Response‐adaptive designs for binary responses: How to offer patient benefit while being robust to time trends?

Response‐adaptive randomisation (RAR) can considerably improve the chances of a successful treatment outcome for patients in a clinical trial by skewing the allocation probability towards better performing treatments as data accumulates. There is considerable interest in using RAR designs in drug development for rare diseases, where traditional designs are not either feasible or ethically questionable. In this paper, we discuss and address a major criticism levelled at RAR: namely, type I error inflation due to an unknown time trend over the course of the trial. The most common cause of this phenomenon is changes in the characteristics of recruited patients—referred to as patient drift. This is a realistic concern for clinical trials in rare diseases due to their lengthly accrual rate. We compute the type I error inflation as a function of the time trend magnitude to determine in which contexts the problem is most exacerbated. We then assess the ability of different correction methods to preserve type I error in these contexts and their performance in terms of other operating characteristics, including patient benefit and power. We make recommendations as to which correction methods are most suitable in the rare disease context for several RAR rules, differentiating between the 2‐armed and the multi‐armed case. We further propose a RAR design for multi‐armed clinical trials, which is computationally efficient and robust to several time trends considered.     

Staff Reactions Toward Lesbian,Gay, or Bisexual (LGB) People Living in Residential Aged Care Facilities (RACFs) Who Actively Disclose Their Sexual Orientation

Fifty-three staff members currently working in residential aged care facilities located in Barcelona, Spain, were asked about the way they would react if a resident told them that he or she felt sexually attracted and had maintained sexual relationships with another resident of the same gender. Acceptance of non-heterosexual sexual orientation was a frequent answer, and around one in four professionals stated that they would try helping the resident in question, by offering a private space or giving some emotional support. However, some reactions were not consistent with a respectful approach toward sexual diversity, as, for instance, informing the resident’s family or advising the resident to keep his or her sexual orientation hidden. We highlight the importance of developing formal policies and offering formal training to staff in order to address the specific needs of older LGB people living in RACFs.     

Using repeated-prevalence data in multi-state modeling of renal replacement therapy

Multi-state models help predict future numbers of patients requiring specific treatments but these models require exhaustive incidence data. Deriving reliable predictions from repeated-prevalence data would be helpful. A new method to model the number of patients that switch between therapeutic modalities using repeated-prevalence data is presented and illustrated. The parameters and goodness of fit obtained with the new method and repeated-prevalence data were compared to those obtained with the classical method and incidence data. The multi-state model parameters’ confidence intervals obtained with annually collected repeated-prevalence data were wider than those obtained with incidence data and six out of nine pairs of confidence intervals did not overlap. However, most parameters were of the same order of magnitude and the predicted patient distributions among various renal replacement therapies were similar regardless of the type of data used. In the absence of incidence data, a multi-state model can still be successfully built with annually collected repeated-prevalence data to predict the numbers of patients requiring specific treatments. This modeling technique can be extended to other chronic diseases.     

Mapping Civic Engagement in Later Life: A Scoping Review of Gerontological Definitions and Typology Proposal

VOLUNTAS: International Journal of Voluntary and Nonprofit Organizations - Research on older people’s civic engagement has increased significantly in the last two decades, as have policy and...     

The Balanced Worth: A Procedure to Evaluate Performance in Terms of Ordered Attributes

There are many problems in the social sciences that refer to the evaluation of the relative performance of some populations when their members’ achievements are described by a distribution of outcomes over a set of ordered categories. A new method for the evaluation of this type of problems is presented here. That method, called balanced worth, offers a cardinal, complete and transitive evaluation that is based on the likelihood of getting better results. The evaluation of each society is based on the probability of obtaining better results with respect to the others. The balanced worth is a refinement of “the worth” (Herrero and Villar in PLoS ONE 8(12):e84784, 2013.  https://doi.org/10.1371/journal.pone.0084784) that overcomes its excessive sensitivity to the differences, due to the presence of ties. We also discuss how this method can be applied for the case of heterogeneous populations and show how it can be applied in different contexts. An empirical example, regarding life satisfaction in Spain is used to illustrate the working of this method.     

Population Structure and the Human Development Index

Social Indicators Research - This paper provides an alternative way of measuring human development that takes explicitly into account the differences in the countries’ population structures....     

A Field in Search of Concepts: The Relevance of Generativity to Understanding Intergenerational Relationships

Intergenerational relationships are increasingly recognized as an important field of practice and research. However, it has been argued that appropriate concepts and theories are still required to guide and consolidate the discipline. Although a number of concepts borrowed from the social sciences have been used with some success thus far, few attempts have been made to conceptualize intergenerational relationships from a psychological and developmental perspective. This article explores the usefulness of the Eriksonian concept of generativity as a framework for understanding intergenerational relationships. We describe the contribution of generativity to the intergenerational field and we explore the prospects, limitations, and potential of this contribution.     

Grandmothers Offering Regular Auxiliary Care for Their Grandchildren: An Expression of Generativity in Later Life?

The study explores the meaning that grandmothers who offer regular childcare attach to that experience and the extent to which the notion of generativity might explain the meaning of the experience of caring for a grandchild. Twenty-four Spanish grandmothers aged 60 and over who provided at least 12 hours a week of childcare were interviewed. Interviews were transcribed verbatim and qualitatively analyzed. The results suggest that grandmothers regard their childcare input as being part of their parental duty of helping in times of need. A range of consequences of caregiving were mentioned, generally positive and satisfactory. Our participants apparently began their caregiving task as an expression of parental generativity, although rewards associated with childcare are linked to grandparental generativity.     

On How Firms Located in an Industrial District Profit from Knowledge Spillovers: Adoption of an Organic Structure and Innovation Capabilities

The canonical approach argues that firms located in industrial districts enjoy advantages for both innovation and performance as a consequence of the exceptionally strong knowledge spillovers that flow freely and spontaneously within them. However, diffusion of shared competences is not as easy and free as postulated in the literature. Using the resource‐based view, we study whether clustered firms perform better than non‐clustered firms, by providing empirical evidence that location of firms in an industrial district does not directly create innovation capabilities or economic rents. This research question is important because it enables us to better understand how firms benefit from this external knowledge flow, both to create advantages in technological innovation and to obtain superior organizational performance. To stand out in capabilities that are often localized at the centre of the same industrial district, a firm needs to develop a learning internal micro‐environment capable of better absorbing localized knowledge spillovers. In particular, the organic form is revealed as a configuration well suited to combining structural flexibility with the productive flexibility offered by the district and to strengthening technological innovation capabilities, thus improving organizational performance.     

How students evaluate university programmes for older people: A comparison between two models in Spain

This study examines how older students evaluate the University Programme for Older People (UPOP) they participate in, and how such evaluation might vary depending on the type of UPOP. The sample was made up of 257 older students (mean age = 67.6 years) and was gathered from two UPOP models, one structured as Older People Classrooms (134 participants) and the second one as University of Experience (123 participants). Participants completed a questionnaire evaluating different dimensions of the programme and two incomplete sentences to identify its weak and strong points. Overall, results suggest that older students are very satisfied with the educational experience. Apart from attracting a different profile of student (younger and more involved), University of Experience students seem to give more importance to methodological issues when compared to Older People Classroom counterparts. These results are discussed in the context of new strategies to improve university courses aimed at older people.