Month: January 2023

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study abroad: The case for independent college counselling for students looking to study abroad

study abroad: The case for independent college counselling for students looking to study abroad
By July 2021, nearly 1.13 million Indian pupils experienced immigrated overseas for their instruction, as for every the Ministry of External Affairs. This number is predicted to increase to 1.8 million by the stop of 2024, in accordance to a report by RedSeer.

Therefore, college students searching to review overseas are demanding pro suggestions on applications, funding, immigration, and so forth. They are relying on a multitude of resources—school counselors, brokers, unbiased counselors, university alums, NRI uncles, and more—for steering. At the very same time, incidents of fly-by-evening “consultants” and agents defrauding students are a induce for issue. Now additional than at any time, there is a circumstance to be built for scholar-1st, and structured school counseling.
Roadblocks

1. Lack of methods in colleges
Faculties are hardly able to meet up with the desire for quality profession counseling. The most current estimates propose that the 350 million college students in India require at minimum 1.4 million profession counselors to maintain a globally appropriate pupil-to-school-counselor ratio. As for every 2022 IC3 Institute’s University student Quest Study of about 10,000 Indian learners disclosed that in 52 {e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} of the respondents’ universities, the ratio of university counselors to students in India is 1:100. The report additional indicated that most university counselors are not formally skilled or undertake counseling in addition to their educating duties.

2. Moral challenges
Brokers occupy a sizeable part of the school counseling domain. Less than contract with colleges, they assist pupils apply to several institutions at no or nominal price. In return, the establishments compensate them with a commission for each acceptance. While this structure is essential to global student recruitment, it is fraught with unethical practices. Because an agent’s organization model hinges on the number of students effectively admitted, and not the high quality of acceptance that they acquire, pupils are generally shortchanged due to colored tips. This kind of incidents have prompted calls for stricter oversight.

3. Unauthorized sharing of students’ and parents’ knowledge

The growing need for international training has also prompted the entry of disruptive VC-led firms focussed on a large volume of consumer acquisition to achieve economies of scale. An vital aspect of their gross sales system is to tactic educational facilities to open their doorways to for-revenue entities. These considerable “lead generation” frequently veers into murky waters, ethically talking.In lieu of organizing or sponsoring “free” webinars and data sessions, faculties are envisioned to share their student databases, from time to time with out the students’/parents’ consent. The recurring (and undesirable) income phone calls that abide by are a whole other nightmare.

Roadmap for the long run

1. Endorsing impartial counseling
The NACAC (National Association for Higher education Admission Counseling) defines counselors as, “professionals who advise or counsel students about producing the changeover from secondary university to university or about transferring from a person university to an additional. The time period generally refers to secondary school counselors, impartial instructional consultants (IECs), …” IECs supply pupils with unbiased assistance for developing a college checklist, analyzing match, getting ready purposes, in search of economical assist, and extra. Due to the fact their supply of income is thoroughly dependent on the high-quality of acceptances, their operational product is quickly pupil centric.

2. Autonomous or governmental regulation
The NACAC Code of Ethics for Ethical Follow in Admissions was laid down to streamline the operating of the faculty counseling sector in the United States and weed out fraudulent tactics. On top of that, organizations these types of as IECA (Unbiased Educational Consultants Affiliation) and HECA (Greater Education Consultants Association) have presented an moral product for college counseling.

Though these unbiased pointers do not alway ensure a fair taking part in area, they support students find the right guidebook (IECA or HECA members) and keep counselors to strict skilled criteria (see IECA’s “Ethical Practices”). It is crucial for India’s examine overseas field to occur up with equivalent standards for autonomous governance

3. Institutional Alter
Provided that a foreign schooling has a direct correlation with the potential earnings of a student’s family members, colleges require to just take a extra structured strategy to counseling. They can—

  • Devote time and resources in the direction of profession counseling
  • Host admissions and occupation counseling industry experts, frequently
  • Concentration on students’ skilled progress and faculty readiness, by way of a devoted curriculum touching upon interaction, networking, composing, crucial imagining, and many others.
  • Schooling instructors and faculty counselors on the finer specifics of larger education in other nations around the world and the application approach
  • Control entry to for-gain entities without the need of a obvious established of pointers in place for information sharing and further more call.

4. Suggestions for mothers and fathers

  • Educate yourselves on the higher education software process properly in advance of their boy or girl commences significant college. A obvious knowledge of the course of action and an early begin can make for an easier navigation via the full college admissions method.
  • Vet admissions consultants meticulously by analyzing their keep track of file, verifying testimonials, and most importantly, ensuring that the consultant’s solution and frame of mind aligns with your child’s wants and ambitions.
  • Do not be dissuaded by unsolicited tips and baseless opinions. Abide by the assistance of your preferred skilled. Just take every thing else with a grain of salt.
  • Be affected person and assure that the child is coping perfectly for the duration of this intensely emotional journey. Try to remember, it’s a marathon not a dash.

It is critical that all stakeholders in the system, notably educators, fully grasp that our responsibilities to learners is by its very character fiduciary, and that will and will have to never ever modify.

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How Higher Education Became The Target Of Bots, Fake Accounts And Online Fraud

How Higher Education Became The Target Of Bots, Fake Accounts And Online Fraud

Guy Tytunovich is the founder and CEO of CHEQ, a leader in go-to-sector security.

Increased education is in a condition of drastic changeover. Considering that the onset of the Covid-19 pandemic, faculties and universities have experienced to quickly adapt to the challenges posed by the virus, going to on the web or hybrid learning designs and developing the procedures and infrastructure to support on line education.

For quite a few pupils, this transform has been a boon, broadening obtain to institutions beforehand out of get to thanks to time or location constraints. But an additional group has also benefited: bots and fraudsters seeking to choose benefit of schools and universities.

As the higher instruction field results in being extra reliant on engineering, it’s also turning out to be additional vulnerable to fraud. The simultaneous improve in on the web enrollment and reduction in necessities for bodily interaction has opened the door for bots masquerading as actual students to defraud universities and harm their name, bottom line and even lawful standing.

