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Eugenia L Siegler,1 Jerad H Moxley,1 Marshall J Glesby2 1Division of Geriatrics and Palliative Care, Weill Cornell Medicine, New York, NY, 10065, USA; 2Division of Infectious Diseases, Weill Cornell Medicine, New York, NY, 10065, USACorrespondence: Eugenia L SieglerDivision of Geriatrics and Palliative Medicine, Weill Cornell Medicine, 525 E. 68th Street, Box 39, New York, NY, 10065, USATel +1 212 746 1729Fax +1 212 746 4888Email els2006@med.cornell.eduPurpose: People with HIV (PWH) are living longer lives and likely experiencing accentuated aging. Comprehensive geriatric assessment (CGA) has been proposed as a way to identify and help meet each individual patient’s needs.Patients and Methods: We performed a retrospective review of the results of CGA in an HIV clinic in New York City. CGA included assessment of basic and instrumental activities of daily living, screens for depression, anxiety, frailty, cognition, and quality of life, along with general discussion of concerns and goals. We compared the group of PWH referred for CGA to those of comparable age who were not referred to determine the factors that were associated with referral. We carried out a descriptive analysis of those undergoing CGA, along with regression to determine factors associated with poorer PHQ-2 depression scores and higher VACS score.Results: A total of 105 patients underwent full CGA during the study period. Mean age of referred patients was 66.5 years, ranging from 50 to 84 years (SD 7.99). More than 92% were virally suppressed. Compared with their non-referred counterparts over 50, referred patients were older and had more functional comorbidities like cerebrovascular disease, neuropathy, and urinary incontinence. More than half complained of fatigue, and 2/3 noted poor memory. Almost 60% were frail or prefrail. Ninety patients were asked about their goals, and the most commonly cited were related to health or finances; fifteen patients were unable to articulate any goals. Having fewer goals and noting weight loss or fatigue were predictive of higher scores on the PHQ-2 depression screen.Conclusion: Although most older PWH undergoing CGA can manage their ADL, many have concerns and deficits beyond their comorbidities. CGA offers an important window into the psychosocial concerns and needs of older PWH.Keywords: comprehensive geriatric assessment, comorbidity, frailty, IADL

Background: Prior research has demonstrated a strong and independent association between loneliness and pain, but few studies to date have explored this relationship in racially and ethnically diverse groups of midlife and older adults. We drew on the diathesis stress model of chronic pain and cumulative inequality theory to examine the relationship of loneliness and the presence and intensity of pain in a nationally representative sample of Black, Latino, and White adults aged 50 or older in the United States., Methods: Data were from Wave 3 of the National Social Life, Health, and Aging Project ( n  = 2,706). We used weighted logistic and ordinary least squares regression analyses to explore main and interactive effects of loneliness and race and ethnicity while adjusting for well-documented risk and protective factors (e.g., educational attainment, perceived relative income, inadequate health insurance, perceived discrimination) and salient social and health factors., Results: Almost half (46%) of the participants reported feeling lonely and 70% reported the presence of pain. Among those who reported pain ( n  = 1,910), the mean intensity score was 2.89 (range = 1-6) and 22% reported severe or stronger pain. Greater loneliness was associated with increased odds of pain presence (AOR = 1.154, 95% CI [1.072, 1.242]) and higher pain intensity ( β  = 0.039, p  < 0.01). We found no significant interaction effects involving Black participants. However, Latino participants who reported greater loneliness had significantly higher levels of pain ( β  = 0.187, p  < 0.001) than their White counterparts with similar levels of loneliness., Discussion: Loneliness is an important correlate of pain presence and intensity and may have a stronger effect on pain intensity among Latino adults aged 50 or older. We discuss clinical and research implications of these findings, including the need for more fine-grained analyses of different types of loneliness (e.g., social, emotional, existential) and their impact on these and other pain-related outcomes (e.g., interference). Our findings suggest a need for interventions to prevent and manage pain by targeting loneliness among middle-aged and older adults, particularly Latino persons., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Camacho, Burnette, Aranda, Moxley, Lukens, Reid and Wethington.)

