohort study

Background: Approximately 70% of patients with colorectal liver metastases (CRLM) experiences intrahepatic recurrence after initial liver resection. This study assessed outcomes and hospital variation in repeat liver resections (R-LR).Methods: This population-based study included all patients who underwent liver resection for CRLM between 2014 and 2022 in the Netherlands. Overall survival (OS) was collected for patients operated on between 2014 and 2018 by linkage to the insurance database. Results: Data of 7479 liver resections (1391 (18.6%) repeat and 6088 (81.4%) primary) were analysed. Major morbidity and mortality were not different. Factors associated with major morbidity included ASA 3+, major liver resection, extrahepatic disease, and open surgery. Five-year OS after repeat versus primary liver resection was 42.3% versus 44.8%, P = 0.37. Factors associated with worse OS included largest CRLM &gt;5 cm (aHR 1.58, 95% CI: 1.07–2.34, P = 0.023), &gt;3 CRLM (aHR 1.33, 95% CI: 1.00–1.75, P = 0.046), extrahepatic disease (aHR 1.60, 95% CI: 1.25–2.04, P = 0.001), positive tumour margins (aHR 1.42, 95% CI: 1.09–1.85, P = 0.009). Significant hospital variation in performance of R-LR was observed, median 18.9% (8.2% to 33.3%).Conclusion: Significant hospital variation was observed in performance of R-LR in the Netherlands reflecting different treatment decisions upon recurrence. On a population-based level R-LR leads to satisfactory survival.</p

Hospital variation and outcomes after repeat hepatic resection for colorectal liver metastases:a nationwide cohort study

Background: Approximately 70% of patients with colorectal liver metastases (CRLM) experiences intrahepatic recurrence after initial liver resection. This study assessed outcomes and hospital variation in repeat liver resections (R-LR).Methods: This population-based study included all patients who underwent liver resection for CRLM between 2014 and 2022 in the Netherlands. Overall survival (OS) was collected for patients operated on between 2014 and 2018 by linkage to the insurance database. Results: Data of 7479 liver resections (1391 (18.6%) repeat and 6088 (81.4%) primary) were analysed. Major morbidity and mortality were not different. Factors associated with major morbidity included ASA 3+, major liver resection, extrahepatic disease, and open surgery. Five-year OS after repeat versus primary liver resection was 42.3% versus 44.8%, P = 0.37. Factors associated with worse OS included largest CRLM &gt;5 cm (aHR 1.58, 95% CI: 1.07–2.34, P = 0.023), &gt;3 CRLM (aHR 1.33, 95% CI: 1.00–1.75, P = 0.046), extrahepatic disease (aHR 1.60, 95% CI: 1.25–2.04, P = 0.001), positive tumour margins (aHR 1.42, 95% CI: 1.09–1.85, P = 0.009). Significant hospital variation in performance of R-LR was observed, median 18.9% (8.2% to 33.3%).Conclusion: Significant hospital variation was observed in performance of R-LR in the Netherlands reflecting different treatment decisions upon recurrence. On a population-based level R-LR leads to satisfactory survival.</p

Outcomes of liver surgery:A decade of mandatory nationwide auditing in the Netherlands

Background: In 2013, the nationwide Dutch Hepato Biliary Audit (DHBA) was initiated. The aim of this study was to evaluate changes in indications for and outcomes of liver surgery in the last decade. Methods: This nationwide study included all patients who underwent liver surgery for four indications, including colorectal liver metastases (CRLM), hepatocellular carcinoma (HCC), and intrahepatic– and perihilar cholangiocarcinoma (iCCA – pCCA) between 2014 and 2022. Trends in postoperative outcomes were evaluated separately for each indication using multilevel multivariable logistic regression analyses. Results: This study included 8057 procedures for CRLM, 838 for HCC, 290 for iCCA, and 300 for pCCA. Over time, these patients had higher risk profiles (more ASA-III patients and more comorbidities). Adjusted mortality decreased over time for CRLM, HCC and iCCA, respectively aOR 0.83, 95%CI 0.75–0.92, P &lt; 0.001; aOR 0.86, 95%CI 0.75–0.99, P = 0.045; aOR 0.40, 95%CI 0.20–0.73, P &lt; 0.001. Failure to rescue (FTR) also decreased for these groups, respectively aOR 0.84, 95%CI 0.76–0.93, P = 0.001; aOR 0.81, 95%CI 0.68–0.97, P = 0.024; aOR 0.29, 95%CI 0.08–0.84, P = 0.021). For iCCA severe complications (aOR 0.65 95%CI 0.43–0.99, P = 0.043) also decreased. No significant outcome differences were observed in pCCA. The number of centres performing liver resections decreased from 26 to 22 between 2014 and 2022, while median annual volumes did not change (40–49, P = 0.66). Conclusion: Over time, postoperative mortality and FTR decreased after liver surgery, despite treating higher-risk patients. The DHBA continues its focus on providing feedback and benchmark results to further enhance outcomes.</p

Practice variation and outcomes of minimally invasive minor liver resections in patients with colorectal liver metastases:a population-based study

Introduction: In 2017, the Southampton guideline stated that minimally invasive liver resections (MILR) should considered standard practice for minor liver resections. This study aimed to assess recent implementation rates of minor MILR, factors associated with performing MILR, hospital variation, and outcomes in patients with colorectal liver metastases (CRLM). Methods: This population-based study included all patients who underwent minor liver resection for CRLM in the Netherlands between 2014 and 2021. Factors associated with MILR and nationwide hospital variation were assessed using multilevel multivariable logistic regression. Propensity-score matching (PSM) was applied to compare outcomes between minor MILR and minor open liver resections. Overall survival (OS) was assessed with Kaplan–Meier analysis on patients operated until 2018. Results: Of 4,488 patients included, 1,695 (37.8%) underwent MILR. PSM resulted in 1,338 patients in each group. Implementation of MILR increased to 51.2% in 2021. Factors associated with not performing MILR included treatment with preoperative chemotherapy (aOR 0.61 CI:0.50–0.75, p &lt; 0.001), treatment in a tertiary referral hospital (aOR 0.57 CI:0.50–0.67, p &lt; 0.001), and larger diameter and number of CRLM. Significant hospital variation was observed in use of MILR (7.5% to 93.0%). After case-mix correction, six hospitals performed fewer, and six hospitals performed more MILRs than expected. In the PSM cohort, MILR was associated with a decrease in blood loss (aOR 0.99 CI:0.99–0.99, p &lt; 0.01), cardiac complications (aOR 0.29, CI:0.10–0.70, p = 0.009), IC admissions (aOR 0.66, CI:0.50–0.89, p = 0.005), and shorter hospital stay (aOR CI:0.94–0.99, p &lt; 0.01). Five-year OS rates for MILR and OLR were 53.7% versus 48.6%, p = 0.21. Conclusion: Although uptake of MILR is increasing in the Netherlands, significant hospital variation remains. MILR benefits short-term outcomes, while overall survival is comparable to open liver surgery. Graphical abstract: [Figure not available: see fulltext.].</p