Bots Focusing on Financial Help And Relief Cash

In California, around 65,000 fake apps for monetary assist were being submitted in the state’s neighborhood university process in 2021, with one particular group school identifying and blocking close to $1.7 million in attempted student aid fraud. The San Diego Local community University District was not so fortunate and paid out out more than $100,000 in fraudulent statements ahead of catching on.

And even as Covid-aid resources wind down, monetary assist fraud is on the increase. In the spring semester of 2022, Salt Lake Local community Faculty been given hundreds of fraudulent programs, which leaders say ended up possible attempts to steal federal Pell Grant funding.

Extra innovative attackers might also impersonate actual students and apply for money help on their behalf with stolen information. In this situation, protection is a lot a lot more challenging, as a evaluation is significantly less probably to capture reputable college student facts.

Type-Fill Assaults On University Email Accounts

The sort of financial help fraud outlined earlier mentioned is much easier to commit at neighborhood faculties than at 4-12 months establishments due to the fact the previous do not have admissions committees to vet applicants, but that does not imply conventional universities are harmless from fraudsters. Pretend account assaults aren’t usually so sophisticated—they really do not have to have to be.

There is a thriving market for .edu e mail addresses, which can generally be obtained via automated kind-fill attacks focusing on university student software processes. These email addresses can be employed to entry student savings or, if gathered at scale, can be offered for a revenue on the dark net or stored for use in even further attacks. These relatively uncomplicated attacks—an outdated version of which is shown in this article—are effortless to carry out and are not technically unlawful, building them an appealing proposition for would-be hackers looking for lower-hanging fruit.

The Financial Affect Of Bot Action

At faculties and universities, the damage induced by these relaxed attacks is frequently ignored, but it can have authentic financial implications.

The acquisition cost for new college students is terribly significant ($2,795 for each college student for a 4-yr private college), and keywords and phrases are particularly aggressive, major to substantial advertising and marketing shell out from schools and universities hunting to hit enrollment targets.

Bot engagement not only wastes that devote, but it also has downstream results hurting conversion attempts and marketing intelligence.

Just about every time a bot or fake user interacts with your commercials, web site or types, that conversation turns into a knowledge level in your CRM. And as that poor knowledge provides up, it can guide to improperly optimized campaigns and lousy conclusions based on inaccurate data, creating friction among marketing’s lead era endeavours and enrollment departments, who have to work through the junk sales opportunities.

Pretend pupils can also negatively affect retention fees and guide to incorrect decisions about which classes to offer in the subsequent semester, and repeated bot site visitors can generate up the expense for every enrollment as bots may make repeat visits through PPC inbound links or social media adverts. Charge-for each-click for greater instruction ads is increased than normal, so even a modest total of bot engagement can promptly turn out to be expensive. And even though the built-in bot-mitigation capabilities available by advert platforms are able, it’s important to know that adverts are not the only resource of bots.

How Larger Ed Can Prevail over The Threat

Presented the likely penalties of bots and pretend users, it’s essential for schools and universities to get techniques to secure them selves from these automated accounts.

A person way to do this is to employ rigid verification procedures for new enrollments. This could consist of requiring buyers to offer proof of their identities, this kind of as a federal government-issued ID or a university student ID, in buy to make an account. It could also be as very simple as introducing reCAPTCHA verification to variety fills, though refined bots are generally able to defeat this protection.

A further essential stage is to monitor site targeted visitors for signs of bot activity. This could incorporate hunting for styles of behavior that are normal of bots, these as targeted visitors spikes from abnormal areas or significant volumes of visits from a solitary IP address. Universities can also use bot mitigation applications made to detect and block bots.

In addition to these specialized measures, colleges and universities should also educate their faculty and employees about the dangers of bots and phony consumers, how to establish them and what to do when bot action is learned.

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Everything you need to know about Utah’s latest voucher proposal

Everything you need to know about Utah’s latest voucher proposal

Utah lawmakers are once again considering a school voucher program that would use taxpayer funds to send students to private schools.

The latest proposal — the “Utah Fits All Scholarship” in HB215 — comes after a similar attempt failed last year.

Supported by conservatives, the program is touted as a way to give parents and kids more choice to find a classroom that works better for them. The scholarship, said bill sponsor Rep. Candice Pierucci, R-Herriman, is meant to help lower income families afford private schools.

Pierucci’s bill includes a $6,000 salary and benefits raise for teachers across the state. It’s meant as a bargaining chip: Approving the vouchers means educators in public schools would see bigger paychecks.

But critics object that the proposal would financially hobble Utah’s public schools, which are already among the least funded in the country. The largest teachers union in the state is leading the opposition.

Here’s what you need to know as the debate heats up.

What are vouchers, generally, and how do they work?

Vouchers can be labeled as tax credits, tax rebates, education savings accounts, backpack funding, or, like in this proposal, scholarships. They’re all the same concept.

They work by taking money collected from taxpayers and setting it aside in a fund for vouchers. That money is then awarded to individual students, who use it to cover all or part of their attendance at a private school.

This creates a funding dilemma for public schools.

In Utah, an amount of money called a weighted pupil unit, or WPU, is awarded to schools for each K-12 student who enrolls.

If 3,000 kids enroll, for instance, the school gets the value of 3,000 WPUs (not counting additional add-ons for students with disabilities). The WPU is currently set by the state at about $4,000.

If fewer kids attend — leaving public schools for private schools — then public schools get less funding. Inversely, private schools that don’t have the same charge to educate all students get more of the share of money.

What does this new bill propose?

In Pierucci’s bill, each student in the program would be awarded $8,000 in a scholarship — or roughly double the WPU allocated to a kid in public school — to attend a private school, including those run by a religious organization.

A family could also use the money for home schooling, such as to pay for books or field trips or tutoring.

“I know everyone wants to call this a voucher bill,” she said. “But I’ll forever say this is a scholarship program because it’s more expansive.”

(Francisco Kjolseth | The Salt Lake Tribune) Rep. Candice Pierucci, R-Herriman, is pictured on Friday, March 4, 2022.

The bills calls for the scholarship administrator to give preference to students who are in families living below the poverty level.