In ecosystems, sharks can be predators, competitors, facilitators, nutrient transporters, and food. However, overfishing and other threats have greatly reduced shark populations, altering their roles and effects on ecosystems. We review these changes and implications for ecosystem function and management. Macropredatory sharks are often disproportionately affected by humans but can influence prey and coastal ecosystems, including facilitating carbon sequestration. Like terrestrial predators, sharks may be crucial to ecosystem functioning under climate change. However, large ecosystem effects of sharks are not ubiquitous. Increasing human uses of oceans are changing shark roles, necessitating management consideration. Rebuilding key populations and incorporating shark ecological roles, including less obvious ones, into management efforts are critical for retaining sharks' functional value. Coupled social-ecological frameworks can facilitate these efforts.

Background: Palliative care (PC) clinicians provide mental healthcare to individuals with serious illnesses. Despite this, there is limited knowledge regarding their mental health training opportunities. Methods: To identify predictors of satisfaction with mental health training opportunities and assess the relationship between training opportunities and clinician comfort in managing mental health comorbidities, we conducted a secondary analysis of a nationwide survey involving 708 PC clinicians. Results: Satisfaction with mental health training was moderate (M = 2.75/5, SD = .915). Access to lectures/webinars was the most common training opportunity (54%). Significant predictors of satisfaction with training included access to lectures/webinars (β = .328, P <.001) and case discussions (β = .231, P = .007). Academic practice settings and satisfactory mental health referrals were associated with a greater number of different training opportunities. Clinicians in academic settings had higher odds of accessing various training opportunities, such as lectures/webinars (OR = 2.58, P <.001) and longitudinal training pathways (OR = 4.51, P <.001). A moderate, positive correlation was found between training satisfaction and comfort in managing mental health comorbidities (r = .30, P <.001). Discussion: This study is among the first to elucidate factors influencing PC clinicians' satisfaction with mental health training. Low-resource training opportunities, such as webinars and lectures, significantly predict satisfaction, suggesting the potential of these scalable solutions to enhance training. The findings underscore the importance of expanding evidence-based mental health training for PC clinicians to improve patient care., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background and Objectives: Technology has potential for providing support for aging adults. This study evaluated the Personal Reminder Information and Social Management 2.0 (PRISM 2.0) software, in terms of enhancing social engagement and quality of life, and decreasing loneliness among older adults., Research Design and Methods: The randomized field trial conducted in diverse living contexts (rural locations, senior housing, and assisted living communities [ALC]). Two hundred and forty-five adults, aged 64 to 99 years, were randomly assigned to the PRISM 2.0 (integrated software system designed for aging through an iterative design process) or a Standard Tablet (without PRISM) Control condition, where participants received the same amount of contact and training as those in the PRISM 2.0 condition. Primary outcomes included measures of loneliness, social support, social connectedness, and quality of life. Secondary outcomes included measures of social isolation, mobile device proficiency, and technology readiness. Data were collected at baseline and 6 and 9 months postrandomization. This article focuses on the 6-month outcomes due to coronavirus disease 2019-related data challenges at 9 months., Results: Contrary to our hypothesis, participants in rural locations and senior housing in both conditions reported less loneliness and social isolation, and greater social support and quality of life at 6 months, and an increase in mobile device proficiency. Participants in the ALCs in both conditions also evidenced an increase in mobile device proficiency. Improvements in quality of life and health-related quality of life were associated with decreases in loneliness., Discussion and Implications: This study provides compelling evidence about the benefits of technology for older adults in terms of enhancing social outcomes and quality of life. However, the findings also underscore that for technology applications to be successful, they need to be adapted to the abilities and needs of the user group and instructional support needs to be provided., Clinical Trials Registration #: NCT03116399., Competing Interests: None., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Gerontological Society of America.)

Caregivers often prioritize the needs of the care recipient and neglect their own health needs. It is imperative to understand the factors related to their self-care practices and engagement in self-care activities. The present study examined the extent to which dementia caregivers engaged in self-care activities, how this varied depending on caregiver characteristics, and whether self-care engagement mediated the relationship between social support and caregiver outcomes. The study utilized baseline data from a diverse sample of dementia caregivers (N = 243) who participated in a randomized trial evaluating a psychosocial technology-based caregiver intervention. Results showed that the dementia caregivers engaged in low levels of self-care activities and that their engagement varied based on the caregivers' background characteristics (age, gender, race/ethnicity, relationship to the care recipient, and employment status). Less caregiver involvement (e.g., less ADL/IADL help provided and more caregiver preparedness) and more social support predicted higher self-care activity engagement. Self-care activity engagement served as a mediator, such that more social support predicted more self-care activities, which, in turn, were associated with more positive perceptions of caregiving and less caregiver burden and depression. The findings suggest a need for interventions that promote self-care engagement among dementia caregivers and underscore the importance of social support and caregiver preparedness to caregivers' well-being.

