Influences of Body Composition, Multimorbidity and Polypharmacy on Physical Mobility of Older Adults

Background and Purpose: The prevalence of falls, and the resulting injuries and complications reflect a key concern in the older adult population. An increased risk of falls is highly correlated with decreases in physical mobility and related functions. The Timed Up-and-Go test (TUG) has an established reliability and validity in assessing physical function and the risk of falling in the older adult population. With age, a person typically has an increased number of health morbidities, which may be reflected in changing body composition and the number of medications associated with diseases. However, the influence of these factors on physical mobility in the older adult population has not been quantified. The purpose of this study was to investigate how common indicators of health, including body mass index (BMI), presence of multimorbidity and polypharmacy influence the TUG performance in the older adult population. Methods: A total of 222 individuals ≥ 65 years of age were recruited (68 men and 154 women, mean age = 75.1 yrs). Additional subjects (28 men and 54 women, mean age = 72.7 yrs) from previous research were included in the analysis of BMI on TUG performance with a total of 304 subjects (96 men and 208 women, mean age= 74.4 yrs). Height and weight were obtained in conjunction with a medical history survey. Subjects completed 3 trials of the TUG test at 3 and 9 m walking distances. Comparison was made between 3 participant groups according to their BMI (underweight: BMI \u3c 24 kg/m2, normal weight: BMI 24-30 kg/m2, overweight: BMI \u3e 30 kg/m2). Multimorbidity was categorized into 2 groups (multimorbidity: ≥ 2 morbidities, non-multimorbidity: 0-1 morbidity). Polypharmacy was categorized into 2 groups (polypharmacy: ≥ 5 medications, non-polypharmacy: 0-4 medications). Non-parametric tests were run for all 3 variables (BMI, multimorbidity, and polypharmacy). Results: The underweight BMI group exhibited a trend of slower performance than normal weight BMI group for the 3 m (underweight = 8.8±5.3s, normal weight = 8.5±3.3s, p = 0.055) and the 9 m TUG distances (underweight = 17.3±8.9s, normal weight = 17.0±6.1s, p = 0.071). There was a trend toward the overweight BMI group having slower performance than the normal weight BMI group on the 9 m distance (normal weight = 17.0±6.1s, overweight = 18.0±5.5s, p = 0.069). The group with ≥ 2 morbidities had slower performance on the 3 m (multimorbidity = 9.2±3.9s, non-multimorbidity = 7.7±2.1s, p \u3c 0.001) and 9 m TUG distances (multimorbidity = 18.3±6.8s, non-multimorbidity = 15.6±4.0s, p \u3c 0.001). The polypharmacy group had slower performance on the 3 m (polypharmacy = 9.6±3.3s, non-polypharmacy = 8.3±3.4s, p = 0.001) and 9 m TUG distances (polypharmacy = 19.1 ± 5.9s, non-polypharmacy = 16.7±6.0s, p = 0.001). Discussion: Being underweight and overweight were shown to impact a person’s walking ability. We expected overweight individuals to have a slower performance on the TUG but underweight individuals did as well. This could be due to frail older adults having decreased muscle mass and strength. Polypharmacy and multimorbidity were shown to also have a significant impact on mobility performance. Limitations: The examined older adult population was relatively healthy as they are community dwelling individuals who are active in the retirement community. Conclusion: This study provided quantitative information regarding the effects of common health indicators (BMI, status of multimorbidity and polypharmacy) on mobility. Understanding the impact of BMI, multimorbidity, and polypharmacy on TUG performance will assist in identifying patients at risk of decrease physical mobility and falls. Wellness interventions might include reducing/altering medications used or adopting a healthier BMI to improve mobility

Bivariate hierarchical Hermite spline quasi--interpolation

Spline quasi-interpolation (QI) is a general and powerful approach for the construction of low cost and accurate approximations of a given function. In order to provide an efficient adaptive approximation scheme in the bivariate setting, we consider quasi-interpolation in hierarchical spline spaces. In particular, we study and experiment the features of the hierarchical extension of the tensor-product formulation of the Hermite BS quasi-interpolation scheme. The convergence properties of this hierarchical operator, suitably defined in terms of truncated hierarchical B-spline bases, are analyzed. A selection of numerical examples is presented to compare the performances of the hierarchical and tensor-product versions of the scheme

The strategic timing of R&D agreements.

We present a model of endogenous formation of R&D agreements among firms in which also the timing of R&D investment is made endogenous. The purpose is to bridge two usually separate streams of literature, the noncooperative formation of R&D alliances and the endogenous timing literature. Our approach allows to consider the formation of R&D agreements over time. It is shown that, when both R&D spillovers and investment costs are sufficiently low, firms may find difficult to maintain a stable R&D agreement due to the strong incentive to invest noncooperatively as leaders. In such a case, to be stable a R&D agreement requires that the joint investment occurs at the initial stage, avoiding any delay. When instead R&D spillover rates are sufficiently high, the cooperation in R&D constitutes a profitable option, although firms also possess the incentive to sequence their investment over time. Finally, when spillovers are asymmetric and the knowledge leaks mainly from the leader to the follower, to invest as follower becomes extremely profitable, making R&D alliances hard to sustain unless firms strategically delay their joint investment in R&D.R&D investment, Spillovers, Endogenous Timing.

I “Ponti pensili” nella Valle di Kathmandu (Nepal)

Nel corso dell’Ottocento, con l’ascesa al potere della famiglia Rana (1845-1951), numerose furono le opere innovative nella valle di Kathmandu sotto la spinta di quanto avveniva in India ed in Europa, sia a livello urbano che architettonico, nonché tecnico e tecnologico. Con la costruzione di nuovi palazzi, venne introdotto un nuovo stile, lo stile neoclassico. Questi furono inseriti in grandi parchi e giardini, arredati con mobili di stile europeo e lo stesso costume di vita si adeguò al nuovo corso. Numerose furono le nuove opere a carattere pubblico, sia con l’apertura di strade a Kathmandu o la creazione di ampi spazi per manifestazioni, il restauro dei grandi opere, come i ghat cittadini sulle sponde del fiume Bagmati, la regimazione delle acque di questo lungo il suo percorso, la realizzazione di ponti e acquedotti

Being in-between in Jackie Kay's Trumpet

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