Students enrolled in any public school in the state cannot use the funds; that includes the many charter schools here, which are public. A student could not, for instance, attend a public school during the day and then use the scholarship for tutoring after school, Pierucci said.

Haven’t we been here before?

Yes. Republican lawmakers championed what would have been the nation’s most comprehensive education voucher proposal in 2007. The measure passed, even with strong opposition from parents, teachers and advocates.

Those groups then rallied to put a referendum on the ballot to rescind the measure, and they won. More than 62{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} of Utah voters sided with the repeal effort.

Pierucci insists her measure this year is not like that one.

But it’s similar to the failed bill she proposed last year, which requested $36 million for the “Hope Scholarship.” It also advocated for vouchers that were double the amount of the WPU and favored lower income students. It was defeated in the House on a 22-53 vote.

What’s driving this push now?

Pierucci said she believes parents want more choice with their kids’ education. That comes as cultural wars have heated up in the classroom, with attacks on books and teaching about race.

The COVID-19 pandemic, she suggests, also showed that not all parents are happy with traditional K-12 schools or charters. State data does show an increase in students shifting to home schooling or private schools when the pandemic was at its height, in fall 2020. But by a year later, the numbers pointed to most of those students returning to their previous public schools.

Still, Pierucci says she’s heard from constituents who want “a bigger approach to school choice.” She said it doesn’t matter if the vouchers only help a handful of families, or if the number of students attending private schools or in home schooling doesn’t dramatically increase.

“That’s not the goal,” she said. “The point is to give people the choice and help them pay for it.”

Minority Senate Whip Kathleen Riebe, D-Cottonwood Heights, worries that mindset — and other parts of the bill — mean there’s no accountability for the program.

(Trent Nelson | The Salt Lake Tribune) Sen. Kathleen Riebe, D-Cottonwood Heights, is pictured on Friday, March 4, 2022.

Utah has an open enrollment system where families can choose to send their kids to whatever school they want — whether that’s their neighborhood school or a charter across town. Riebe says that means the system is already set up for choice if something is not working for a child. She’s been in education in Utah for 22 years, currently working as a school technology specialist in Granite School District.

She worries the bill is coming as part of a national Republican push to privatize education — from those angry about public school policies or curriculum they see as too progressive — and to force more competition in schooling.

She points to current Utah Senate President Stuart Adams, R-Layton, who also sits on the board of the conservative American Legislative Exchange Council. One of the top education platforms for that GOP group is vouchers; and Stuart has said he supports the bill.

The proposal has the support of several national groups, including the conservative group Heritage Action.

How much money would be budgeted for this?

The bill is requesting $42 million for the voucher program. At $8,000 per scholarship, plus administrative costs, Pierucci expects that to cover about 5,000 students.

Pierucci said she arrived at the $8,000 figure by combining the roughly $4,000 WPU with the average amount spent by each Utah school district on students, which is about another $4,000.

That second portion is collected locally, through property taxes, and is subject to local control and decision making on how to spend it.

Riebe, though, feels the scholarships are justifying taking state funding to double what a student in the public system would normally be allocated by the state alone. She doesn’t think it’s fair to calculate local funding into that, especially when it varies based on where the district is located.

Why is the voucher program connected to teacher salary increases?

Another $200 million is requested in the bill to cover the $6,000 teacher salary and benefits raises statewide. Pierucci said she wanted to tie the two together because she sees it as investing in the most important parts of education: students and teachers.

“To me, this is about showing we believe in the system. We want to fix the public education system,” by adding more funding for educators, she said.

She also said she believes people have a “scarcity mentality” about funding for education in Utah, which is ranked second to last, ahead of Idaho, for spending per pupil. But she said this money isn’t siphoned from education and the Legislature still intends to provide a historic increase for education funding this session (even with talk of tax cuts).

Utah Gov. Spencer Cox had recommended the pay increase for teachers in his proposed budget, but has yet to say whether he supports the two proposals being tied together. His spokesperson didn’t immediately respond to a request for comment, but last year, he said he’d veto the voucher bill.

The Utah State Board of Education also opposed the voucher bill last session. It has not taken a position yet this year.

The Utah PTA opposes the new bill, saying although it “supports the increase of teacher salaries, we cannot support the distribution of up to $8,000 per student to education service providers” in the private sector.

The Utah Education Association is calling for the two parts of the bill to be decoupled. “The educator salary raises should not come with strings attached,” said Renée Pinkney, president of the association.

(Rachel Rydalch | The Salt Lake Tribune) UEA President Renée Pinkney, left, leans over to Kelly Whited Jones at a rally at the Capitol in Salt Lake City on Saturday, Jan. 29, 2022.

What do opponents say?

Opponents are obviously worried about the cost of the vouchers and the impact on public education funding. Pinkney also believes the setup furthers inequalities.

“When you are taking public dollars away from public schools and giving them to private schools,” she said, “you are creating opportunity gaps for students.”

The average tuition for most private schools in the state is roughly $11,000, according to Private School Review, which means the $8,000 scholarship may not cover all of the cost for some families. Tuition at both Waterford and Rowland Hall, two popular private schools in the state, are both more than $20,000.

Other teacher unions, including the Ogden Education Association, have joined in the opposition; Ogden teachers are worried about the lack of regulations for private schools and home schooling.

Private schools don’t have to hire licensed teachers. The state does not set their curriculum; they can choose what to teach. They can enroll students on a preferential basis, allowing for possible discrimination.

Private schools also are not required to provide services for students with disabilities, like public schools are. In fact, to accept the voucher, the bill will require parents sign a waiver relinquishing their rights to sue if they have a disability discrimination claim.

“Private education is not subject to the same oversight as public education,” the Ogden association wrote. “That is concerning when spending public dollars.”

Parents who choose to home school their students are similarly not held to any standards in the state.

How many private schools are there in Utah, and how many students are in home schooling?

There are 235 private schools in the state, according to data from the Utah State Board of Education.

The state is not required to and doesn’t track exactly how many students attend those schools. The best estimate from the National Center for Education Statistics is that roughly 3{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} of K-12 students in Utah are enrolled in private institutions.