Objectives: Social isolation and loneliness are serious public health issues given the association with negative physical, mental; and cognitive health outcomes and increased risk for mortality. Due to changes in life circumstances many aging adults are socially isolated and experience loneliness. We examined the relationships among four correlated but distinct constructs: social network size, social support, social isolation, and loneliness as they relate to indices of health and wellbeing among diverse subpopulations of older adults. Guided by WHO's International Classification of Functioning, Disability and Health (ICF) we also examined factors that predict loneliness and social isolation. Methods: Analyses of baseline data from sample of older adults who participated in an intervention trial that examined the beneficial effects of a software system designed to support access to resources and information, and social connectivity. Participants included 300 individuals aged 65-98, who lived alone, were primarily of lower socio-economic status and ethnically diverse. Participants completed a demographics questionnaire, self-report measures of health, depression, social network size, social support, and loneliness. Results: Loneliness was strongly associated with depression and self-ratings of health. In turn, greater social isolation and less social support were associated with greater loneliness. Social isolation was associated with depression and lower self-ratings of health. The association between social isolation and health was mediated by loneliness. Individuals in the older cohorts (80+) reported less social support. With respect to loneliness, having a smaller social network, more functional limitations, and limitations in engaging meaningful activities was associated with higher levels of loneliness and greater social isolation. Conclusion: The findings underscore the importance of social connectively to wellbeing for older adults and suggest that those in the older cohorts, who have a small social network, and with greater physical and functional impairments may be particularly vulnerable to being socially isolated and lonely. The findings provide guidance for future interventions. In this regard, we discuss how Information and Communication Technologies (ICTs) may be used to promote social connectivity and engagement. Strategies to make the usability and availability of these applications for aging adults are highlighted., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Czaja, Moxley and Rogers.)

Background and Objectives: Delay discounting is a common behavioral phenomenon that can influence decision making. A person with a higher discounting rate (DR) will have a stronger preference for smaller, more immediate rewards over larger, delayed rewards than will a person with a lower DR. This study used a novel approach to investigate, among a diverse sample of older adults, discounting of the time people were willing to invest to acquire technology skills across various technologies., Research Design and Methods: One hundred and eighty-seven male and female adults 65-92 years of age participated in the study and were given presentations on 5 different technologies spanning domains that included transportation, leisure, health, and new learning. A measure of discounting was computed based on participants' assessments of how much additional time they would be willing to spend to acquire increased skill levels on each of the technologies and their ratings of importance of attaining those skill levels. Measures of participants' perceived value of the technologies, technology readiness, and self-assessed cognitive abilities were also collected., Results: The findings indicated a significant and robust effect of lower DRs with increasing age. Higher perceived value of the technologies and higher levels of positive technology readiness predicted willingness to invest more time to learn the technologies, whereas self-assessments of cognitive abilities predicted the levels of technology skills that participants desired on the 5 technologies., Discussion and Implications: Our findings demonstrate that for realistic decision-making scenarios related to the acquisition of technology skills, DRs decrease with increasing age, even within an older adult cohort, and that discounting is related to the perceived value of the technology. The findings also have important implications for the design and marketing of technology products for older consumers., (© The Author(s) 2021. Published by Oxford University Press on behalf of The Gerontological Society of America.)

In two studies, the SCRABBLE skill of male and female participants at the National SCRABBLE Championship was analyzed and revealed superior performance for males. By collecting increasingly detailed information about the participants' engagement in practice-related activities, we found that over half of the variance in SCRABBLE performance was accounted for by measures of starting ages and the amount of different types of practice activities. Males and females did not differ significantly in the benefits to their performance derived from engagement in SCRABBLE-specific practice alone (purposeful practice). However, gender differences in performance were fully mediated by lower engagement in purposeful practice by females and by their rated preference for playing games of SCRABBLE-an activity where more extended engagement is not associated with increased SCRABBLE performance. General implications from our account of gender differences in skill acquisition are discussed, and future research is proposed for how the duration of engagement in effective deliberate practice can be experimentally manipulated.

