Age specific recruitment and retention to a large multicentre observational breast cancer trial in older women: the Age Gap Trial

Introduction Recruitment and retention are two of the most important factors in successfully running clinical trials. Many trials encounter problems with both, causing delays or preventing study progress. These issues are greater in older adults and patients with cancer. Materials and methods We assessed recruitment and retention in a large, multicentre, observational breast cancer study in older female patients (>70 years, N = 3440). Data collected by the Age Gap study were used to assess rates of, and reasons for, patients not being recruited or retained. Statistical analysis assessed the impact of age as a predictor of recruitment and retention. Results Between February 2013 and June 2018, 6876 patients were screened and 3456 were consented across 56 United Kingdom (UK) breast units. Reasons for non-recruitment included ineligibility, clinician issues, staffing resource issues, patients' lack of interest or time and trial burden. In comparison with the age demographics of patients with breast cancer in the UK, women aged 70–75 years were over-represented compared to older age groups. Logistic regression demonstrated that older age significantly reduced the odds of consent (OR = 0.96, CI: 0.938–0.982; p < 0.001). Multivariate analysis showed that age (p < 0.001), markers of poor functional ability (Eastern Cooperative Oncology Group Performance Status (p = 0.011)) and instrumental activities of daily living (p = 0.026) were significant predictors of withdrawal. Discussion This study has demonstrated that selection and attrition bias for age are apparent despite a range of ‘age friendly’ study design measures. Exploration of the underlying reasons for this and development of measures to address this should be the focus of further research

Treatment effects may remain the same even when trial participants differed from the target population

Objective RCTs have been criticised for lacking external validity. We assessed whether a trial in people with type I diabetes mellitus (T1DM) mirrored the wider population, and applied sample-weighting methods to assess the impact of differences on our trial's findings. Study design and setting The REPOSE trial was nested within a large UK cohort capturing demographic, clinical and quality of life (QoL) data for people with T1DM undergoing structured diabetes-specific education. We firstly assessed whether our RCT participants were comparable to this cohort using propensity score modelling. Following this we re-weighted the trial population to better match the wider cohort and re-estimated the treatment effect. Results Trial participants differed from the cohort in regards to sex, weight, HbA1c and also QoL and satisfaction with current treatment. Nevertheless, the treatment effects derived from alternative model weightings were similar to that of the original RCT. Conclusions Our RCT participants differed in composition to the wider population but the original findings were unaffected by sampling adjustments. We encourage investigators take steps to address criticisms of generalisability, but doing so is problematic: external data, even if available, may contain limited information and analyses can be susceptible to model misspecification

Power to Gas in the Austrian Transmission Grid

Abweichender Titel laut Übersetzung der Verfasserin/des VerfassersZsfassung in engl. SpracheIn Zeiten des Aufschwunges erneuerbarer Energiequellen kommt es in den Übertragungsnetzen zu einer Verschiebung der Flexibilität zwischen Erzeuger und Verbraucher. Gegenüber den Vorteilen der erneuerbaren Energieträger, wie die Reduzierung der Treibhausgasemissionen, steht der große Nachteil des fluktuierenden Energieangebots entgegen. Die fehlende Flexibilität der Erzeugerseite muss und wird mittels Energiespeicher auf die Verbraucherseite übertragen. Vor allem in Westösterreich dient eine Großzahl von Pumpspeicherkraftwerken zur Energiespeicherung. Die Energieerzeugung aus erneuerbaren Quellen hingegen findet großteils im Osten Österreichs statt. Somit kommt es zu regem Energietransport zwischen Ost- und Westösterreich, der mit dem Ausbau erneuerbaren Energiequellen eine immer größer werdende Belastung für das österreichische Übertragungsnetz darstellt. Der neue Technologieansatz, Power to Gas, stellt eine Methode dar, Strom chemisch in Gas umzuwandeln. Je nach Anwendung könnte der neugewonnene Energieträger Gas, in Gasspeichern oder direkt im Gasübertragungsnetz, gespeichert werden. Diese Technologie könnte somit eine Antwort auf die Frage nach neuen potentiellen Energiespeichern sein. In der folgenden Diplomarbeit werden verschiedene Speichertechnologien vorgestellt und verglichen, das Power to Gas Prinzip wird dabei detailliert vorgestellt. Weiters wird eine mögliche Integration der Power to Gas Methode in den österreichischen Übertragungsnetzen untersucht. Hierbei wird, unter Beachtung der technologischen Umstände, nach optimalen Lokalitäten für die Integration von Power-to-Gas-Anlagen in Österreich gesucht. Einfluss bei der Findung geeigneter Standorte haben beispielsweise Parameter wie die Auslastung des elektrischen Übertragungsnetzes und die Anbindung an das Gas und Stromübertragungsnetz. Mittels geeigneter Ansätze und Simulationen wird nach optimalen Lokalitäten für Power-to-Gas-Anlagen gesucht. Im Vordergrund steht dabei wie sich die Auslastung bzw. die Zuverlässigkeit des österreichischen Stromnetzes verhält.In times of recovery of renewable energy sources, a shift of flexibility between generators and loads in the electrical grid takes place. The advantages of renewable energy sources like the reduction of greenhouse emissions are offset by the fluctuating supply. The lack of flexibilty on the part of generators must and will be balanced by energy storage systems. Especially in western Austria many pumped hydro storages are used. However, the generation of renewable energy mostly takes place in eastern Austria. Thus it comes to a brisk energy transport between east and west, which rises by installing more volatile plants. This fact will cause high network loads which makes the operation of the power grid difficult. The new technological approach, power to gas, represents a method to form electrical energy into chemical energy. Depending on the application, the newfound energy carrier gas could be stored in gas storage systems or directly in the gas grid. This technology could therefore be an answer to the question for new potential energy storage systems. In the following thesis different energy storage systems are discribed and compared, the power to gas principle is presented here in detail. Furthermore, a possible integration of the power to gas method in the Austrian power grid is investigated. Taking account of technological circumstances, optimal location for power to gas plants are seeked. The search of optimal locations depends on parameters like the workload of the power grid or a suitable connection to gas and electricity grid. Appropriate approaches and simulations are used to search for optimal locations for power-to-gas plants. The focus is mainly on how the workload and reliability of the Austrian power grid reacts.8