Some consider that to be too high, but it would amount to about 15,000 students. By comparison, Utah’s public schools have 675,000 kids enrolled. A higher percentage — 11{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} — opt for charter schools, which are also public.

The only state with a smaller percentage of students in private schools is Wyoming at 2{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}, according to the National Center for Education Statistics.

The majority of zip codes in Utah do not have a private school.

“Private institutions in Utah are centered along the Wasatch Front,” the Ogden Education Association notes. “This discriminates against our rural students and families, creating an inequity.”

(Christopher Cherrington | The Salt Lake Tribune)

The state also doesn’t regularly track the home school population; its last estimate was in 2016, when the total was roughly 16,000 students. National estimates say it’s grown at a slow and steady pace, putting it probably around 21,000 or less now.

In 2020 and 2021 — during the pandemic — the Utah Board of Education did track how many students were signing transfer papers to leave public schools. According to that data, there was a jump in 2020 for those switching to home school.

In a typical year, Utah sees about 900 to 1,000 of those transfers. That year, there were 3,375. But in 2021, the number dropped back down to normal again, with 1,227. Many of those who left returned to their previous public schools.

The same happened with transfers to private schools.

Overall, about 95{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} or more of K-12 students in the state are going to public schools.

What does the data say? Are vouchers effective?

In Louisiana, students in the voucher program saw their math and science scores drop dramatically. Similar studies of Ohio’s and Indiana’s voucher programs found similar results.

In Milwaukee’s program, students who participated were more likely to graduate high school than those in the public system. But the state ranked near the bottom of all states in math scores, which worsened since the launch of the subsidies. And studies found that students who returned to public schools after trying the vouchers saw significant improvement.

In Arizona, New Hampshire and Wisconsin, more than 70{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} of the funding for vouchers went to students who were already attending private schools before the voucher programs were created there, according to the National Coalition for Public Education, which opposes vouchers.

Riebe says she doesn’t understand why the data on in the ineffectiveness of vouchers isn’t being considered by the Utah Legislature. “This shouldn’t be how we run legislation,” she said.

She’s proposing that the state instead pause the voucher program and conduct a pilot study. That would entail testing a student, for instance, who left a private school school for a public school at the start of that switch and then a year later to see if the child improved.

The current proposal from Pierucci specifically prohibits doing any kind of research like that.

What’s next?

The bill will move through committee hearings, where the public can weigh in. It passed its first committee on Thursday and goes next to the House floor and then Senate. As it’s still early in the session, it’s very likely to change before any possible final passage.

(Francisco Kjolseth | The Salt Lake Tribune) Students from the private Waterford School in Sandy are pictured in 2017.

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UM-Flint recognized by U.S. News & World Report for excellence in online education

UM-Flint recognized by U.S. News & World Report for excellence in online education

The University of Michigan-Flint has been regarded for its excellence in on the net instruction by U.S. News & Entire world Report in its freshly printed “Ideal On the net Courses” rankings.

The college was honored for its on the net bachelor’s diploma applications and acquired recognition for its general business enterprise software. Additionally, UM-Flint’s on the internet master’s diploma packages in training and nursing were lauded.

“UM-Flint is focused to giving a flexible on the net mastering knowledge without compromising on high-quality or benefit,” claimed Nick Gaspar, director of on the web and electronic instruction. “This recognition proves that our college offers pupils access to a high-quality on the net schooling even though balancing loved ones, work and daily life commitments.”

UM-Flint initial started on line packages in 2000.

UM-Flint’s School of Administration provides an on the internet general enterprise bachelor’s diploma that presents students a wide small business track record and wonderful flexibility in selecting their system of examine. Elective selections involve accounting, entrepreneurship, finance, worldwide small business, advertising, management, and functions and supply chain management. These possibilities allow for pupils to personalize their curriculum centered on their profession interests and aspirations. 

“Our college is not new to online teaching,” claimed Yener Kandogan, interim dean for the Faculty of Management. “We have been providing on the web bachelor’s enterprise plans for practically 20 several years and have been increasing our training solution and on the net student engagement in the course of that time. This position is a reflection and recognition of individuals attempts. Our plan has continually been at the major in the condition and been identified as a premiere system in the place.”

UM-Flint’s University of Training & Human Expert services gives on the web master’s degree programs in secondary schooling and educational administration, an on the web instruction specialist plan and a doctoral method in education and learning.

“UM-Flint has a extensive record of recognizing professionals’ troubles in earning levels for promotion whilst working entire time,” stated Beth Kubitskey, dean for the College of Schooling and Human Company. “Our learn, specialist and doctoral degrees in academic administration/leadership are built to be adaptable for the college students although making sure a large high-quality, exercise-dependent academic encounter. Our graduates depart with the up to date practical techniques that enable them to lead faculties and faculty districts. Moreover, our program also focuses on the capacity of our graduates to perform as transform agents in the communities they provide.”

The Faculty of Nursing presents an on the internet RN to BSN undergraduate method an on the net Progress to Nurse Practitioner with both of those MSN and DNP plan an on the web MSN to DNP – Sophisticated Observe observe that is developed for latest registered nurses who have attained their MSN degree and certifications these types of as NP, CNS, CRNA and CNM and an on the web Health practitioner of Nursing Practice.  

“UM-Flint’s College of Nursing is fully commited to ensuring nurses can progress their instruction to handle the at any time-expanding complexity of health care and difficulties for obtain to care,” mentioned Cynthia McCurren, dean of SON. “Offering on-line program operate supplies versatility for performing professionals and our emphasis on top quality education to be certain preparing for innovative nursing roles sets us aside.”

UM-Flint’s on-line courses provide the very same arduous training as on-campus programs. Students will be awarded diplomas from the globally acknowledged College of Michigan model that is acknowledged by companies.

According to new information from the Federal Reserve Lender of New York, the median once-a-year wage for a full-time employee, ages 22 to 27, with at minimum a bachelor’s degree is $52,000. For a comprehensive-time worker with a higher university diploma, that figure drops to $30,000. The change marks a shell out hole of $22,000, the greatest on file with the New York Fed, which tracks earnings from 1990.