Complex interactions between protected populations may challenge the recovery of whole ecosystems. In California, white sharks ( Carcharodon carcharias ) mistargeting southern sea otters ( Enhydra lutris nereis ) are an emergent impact to sea otter recovery, inhibiting the broader ecosystem restoration sea otters might provide. Here, we integrate and analyze tracking and stranding data to compare the phenology of interactions between white sharks and their targeted prey (elephant seals, Mirounga angustirostris ) with those of mistargeted prey (sea otters, humans). Pronounced seasonal peaks in shark bites to otters and humans overlap in the late boreal summer, immediately before the annual adult white shark migration to elephant seal rookeries. From 1997 to 2017, the seasonal period when sharks bite otters expanded from 2 to 8 months of the year and occurred primarily in regions where kelp cover declined. Immature and male otters, demographics most associated with range expansion, were disproportionately impacted. While sea otters are understood to play a keystone role in kelp forests, recent ecosystem shifts are revealing unprecedented bottom-up and top-down interactions. Such shifts challenge ecosystem management programs that rely on static models of species interactions., Competing Interests: None declared.

Traditional forms of marine wildlife research are often restricted to coarse telemetry or surface-based observations, limiting information on fine-scale behaviours such as predator-prey events and interactions with habitat features. We use contemporary animal-attached cameras with motion sensing dataloggers, to reveal novel behaviours by white sharks, Carcharodon carcharias, within areas of kelp forest in South Africa. All white sharks tagged in this study spent time adjacent to kelp forests, with several moving throughout densely kelp-covered areas, navigating through channels and pushing directly through stipes and fronds. We found that activity and turning rates significantly increased within kelp forest. Over 28 h of video data revealed that white shark encounters with Cape fur seals, Arctocephalus pusillus pusillus, occurred exclusively within kelp forests, with seals displaying predator evasion behaviour during those encounters. Uniquely, we reveal the use of kelp forest habitat by white sharks, previously assumed inaccessible to these large predators.

Predatory behavior and top-down effects in marine ecosystems are well-described, however, intraguild interactions among co-occurring marine top predators remain less understood, but can have far reaching ecological implications. Killer whales and white sharks are prominent upper trophic level predators with highly-overlapping niches, yet their ecological interactions and subsequent effects have remained obscure. Using long-term electronic tagging and survey data we reveal rare and cryptic interactions between these predators at a shared foraging site, Southeast Farallon Island (SEFI). In multiple instances, brief visits from killer whales displaced white sharks from SEFI, disrupting shark feeding behavior for extended periods at this aggregation site. As a result, annual predations of pinnipeds by white sharks at SEFI were negatively correlated with close encounters with killer whales. Tagged white sharks relocated to other aggregation sites, creating detectable increases in white shark density at Ano Nuevo Island. This work highlights the importance of risk effects and intraguild relationships among top ocean predators and the value of long-term data sets revealing these consequential, albeit infrequent, ecological interactions.

Background and Objectives: Regardless of the increased deployment of technologies in everyday living domains, barriers remain that hamper technology adoption by older adults. Understanding barriers to adoption such as individual differences in attitudes toward computers is important to the design of strategies to reduce age-related digital disparities., Research Design and Methods: This article reports a time-sequential analysis of data from the Edward R. Roybal Center on Human Factors and Aging Research and the Center for Research and Education on Aging and Technology Enhancement (CREATE) on computer attitudes among a large (N = 3,917), diverse sample of community-dwelling adults aged from 18 to 98 years. The data were gathered from 1994 to 2013., Results: The findings indicated that there are still age disparities in attitudes; older adults report less comfort with and less efficacy about using computers than younger people. We also found a cohort (birth year) effect; attitudes are generally more positive among more recent birth cohorts. Those who have more education and experience with computers also have more positive attitudes. Males generally have more positive attitudes than females; however, the gender difference decreases with increased age., Discussion and Implications: Technology affords potential benefits for older people, but lack of uptake in technology clearly puts older adults at a disadvantage in terms of negotiating today's digital world. This article provides insight into attitudinal barriers that may affect on technology uptake among older adults. The findings have implications for the design of technology training programs, design of technology systems, and policy.

