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Background: Frailty, rather than age, is associated with postoperative morbidity and mortality. We sought to determine whether preoperative frailty as defined by a novel scoring system could predict the outcomes among older patients undergoing esophagectomy. Methods: We identified patients 65 years or older who underwent esophagectomy between 2011 and 2021 at our institution. Frailty was assessed using the MSK-FI, which consists of 1 component related to functional status and 10 medical comorbidities. We used a multivariable logistic regression model to test for the associations between frailty and short-term outcomes, with continuous frailty score as the predictor and additionally adjusted for age and Eastern Cooperative Oncology Group performance status. Results: In total, 447 patients were included in the analysis (median age of 71 years [interquartile range, 68–75]). Most of the patients underwent neoadjuvant treatment (81%), an Ivor Lewis esophagectomy (86%), and minimally invasive surgery (55%). A total of 22 patients (4.9%) died within 90 days of surgery, 144 (32%) had a major complication, 81 (19%) were readmitted, and 31 (7.2%) were discharged to a facility. Of the patients who died within 90 days, 19 had a major complication, yielding a failure-to-rescue rate of 13%. The risk of 30-day major complications (OR, 1.24 [95% CI, 1.09–1.41]; p = 0.001), readmissions (OR, 1.31 [95% CI, 1.13–1.52]; p < 0.001), and discharge to a facility (OR, 1.86 [95% CI, 1.49–2.37]; p < 0.001) increased with increasing frailty. Frailty and 90-day mortality were not associated. Conclusions: Frailty assessment during surgery decision-making can identify patients with a high risk of morbidity.

Recent research points to the need for a specific research focus on language task engagement because task engagement can lead to increased motivation, persistence, satisfaction, and learner achievement (Early, Rogge, & Deci, 2014; Henri, Halverson, & Graham, 2015; Reeve & Lee, 2014); a major gap in the research in this area is the lack of a unifying model. This study responds to this gap in order to move understandings of language task engagement forward. To meet this purpose, the present study applies both descriptive and statistical data to develop and validate a model of language task engagement. The article describes the exploration of language task engagement from two main sources: (1) the large body of literature around engagement, which was used as one source of data for model-building, and (2) online surveys of student, teacher, and researcher perspectives that were collected and analyzed from multiple sources and contexts. To explain the model, the article first presents a brief justification for exploring the engagement construct, differentiating task engagement from related concepts. The paper then outlines the study methodology, presents and describes the model based on the literature and other data, and provides conclusions and recommendations.

This ethnographic case study aims to examine second language socialization (SLS) in a massively multiplayer online game (MMOG) called Stronghold Kingdoms (SK). To explore the affordances of this community for SLS, the social dynamics in a Faction community during 4 life-time periods, namely, war, post-war peace and life in exile, end of the world, and immigration to a new world were investigated using three methods: observation, analysis of records (in-game forum exchanges), and interview. The results suggested that the norms of the Faction community, that is, communication, collaboration, skills, support, rules, closeness, trust, status, and shared experiences provided a supportive environment for SLS. Moreover, the results of an in-depth interview conducted with one of the Faction non-native English speakers (NNES) revealed that the affordances of SK were important in the development and improvement of second language skills. Therefore, this study offers implications for second language pedagogy and research.