To master far more about UM-Flint’s online offerings take a look at its on the net levels and certificates webpage. 

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Families, Educators to Share Homeschooling Resources Over Traditional Mexican Dish

Families, Educators to Share Homeschooling Resources Over Traditional Mexican Dish

ANAHEIM, Calif., Jan. 19, 2023 /PRNewswire/ — Pozole, tacos, and…. homeschooling? Orange County family members will celebrate university decision by sharing homeschool data more than a delightful pozole food at Cristi’s Restaurant on Thursday, Jan. 26.

The cost-free, consciousness-setting up function runs from 5 to 8:00 p.m. and will aspect a 20-minute homeschool presentation every hour, as well as an facts desk where by households can master more about finding curriculum and local community if they select homeschooling.

In addition to sharing info about homeschooling, attendees will take part in Cristi’s Restaurant’s famous Jueves Pozolero. An crucial Mexican custom, Jueves Pozolero refers to mates and relatives sharing a neighborhood meal of pozole — a stew for distinctive situations. Totally free pozole or tacos will be obtainable to the to start with 30 dad and mom.

This celebration is prepared to coincide with the celebration of Countrywide School Preference 7 days (Jan. 22-28, 2023), which will characteristic tens of countless numbers of school preference celebrations throughout all 50 states. Other flagship celebrations in California contain a faculty reasonable in Riverside County and a pep rally in Granada Hills.

“Moms and dads are the most important voice in their children’s schooling. Let us all get jointly and assist them to study additional about School Decision,” stated Magda Gomez of Broadway Productions. “In this article in California, our Hispanic youth is the 2nd race in entering the juvenile justice procedure and not graduating from significant school. Collectively, we can change this! Let’s help College Selection Week’s newest software, ‘Conoce tus Opciones Escolares’ to aid Hispanic mother and father.”

This event is structured by Broadway Productions, which supports Hispanic mothers and fathers by combining artwork and education and supplying them with sources, all entirely in Spanish in collaboration with regional corporations, state establishments and local community leaders.

Cristi’s Cafe Kitchen (inside of Los Bandidos Tacos) is positioned at 3414 W Ball Rd, Anaheim, CA 92804.

Nationwide University Decision 7 days (NSCW) informs, evokes, and empowers parents to find the K-12 education and learning options readily available for their small children, including standard public, constitution, magnet, on line, private, and residence education. Each and every January, tens of hundreds of schools, businesses, and people today prepare distinctive events and activities to shine a constructive spotlight on successful training possibilities in their communities. The 7 days is a undertaking of the nonpartisan, nonpolitical National University Option Awareness Foundation.

Source Countrywide School Preference 7 days

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Frailty and Mortality Risk in COPD

Frailty and Mortality Risk in COPD

Introduction

Approximately one in five people with COPD are also living with frailty.1 Frailty is a multidimensional syndrome, characterised by decreased reserve and diminished resistance to stressors.2 It is relevant across diagnoses, including multimorbidity, and can provide a holistic measure of a person’s health and risk of adverse outcomes. People with both COPD and frailty experience poorer physical and mental health,3 higher risk of readmission4 and mortality,5 and are at higher risk of not receiving disease modifying treatments3,6 compared to those with COPD without frailty. Identifying frailty in respiratory research and practice has been recognised as important by public and professional stakeholders.7

Several measures have been used to identify frailty in people with COPD, and there is no universal agreement on which frailty measure should be used.8 While comprehensive geriatric assessment is the gold-standard approach to identify this syndrome and direct appropriate clinical care,9 brief tools to approximate frailty are essential to identify potential candidates for additional support, and measure frailty as a clinical or research outcome. The Fried Frailty Phenotype (FFP) is one of the most well-established measures of frailty,8 comprising five characteristics: unintentional weight loss, exhaustion, low physical activity, slowness and weakness.10 The Short Physical Performance Battery (SPPB)11 incorporates static balance tests, four-metre gait speed (4MGS), and the five sit-to-stand test, and has recently been recommended by the European Medicines Agency for baseline characterisation of physical frailty in people aged ≥65 years enrolled in clinical trials. Both measures are responsive to change following pulmonary rehabilitation3,12 and predictive of adverse events,13,14 including mortality.14 Using the FFP, people with COPD and frailty have been found to have higher risk of mortality compared to people with COPD without frailty (adjusted HR 1.4; 95{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} CI 0.97 to 2.0);15 and compared to people with neither COPD nor frailty (adjusted HR 2.7, 95{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} CI 1.07–6.94).16 While SPPB scores are predictive of mortality in COPD,14 this has not been explored with SPPB scores dichotomised by thresholds for frail versus not frail.

Although both the FFP and SPPB measures have been used to identify people living with frailty, little is known about the comparative characteristics of these measures when used with people with COPD. One study with 395 lung transplant candidates measured frailty using both measures to assess their construct and predictive validity.6 Despite more people being categorised as frail using FFP versus SPPB (28{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} vs 10{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}), both measures were associated with physiological and functional baseline characteristics and outcomes. However, only 30{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} of participants had COPD, and this study did not explore associations between the frailty measures and broader domains of health (eg, psychological, quality of life). Moreover, the multivariate modelling did not control for any widely used and validated prognostic index (eg, Age Dyspnoea Obstruction [ADO] or Body mass index, Obstruction, Dyspnoea, Exercise performance [BODE]).17

How the FFP and SPPB identify people living with frailty, and their varying predictive properties, may have important implications for their use and interpretation. Yet, these measures have not been directly compared in people living with COPD. Differences in the frailty definitions selected may modify the target population and interventional response and/or inform how evidence relating to frailty is synthesised. To support data-driven decision-making in clinical practice and research, this study aimed to compare the FFP and SPPB measures of frailty in people with stable COPD. Objectives were to (a) describe prevalence of, and overlap in, identification of frailty using the two measures; (b) compare disease and health characteristics in those identified as living with frailty using the two measures, and (c) compare the predictive value of the two frailty measures in relation to survival time.