Background and Objective: As part of the PRISM (Personal Reminder Information & Social Management) randomized field trial, a large group of older adults ( N = 150) received a computer system in their home that presented them with the opportunity to play eleven different video games. While researchers have often assessed older adults' gaming preferences and habits through survey data and focus groups, this trial represented a unique opportunity to study gaming behavior "in the wild" over an entire year., Research Design and Methods: We present an exploration of game usage data, individual differences in game preferences and gaming habits, and individual difference predictors of game use., Results: Although few individual difference variables consistently predicted game use and preferences, there were clear favorites among the different games, and results demonstrate that given the opportunity and training many older adults may become active and long-term gamers., Discussion and Implications: Findings have implications for designing video games that older adults enjoy, supporting enjoyable and meaningful interactions with video games across the life span, and for designing cognitive, social, and health interventions involving games.

Text-to-speech and related read-aloud tools are being widely implemented in an attempt to assist students' reading comprehension skills. Read-aloud software, including text-to-speech, is used to translate written text into spoken text, enabling one to listen to written text while reading along. It is not clear how effective text-to-speech is at improving reading comprehension. This study addresses this gap in the research by conducting a meta-analysis on the effects of text-to-speech technology and related read-aloud tools on reading comprehension for students with reading difficulties. Random effects models yielded an average weighted effect size of ([Formula: see text] = .35, with a 95% confidence interval of .14 to .56, p < .01). Moderator effects of study design were found to explain some of the variance. Taken together, this suggests that text-to-speech technologies may assist students with reading comprehension. However, more studies are needed to further explore the moderating variables of text-to-speech and read-aloud tools' effectiveness for improving reading comprehension. Implications and recommendations for future research are discussed.

As the sampling frequency and resolution of Earth observation imagery increase, there are growing opportunities for novel applications in population monitoring. New methods are required to apply established analytical approaches to data collected from new observation platforms (e.g., satellites and unmanned aerial vehicles). Here, we present a method that estimates regional seasonal abundances for an understudied and growing population of gray seals (Halichoerus grypus) in southeastern Massachusetts, using opportunistic observations in Google Earth imagery. Abundance estimates are derived from digital aerial survey counts by adapting established correction-based analyses with telemetry behavioral observation to quantify survey biases. The result is a first regional understanding of gray seal abundance in the northeast US through opportunistic Earth observation imagery and repurposed animal telemetry data. As species observation data from Earth observation imagery become more ubiquitous, such methods provide a robust, adaptable, and cost-effective solution to monitoring animal colonies and understanding species abundances.

Video game interventions with the aim to improve cognition have shown promise for both younger (e.g., Powers et al., 2013) and older adults (e.g., Toril, Reales, and Ballesteros, 2014). Most studies suggest that fast-paced action games produce the largest benefits, but a recent video game intervention with older adults found that an action game intervention can result in poor adherence (Boot et al., 2013). To increase intervention adherence, we investigated older adult video game preferences that might bolster adherence by having participants play a competitive game (Mario Kart DS) or a cooperative game (Lego Star Wars: The Complete Saga) alone or with a partner. Although hypotheses regarding cooperative and multi-player gameplay were not supported, converging evidence suggests multi-player game play may lead to greater enjoyment, which was related to intervention adherence in a previous study (Boot et al., 2013). Insights for gaming intervention studies in older populations are also provided.

Individual differences in memory performance in a domain of expertise have traditionally been accounted for by previously acquired chunks of knowledge and patterns. These accounts have been examined experimentally mainly in chess. The role of chunks (clusters of chess pieces recalled in rapid succession during recall of chess positions) and their relations to chess skill are, however, under debate. By introducing an independent chunk-identification technique, namely repeated-recall technique, this study identified individual chunks for particular chess players. The study not only tested chess players with increasing chess expertise, but also tested non-chess players who should not have previously acquired any chess related chunks in memory. For recall of game positions significant differences between players and non-players were found in virtually all the characteristics of chunks recalled. Size of the largest chunks also correlates with chess skill within the group of rated chess players. Further research will help us understand how these memory encodings can explain large differences in chess skill.