BackgroundOlder age is associated with poorer outcomes of SARS-CoV-2 infection, although the heterogeneity of ageing results in some older adults being at greater risk than others. The objective of this study was to quantify the association of a novel geriatric risk index, comprising age, modified Charlson comorbidity index, and Eastern Cooperative Oncology Group performance status, with COVID-19 severity and 30-day mortality among older adults with cancer.MethodsIn this cohort study, we enrolled patients aged 60 years and older with a current or previous cancer diagnosis (excluding those with non-invasive cancers and premalignant or non-malignant conditions) and a current or previous laboratory-confirmed COVID-19 diagnosis who reported to the COVID-19 and Cancer Consortium (CCC19) multinational, multicentre, registry between March 17, 2020, and June 6, 2021. Patients were also excluded for unknown age, missing data resulting in unknown geriatric risk measure, inadequate data quality, or incomplete follow-up resulting in unknown COVID-19 severity. The exposure of interest was the CCC19 geriatric risk index. The primary outcome was COVID-19 severity and the secondary outcome was 30-day all-cause mortality; both were assessed in the full dataset. Adjusted odds ratios (ORs) and 95% CIs were estimated from ordinal and binary logistic regression models.Findings5671 patients with cancer and COVID-19 were included in the analysis. Median follow-up time was 56 days (IQR 22-120), and median age was 72 years (IQR 66-79). The CCC19 geriatric risk index identified 2365 (41·7%) patients as standard risk, 2217 (39·1%) patients as intermediate risk, and 1089 (19·2%) as high risk. 36 (0·6%) patients were excluded due to non-calculable geriatric risk index. Compared with standard-risk patients, high-risk patients had significantly higher COVID-19 severity (adjusted OR 7·24; 95% CI 6·20-8·45). 920 (16·2%) of 5671 patients died within 30 days of a COVID-19 diagnosis, including 161 (6·8%) of 2365 standard-risk patients, 409 (18·5%) of 2217 intermediate-risk patients, and 350 (32·1%) of 1089 high-risk patients. High-risk patients had higher adjusted odds of 30-day mortality (adjusted OR 10·7; 95% CI 8·54-13·5) than standard-risk patients.InterpretationThe CCC19 geriatric risk index was strongly associated with COVID-19 severity and 30-day mortality. Our CCC19 geriatric risk index, based on readily available clinical factors, might provide clinicians with an easy-to-use risk stratification method to identify older adults most at risk for severe COVID-19 as well as mortality.FundingUS National Institutes of Health National Cancer Institute Cancer Center.

Purpose: Treatment patterns for head and neck squamous cell carcinoma (HNSCC) vary among older adults because of concerns about their health status. Geriatric assessment may guide treatment for older adults with HNSCC by assessing their health status. Methods and Materials: We conducted a retrospective review of adjuvant treatment received by older patients with HNSCC who completed a novel geriatric assessment, the electronic Rapid Fitness Assessment, before treatment. The electronic Rapid Fitness Assessment yields an accumulated geriatric deficits (AGD) score. Higher AGD score indicates greater frailty. Comparators were age and performance status. The Wilcoxon rank sum test compared differences between those who did and did not receive adjuvant radiation therapy and chemotherapy. Results: The cohort included 73 patients, of whom 56 (77%) had oral cavity cancer. The most common geriatric deficits were major distress, social activity limitation, depression, and impaired activities of daily living. AGD score, age, and performance status were not associated with receipt of adjuvant radiation. Patients who received adjuvant chemotherapy had a significantly lower median AGD score than those who did not (3 vs 6; P = .044), but there was no association with age and performance status. Of the 17 patients with newly diagnosed disease and either positive margins or extranodal extension, only 9 received adjuvant radiation and only 3 received systemic therapy. Most often, systemic therapy was omitted because of patient preference or comorbidities and poor performance status. There was a nonstatistically significant lower AGD score between patients who did and did not receive standard fractionated radiation therapy (median, 4 vs 6.5; P = .13). Conclusions: Receipt of adjuvant chemotherapy was associated with frailty. Rates of chemotherapy utilization were very low, indicating the need for novel strategies to mitigate the toxicity burden in this patient population. Receipt of adjuvant radiation therapy was not associated with frailty; however, there was a trend toward lower frailty among those who did receive radiation therapy.

Following social-constructivist approaches in education, there has been a growing interest in employing Web 2.0 technologies in language classes. While the effectiveness of these digital teaching crafts has been corroborated in many studies (see Crook et al., 2008, for a survey), there is always doubt if they have reached a normalized state in L2 classes (Bax, 2003). This study, therefore, attempts to investigate the attitude of a group of language teachers towards the effectiveness of these emerging technologies in L2 classes. There were 53 participants in the study affiliated with universities, Ministry of Education, and language schools in Dezful. A questionnaire based on Son (2011) was designed in which Likert-scaled items were used to assess the factors of familiarity, perception, and use of online technologies in the classroom. The results suggested that most of the respondents exhibited low degrees of familiarity and use towards the technologies under investigation despite considering computerized tools as effective in the teaching-learning process. Besides, further explanations in semi-structured interview sessions indicated that most of the participants expected policy makers to incorporate supplementary Information Technology (IT) courses and facilities into teacher education and in-service programs as well as educational settings.