Methods

Design

Cohort study.

Setting

Hillingdon Borough, North West London, United Kingdom.

Participants

Participants were consecutively identified and recruited from community respiratory and pulmonary rehabilitation assessment clinics, between November 2011 and January 2015. Eligible participants included people aged 35 years or over with a physician diagnosis of COPD (consistent with GOLD criteria18), and appropriate for pulmonary rehabilitation referral in line with British Thoracic Society Guidance: able to walk at least five metres, experiencing functional impairment due to breathlessness, and no previous supervised pulmonary rehabilitation in the previous 12 months. Exclusions included exacerbation of their COPD within the past four weeks that required a change in medication, or if moderate-intensity exercise was deemed unsafe (eg, due to unstable cardiac condition). Data from this ongoing research cohort have been published previously.3,19 The current study includes those with complete data for both frailty measures. Where people were assessed for pulmonary rehabilitation more than once during the study period, only their first assessment was included.

Frailty Measures

We compared the FFP and the SPPB, collected at baseline assessments.

The five characteristics of the FFP were assessed, respectively, using self-report unintentional weight loss history, two self-report questions on exhaustion from the Centre for Epidemiological Studies Depression (CES-D) questionnaire, self-reported physical activity from the modified Minnesota Leisure-Time physical activity questionnaire, handgrip dynamometry (weakness), and 4MGS (slowness). The 4MGS was completed using processes validated in COPD20 on a flat, unobstructed course, following a demonstration by the assessor. Participants were able to use their usual walking aids if applicable, and the faster of two attempts completed sequentially without rest was used. Presence or absence of each FFP characteristic was assessed and scored based on standardised criteria, described in detail previously.3 People meeting three or more criteria were considered to be living with frailty;10 those meeting 1–2 (prefrail) or 0 criteria (robust) were considered not to be living with frailty.

For the SPPB,11,21 performance in static balance, 4MGS, and five sit-to-stand tests were each assessed following a standardised protocol from the National Institute of Ageing, and scored from 0 to 4. The sit-to-stand component followed processes validated in COPD,22 including the use of a straight-backed armless chair with a floor-to-seat height of 48cm. Participants began with an initial stand and sit: those completing this successfully completed the five sit-to-stands, while the test was terminated for those unable to complete this initial manoeuvre. Each SPPB component contributes to a total score from 0 to 12, with higher scores indicating robustness. People scoring ≤7 were considered to be living with frailty,21 in line with European Medicines Agency guidance. As there is no consensus over optimal cut-offs when using the SPPB, we also conducted sensitivity analyses using alternative cut-off values of ≤823 and ≤9.24

Analysis

Prevalence and Overlap in Identification of Frailty

The prevalence of participants identified as living with frailty using each measure were described as percentages, and agreement described using Cohen’s Kappa. Agreement was categorised: slight ≤0.20, fair 0.21–0.40, moderate 0.41–0.60, substantial 0.61–0.80, almost perfect 0.81–1.00.25 Overlap in frailty categorisation between the two measures was illustrated using a Venn diagram. Post-hoc analysis explored areas of convergence and divergence between the measures through tabulating and examining inter-item correlations.

Comparison of Population Characteristics

The following characteristics (scale, ranges if applicable) from participants’ baseline assessment were described for those identified as living with or without frailty by each measure: age (years); forced expiratory volume in one second percent-predicted (FEV1{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} predicted); breathlessness (Medical Research Council [MRC] Dyspnoea, 1–5); Age Dyspnoea Obstruction (ADO) Index (0–14); Body Mass Index (BMI); comorbidities (age-adjusted Charlson comorbidity index); exercise capacity (Incremental Shuttle Walk Test [ISWT] distance in metres); anxiety symptoms (Hospital Anxiety and Depression Scale [HADS], 0–21); depression symptoms (HADS, 0–21); health-related quality of life (Chronic Respiratory Questionnaire Dyspnoea [5–35], Emotion [7–49], Fatigue [4–28] and Mastery [4–28] domains); and independence in basic activities of daily living (Katz questionnaire, scores 1–6 dichotomised some dependence [scores 1–5] and independent [score 6]). Questionnaires and physical measures were collected during their assessment in an outpatient consultation room. Additional information about these measures can be found within the Supplementary Material Table S1.

Following distribution checks for normality, characteristics were described using mean/medians and standard deviations/interquartile ranges (as appropriate) for continuous variables, and using frequencies and percentages for categorical variables. Independent t-tests/Mann Whitney U-tests and chi squared tests (as appropriate) were used to compare those identified as living with and not living with frailty within each measure. A p-value of less than 0.01 was used as the threshold for statistical significance to reduce risk of type 1 error due to multiple testing.26

Predictive Value for Mortality

It is recommended that, in survival analysis, there should be a minimum of 10 events per independent variable included in the model.27 As there were 376 deaths, there were sufficient cases for multivariable modelling.

Participants were followed up prospectively, and date of death was identified from hospital records and/or central National Health Service databases. Time to death in days was calculated from the date of assessment until date of death. Participants who survived were censored on 29th January 2021.

Kaplan–Meier plots and log rank tests were used to assess whether each frailty measure identified groups with different survival curves. The following disease and health characteristics were also assessed for associations with mortality using univariate Cox regression (or appropriate alternatives if proportional hazard assumption was violated), to inform subsequent adjusted analysis: Body Mass Index, comorbidity index, exercise capacity, anxiety, depression, independence in activities of daily living, and pulmonary rehabilitation completion. In separate models for each frailty measure, variables associated with mortality in univariable analyses (p < 0.05) were included in multivariable Cox Regression analysis (or appropriate alternatives if proportional hazard assumption was violated). In all cases, the multivariable analyses included checking for collinearity (r < 0.75), and controlling for sex and the ADO index: the former to account for known sex differences in mortality,28 the latter to determine the prognostic value of the FFP and SPPB over and above an established validated prognostic indicator.29 Analyses were undertaken using IBM SPSS Statistics 27.30

Ethical Approval

Study procedures complied with the Declaration of Helsinki. All participants gave informed consent. The recruitment and follow-up of the cohort received ethical approval from the West London (11/H0707/2) and London Camberwell St Giles (11/LO/1780) research ethics committees.