Objectives: Depression is a risk factor for cognitive decline and dementia. This risk may vary with age of onset and depression subtype. Late onset depression (LOD, 60 years and older) is associated with more cognitive decline, whereas early onset depression (EOD, before 60 years) is associated with more residual depressive symptoms. Potential differences may reflect divergent etiologies. These onset differences, however, have not been examined in the melancholic subtype of depression in older adults., Methods: Data were obtained from the Neurocognitive Outcomes of Depression in the Elderly study. Participants (N = 284, 73% EOD-melancholic (EOD-M) and 27% LOD-melancholic (LOD-M)) were followed up over 3 years. Factor analyses examined differences in baseline depressive symptoms. Hierarchical linear growth curve models examined changes in depressive symptoms (Montgomery-Asberg Depression Rating Scale) and cognition (mini mental state examination). An annual clinical review panel assigned diagnoses of dementia., Results: The LOD-M participants had more vegetative symptoms at baseline. LOD-M exhibited greater cognitive decline but fewer residual depressive symptoms than EOD-M. Among participants who remained in the study for at least 1 year, in uncontrolled analyses, a greater percentage of LOD-M compared with EOD-M developed dementia (23.0% vs. 7.8%). Whereas in logistic analyses, controlling for baseline demographics, age at onset remained a predictor of dementia, the odds ratio suggested that the effect was relatively small., Conclusions: The EOD-M and LOD-M participants have a different presentation and course. LOD-M may represent a syndrome of neuropsychiatric deterioration with expression of both depressive symptoms and cognitive decline., (Copyright © 2014 John Wiley & Sons, Ltd.)

A meta-analysis was conducted of studies that measured the effects of both age and skill in chess on the tasks of selecting the best move for chess positions (the best move task) as well as recalling chess game positions (the recall task). Despite a small sample of studies, we demonstrated that there are age and skill effects on both tasks: age being negatively associated with performance on both tasks and skill being positively associated with performance on both tasks. On the best move task, we found that skill was the dominant effect, while on the recall task, skill and age were approximately equally strong effects. We also found that skill was best measured by the best move task. In the case of the best move task, this result is consistent with the argument that it accurately replicates expert performance (Ericsson & Smith, 1991). Results for the recall task argue that this task captures effects related to skill, but also effects likely due to a general aging process. Implications for our understanding of aging in skilled domains are also discussed.

Various potential measures of quality of care are being used to differentiate hospitals. Last year, on the basis of diagnostic and demographic data, the Health Care Financing Administration identified hospitals in which the actual death rate differed from the predicted rate. We have developed a similar model. To understand why there are high-outlier hospitals (in which the actual death rate is above the predicted one) and low-outlier hospitals (in which the actual death rate is below the predicted one), we reviewed 378 medical records from 12 outlier hospitals treating patients with one of three conditions: cerebrovascular accident, myocardial infarction, and pneumonia. After adjustment for the severity of illness, the death rate in the high outliers exceeded that predicted from the severity of illness alone by 3 to 10 percent, and in the low outliers, the actual death rate fell short of the severity-adjusted predictions by 10 to 15 percent (P less than 0.01). Reviews of the process of care using 125 criteria revealed no differences between the high and low outliers. However, detailed reviews by physicians of the records of patients who died during hospitalization revealed a higher rate of preventable deaths in the high outliers than in the low outliers. For the three conditions studied, we project that 5.7 percent of a standard cohort of patients admitted to the high-outlier hospitals would have preventable deaths, as compared with 3.2 percent of patients admitted to the low-outlier hospitals (P less than 0.05). A meaningful comparison of hospital death rates requires adjustment for severity of illness. Our findings indicate that high-outlier hospitals care for sicker patients. However, these same hospitals or their medical staffs may also provide poorer care. Our results need confirmation before death-rate models can be used to screen hospitals.

The results of treatment of 198 patients with Hodgkin's disease with MOPP (mechlorethamine, vincristine, procarbazine, and prednisone) were analyzed. Eighty percent attained complete remission, and 68% of patients achieving a complete remission have remained disease free beyond 10 years from the end of treatment. Results of autopsy on patients who died of other causes while in clinical complete remission did not show evidence of residual tumors except in one patient. Asymptomatic patients and patients with mixed-cellularity or lymphocytic-depleted Hodgkin's disease do significantly better than symptomatic patients and those with nodular sclerosing histologic type. Advanced Hodgkin's disease appears to be curable by chemotherapy.