Challenges in Cost-Effectiveness Analysis Modelling of HPV Vaccines in Low- and Middle-Income Countries: A Systematic Review and Practice Recommendations

Low- and middle-income countries (LMICs) face a number of challenges in implementing cervical cancer prevention programmes that do not apply in high-income countries. This review assessed how context-specific challenges of implementing cervical cancer prevention strategies in LMICs were accounted for in existing cost-effectiveness analysis (CEA) models of human papillomavirus (HPV) vaccination. The databases of MEDLINE, EMBASE, NHS Economic Evaluation Database, EconLit, Web of Science, and the Center for the Evaluation of Value and Risk in Health (CEA) Registry were searched for studies published from 2006 to 2015. A descriptive, narrative, and interpretative synthesis of data was undertaken. Of the 33 studies included in the review, the majority acknowledged cost per vaccinated girl (CVG) (26 studies) and vaccine coverage rate (21 studies) as particular challenges for LMICs, while nine studies identified screening coverage rate as a challenge. Most of the studies estimated CVG as a composite of different cost items. However, the basis for the items within this composite cost was unclear. The majority used an assumption rather than an observed rate to represent screening and vaccination coverage rates. CVG, vaccine coverage and screening coverage were shown by some studies through sensitivity analyses to reverse the conclusions regarding cost-effectiveness, thereby significantly affecting policy recommendations. While many studies recognized aspects of the particular challenges of HPV vaccination in LMICs, greater efforts need to be made in adapting models to account for these challenges. These include adapting costings of HPV vaccine delivery from other countries, learning from the outcomes of cervical cancer screening programmes in the same geographical region, and taking into account the country's previous experience with other vaccination programmes

Bielefelder Fragebogen zu Studienbedingungen und Gesundheit als Basis für die Gestaltung von SGM an Hochschulen

Burian J, Lehnchen J, Heumann E, Helmer SM, Stock C. Bielefelder Fragebogen zu Studienbedingungen und Gesundheit als Basis für die Gestaltung von SGM an Hochschulen. In: Timmann M, Paeck T, Fischer J, et al., eds. Handbuch Studentisches Gesundheitsmanagement - Perspektiven, Impulse und Praxiseinblicke. Berlin, Heidelberg: Springer Berlin Heidelberg; 2022

Integration of sex/gender into environmental health research. Results of the interdisciplinary research network Sex/Gender-Environment-Health (GeUmGe-NET)

Bolte G, David M, Debiak M, et al. Integration von Geschlecht in die Forschung zu umweltbezogener Gesundheit. Ergebnisse des interdisziplinären Forschungsnetzwerks Geschlecht – Umwelt – Gesundheit (GeUmGe-NET). BUNDESGESUNDHEITSBLATT-GESUNDHEITSFORSCHUNG-GESUNDHEITSSCHUTZ. 2018;61(6):737-746.The comprehensive consideration of sex/gender in health research is essential to increase relevance and validity of research results. Contrary to other areas of health research, there is no systematic summary of the current state of research on the significance of sex/gender in environmental health. Within the interdisciplinary research network Sex/Gender-Environment-Health (GeUmGe-NET) the current state of integration of sex/gender aspects or, respectively, gender theoretical concepts into research was systematically assessed within selected topics of the research areas environmental toxicology, environmental medicine, environmental epidemiology and public health research on environment and health. Knowledge gaps and research needs were identified in all research areas. Furthermore, the potential for methodological advancements by using gender theoretical concepts was depicted. A dialogue between biomedical research, public health research, and gender studies was started with the research network GeUmGe-NET. This dialogue has to be continued particularly regarding a common testing of methodological innovations in data collection and data analysis. Insights of this interdisciplinary research are relevant for practice areas such as environmental health protection, health promotion, environmental justice, and environmental health monitoring