Results

Participant Characteristics

Of 1084 unique referrals for people with COPD during the study period, 1019 attended their assessment. Of these, 716 (70{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) were eligible to be included in the research cohort. Of 716 individual participant assessments during the study period, SPPB scores were missing for 2 participants and the remaining 714 had data for both frailty measures. Four-hundred and twenty-one (59{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) were male, and the mean (SD) age was 69.9 (9.7) years. Participant characteristics are shown in Table 1.

Table 1 Participant Characteristics (n = 714)

Prevalence and Overlap in Frailty Identification

Similar proportions of the sample were identified as living with frailty using the FFP (26.2{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}, n = 187) and SPPB (23.7{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}, n = 169) measure. There was moderate agreement between the measures (K = 0.469, SE = 0.038, p = <0.001), with matching classifications of frail or not frail in 572 (80.1{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) of cases (Figure 1). Sensitivity analysis using SPPB cut-offs of ≤8 and ≤9 led to higher proportions of the sample being identified as frail (33.6{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} [n = 240] and 46.1{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} [n = 329], respectively), but lower proportions of matching classifications (76.9{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} [n = 549] and 70.0{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} [n = 500], respectively) and lower kappa agreement scores with the FFP (0.452 and 0.377, respectively).

Figure 1 Venn diagram of frailty classification using Fried Frailty Phenotype (FFP) and Short Physical Performance Battery (SPPB) measures (n = 714).

Post-hoc analyses of inter-item correlations (Table 2) suggest that classification discrepancies may have arisen particularly from the weight loss and exhaustion components of the FFP, both of which show the lowest correlations with each SPPB item. Balance was the SPPB item least correlated with the FFP items.

Table 2 Inter-Item Correlation Between Fried Frailty Phenotype and Short Physical Performance Battery Components

Disease and Health Characteristics by Frailty Measure

Participants identified as living with frailty using either the FFP or SPPB were significantly older and had more comorbid conditions but did not show substantial differences in FEV1{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} predicted or BMI (Table 3). Participants with frailty identified using either measure scored lower on functional exercise capacity and reported more breathlessness and dependence in activities of daily living, higher depression symptoms, and poorer quality of life on the CRQ domains of fatigue, emotion, and mastery. Only participants identified as living with frailty using the FFP (not SPPB) reported significantly poorer anxiety and worse CRQ dyspnoea. Sensitivity analysis using cut-offs of ≤8 and ≤9 for SPPB found similar patterns, but as the cut-off score increased the SPPB showed significant differences in anxiety (≤8 only) and CRQ dyspnoea (≤8 and ≤9) between those with and without frailty.

Table 3 Comparison of People Identified as Living with Frailty versus without Frailty Using the Fried Frailty Phenotype and Short Physical Performance Battery (n = 714)

Predictive Value in Relation to Survival

Of the 714 participants, 376 (52.7{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) had died by 29th January 2021. Mean survival time was 2270 days (95{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} CI 2185–2355); approximately 6 years. For both the FFP and SPPB measure, a higher proportion of people with frailty had died by end of the study period than the non-frail groups: FFP 71.7{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} (n = 134) with frailty vs 45.9{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} (n = 242) without frailty died; SPPB 72.2{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} (n = 122) with frailty vs 46.6{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} (n = 254) without frailty died.

Survival time was approximately 2 years shorter for those with frailty versus without frailty, using either the FFP (mean 1795 days [95{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} CI 1629–1961] vs mean 2439 days [95{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} CI 2344–2533]) or SPPB (mean 1698 days [95{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} CI 1530–1866] vs 2435 days [95{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} CI 2342–2527]). As illustrated in the Kaplan–Meier plots in Figure 2, both measures identified a frail group with significantly shorter survival than the group who were not frail.

Figure 2 Kaplan–Meier plots showing survival of frail vs non-frail groups using the Fried Frailty Phenotype and Short Physical Performance Battery.

Univariate Cox regression analysis found that BMI, comorbidities, and exercise capacity were also significantly related to survival, while activities of daily living, anxiety, depression, and pulmonary rehabilitation completion were not. The final multivariable models for each frailty measure and survival included ADO and sex (as forced variables) as well as comorbidities, exercise capacity and BMI. When controlling for these variables, frailty measured using the FFP measure remained a significant independent predictor of survival, while frailty measured using the SPPB did not. However, both showed comparable point estimates, suggesting in either case an increase in mortality risk for those with frailty (Table 4). Sensitivity analysis using the alternative SPPB cut-offs of ≤8 and ≤9 found similar results (≤8 cut-off HR = 1.73, 95{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} CI 1.41–2.12 and aHR = 1.00, 95{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} CI 0.77–1.29; ≤9 cut-off HR = 1.78, 95{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} CI 1.45–2.18 and aHR = 1.04, 95{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} CI 0.81–1.33).

Table 4 Univariable and Multivariable Prediction of Mortality Comparing the Fried Frailty Phenotype and Short Physical Performance Battery

Discussion

This study compared the properties of the FFP and SPPB measures in people with COPD. We found moderate agreement in frailty classification, including matching classification of frail or not frail in 80{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} cases. Participants identified as living with frailty using either measure differed significantly from non-frail participants in similar ways: they were older, had more comorbidities and lower functional exercise capacity, and reported more dependence in activities of daily living, higher depression symptoms, and poorer health-related quality of life. People identified as frail using the FFP also reported significantly worse anxiety symptoms. Both measures showed predictive value in relation to survival. While the FFP provided slightly higher independent predictive value than the SPPB when used alongside other measures, including the ADO Index, this difference was marginal and trivial.

This study is the largest to date to use either the validated version of the FFP measure or the SPPB to predict mortality in people with COPD. Building on prior work by Singer et al that compared these measures in 395 candidates for lung transplant,6 we also found approximately 80{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} matching classifications between the two measures. Moreover, our adjusted hazard ratios for mortality were similar to those for delisting or death before lung transplant (FFP aHR 1.30, 95{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} CI 1.01–1.67; SPPB aHR 1.53, 95{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} CI 1.19–1.59).6 Together with smaller studies of the FFP13,16 and SPPB14 measures in people with COPD, there is growing evidence that each measure provides additional prognostic information when predicting mortality in this population, even when including established indexes such as ADO, in the current study, and BODE in the study by Fermont et al14

The FFP and SPPB both identified a group with multidimensional health challenges. Corroborating previous work, we found that around 1 in 4 people with COPD attending pulmonary rehabilitation were living with frailty31,32 and that those with frailty on either measure had lower exercise capacity,6,12 poorer physical function33,34 and increased breathlessness,12,13,33,34 but little difference in lung function.6,12,33 We extend these findings by illustrating associations of frailty, on either measure, with other dimensions of health, including higher depression symptoms, increased dependence in activities of daily living, and lower health-related quality of life. These differences tended to not only be significant but clinically meaningful.35,36 These wider correlates of frailty are in line with qualitative descriptions of the multidimensional losses experienced by people living with both COPD and frailty.37 The FFP measure additionally discriminated between people with different levels of anxiety and CRQ dyspnoea where the SPPB did not. This may reflect closer links between these broader self-reported aspects of health and the self-reported components of the FFP, such as exhaustion.

Measurement of frailty in respiratory research and care is increasingly recognised as important.7,38 Given varying resources and equipment available across settings (eg, handgrip dynamometers), it is helpful to know that there is substantial overlap between those identified as frail using the FFP or SPPB measure and that both measures identify people experiencing multidimensional health challenges. Decisions driven by pragmatic considerations can now be made with an understanding of the different emphases of each measure. For example, the FFP may identify people with more psychological symptoms and be less discriminant in relation to the presence of balance difficulties, while the SPPB may be less discriminant in relation to presence of exhaustion and weight loss. Moreover, this knowledge may inform more purposive use of either measure, for example, depending on the theorised mechanisms and targets of a particular intervention. Importantly, it should be acknowledged that both the FFP and SPPB are only surrogate markers of frailty: a comprehensive geriatric assessment remains the gold-standard approach to identify this syndrome and direct appropriate clinical care.9

Our data show that those identified as frail using the FFP or SPPB are twice as likely to die in the subsequent six years or so than their non-frail counterparts. Although there are limited trial data, growing evidence supports the potential of pulmonary rehabilitation in reversing frailty,3,32 but also of the difficulties those with frailty face in completing this intervention.3,37 Adapted pulmonary rehabilitation approaches for this group that integrate comprehensive geriatric assessment may have a role here,39 and work in this area is ongoing.40 Alongside this, the increased risk of mortality and poorer multidimensional health in those with COPD and frailty should also prompt thinking around the information and support needs of this group, which might include a role for integrated working with palliative care specialists and advance care planning.41

Although the single centre design and restriction to people attending an initial pulmonary rehabilitation assessment may reduce external validity, the large sample size and consecutive recruitment may support some generalisability to other outpatient cohorts. The focus on baseline data (with only survival as follow-up data) also meant little frailty data was missing for this cohort. This analysis included relevant disease characteristics, physical tests and self-reported health across multiple dimensions, including physical and psychological symptoms, activities of daily living and quality of life. This allowed us to comprehensively characterise those with frailty, but also adjust for several important confounders. These measures are routinely collected by skilled professionals during clinical assessments, supporting internal validity. It is important to acknowledge that including the separate component variables for Age, Dyspnoea and Obstruction may have accounted for more variance in the multivariate modelling than the composite ADO index, however it was deemed valuable to understand the prognostic value of the FFP and SPPB over and above an established prognostic indicator. Our long-term mortality follow-up helps demonstrate the value of two common frailty measures over an extended duration, but future work exploring comparative predictive value in relation to hospitalisation and readmission may also be useful. Importantly, this comparison only included two measures of frailty, both of which require physical tests which are not always feasible or practical. Further comparative work exploring the properties of other types of frailty measure including self-report screening tools (eg, FRAIL Scale42) and clinical-judgement-based approaches (eg, the Clinical Frailty Scale43) in COPD is needed. In addition, applicability across different ethnicities is unknown due to lack of data on this characteristic.

In conclusion, we found that in stable COPD, both the FFP and SPPB measures identify people with multidimensional health challenges and increased mortality risk. When used alongside other established measures, including the ADO index, both the FFP and SPPB frailty measures offer added value in predicting mortality.

Data Sharing Statement

All data requests should be submitted to Dr William D-C Man ([email protected]) for consideration. Access to anonymised data might be granted following investigator review.

Acknowledgments

Thank you to the participants for contributing their time to this research, and to Jane Canavan, Sarah Jones, and the clinical teams for supporting data collection. Matthew Maddocks and William DC Man are co-senior authors for this study.

Funding

This study was funded by a Medical Research Council New Investigator Research Grant and a National Institute for Health and Care Research (NIHR) Clinician Scientist Award (DHCS/07/07/009) held by WDCM and a NIHR Career Development Fellowship (CDF-2017-10-009) held by MM. RB is funded an NIHR Clinical Doctoral Research Fellowship (ICA-CDRF-2017-03-018). CE is funded by a Health Education England/National Institute of Health Research Senior Clinical Lectureship (ICA-SCL-2015-01-001). This research was supported by the NIHR Collaboration for Leadership in Applied Health Research and Care South London, now recommissioned as NIHR Applied Research Collaboration South London. This publication presents independent research funded by the NIHR. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, NIHR or the Department of Health and Social Care.

Disclosure

LJB, REB, SP, JAW, OP, SSCK, WG, CJE, and MM have no conflicts to declare. CMN reports personal fees from Novartis, outside the submitted work. WDCM reports grants from Medical Research Council, National Institute for Health and Care Research, and British Lung Foundation, during the conduct of the study. WDCM also involved in educational activities with Mundipharma, Novartis, and European Conference and Incentive Services DMC; and is also part of the advisory board for Jazz Pharmaceuticals, outside the submitted work. The authors report no other conflicts of interest in this work.

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