Our Grandparents, Our Parents, Our Future Selves: Optimizing Function in Old Age. Syracuse Seminar Series on Aging.

Most of my research at Yale University School of Medicine over the past several years has focused on identifying older adults at risk of functional decline and disability, identifying events that may precipitate the transition from functional independence to disability, and developing strategies to postpone or reduce frailty and disability. As a result of the Precipitating Events Project (PEP) and other research conducted by the Yale Center on Aging/Pepper Center, we now realize that age is only a proxy for other factors that lead to disability, and that some of these factors can be modified to reduce the risk of disability. In fact, disability rates have been steadily declining among older adults for decades.geriatrics, aging, gerontology, disability, precipitating event, functional decline, vulnerability, compression of morbidity, reserve organ capacity, exercise, physical activity, falls, Yale PREHAB study, lifestyle interventions, independence, elders, FICSIT trial, frailty

Prospective relationships between body weight and physical activity: an observational analysis from the NAVIGATOR study

Objectives: While bidirectional relationships exist between body weight and physical activity, direction of causality remains uncertain and previous studies have been limited by self-reported activity or weight and small sample size. We investigated the prospective relationships between weight and physical activity. Design: Observational analysis of data from the Nateglinide And Valsartan in Impaired Glucose Tolerance Outcomes Research (NAVIGATOR) study, a double-blinded randomised clinical trial of nateglinide and valsartan, respectively. Setting Multinational study of 9306 participants. Participants: Participants with biochemically confirmed impaired glucose tolerance had annual measurements of both weight and step count using research grade pedometers, worn for 7 days consecutively. Along with randomisation to valsartan or placebo plus nateglinide or placebo, participants took part in a lifestyle modification programme. Outcome measures: Longitudinal regression using weight as response value and physical activity as predictor value was conducted, adjusted for baseline covariates. Analysis was then repeated with physical activity as response value and weight as predictor value. Only participants with a response value preceded by at least three annual response values were included. Results: Adequate data were available for 2811 (30%) of NAVIGATOR participants. Previous weight (χ2=16.8; p<0.0001), but not change in weight (χ2=0.1; p=0.71) was inversely associated with subsequent step count, indicating lower subsequent levels of physical activity in heavier individuals. Change in step count (χ2=5.9; p=0.02) but not previous step count (χ2=0.9; p=0.34) was inversely associated with subsequent weight. However, in the context of trajectories already established for weight (χ2 for previous weight measurements 747.3; p<0.0001) and physical activity (χ2 for previous step count 432.6; p<0.0001), these effects were of limited clinical importance. Conclusions: While a prospective bidirectional relationship was observed between weight and physical activity, the magnitude of any effect was very small in the context of natural trajectories already established for these variables

Emission of the greenhouse gas nitrous oxide from riparian forest buffers, warm-season and cool-season grass filters and crop fields

Paper presented at the 11th North American Agroforesty Conference, which was held May 31-June 3, 2009 in Columbia, Missouri.In Gold, M.A. and M.M. Hall, eds. Agroforestry Comes of Age: Putting Science into Practice. Proceedings, 11th North American Agroforestry Conference, Columbia, Mo., May 31-June 3, 2009.Denitrification is recognized as the major mechanism for reducing nitrate in riparian buffers and thus diminishing non-point source pollution (NPS) of surface water bodies subject to high nitrogen loads. However, increasing denitrification rates in riparian buffers may be trading the problem of NPS pollution of surface waters for atmospheric deterioration and increased global warming potential because denitrification produces nitrous oxide (N2O), a greenhouse gas also involved in stratospheric ozone depletion. It is therefore important to quantify the emissions of N2O from different kinds of vegetated riparian buffer systems, and identify ways to minimize emissions while simultaneously maximizing denitrification. We measured N2O emissions from soils; nitrate (NO3--N) and dissolved N2O in groundwater; and soil properties in riparian forest buffers, warm-season and cool-season grass filters, and a crop field located in the Bear Creek watershed in central Iowa. Results suggest that N2O emissions from soils in all riparian buffers were significantly less than in the crop field, but no differences among types of riparian buffers were observed. Nitrate in outflow groundwater of riparian buffers was significantly lower than in inflow groundwater of riparian buffers. However, dissolved N2O in inflow and outflow groundwater of riparian buffers were not significantly different from one another. These results are useful in developing management protocols for riparian forest and other perennial vegetation practices for NPS pollution attenuation and additional multiple benefits.Thomas M. Isenhart (1), Dong-Gill Kim (2), and Richard C. Schultz (1) ; 1. Natural Resource Ecology and Management, Iowa State University, Ames, IA, 50011. 2. Department of Civil and Environmental Engineering, University College Cork, Cork, Ireland.Includes bibliographical references

Breathlessness in the elderly during the last year of life sufficient to restrict activity

OBJECTIVES: Breathlessness is prevalent in older people. Symptom control at the end of life is important. This study investigated relationships between age, clinical characteristics and breathlessness sufficient to have people spend at least one half a day in that month in bed or cut down on their usual activities (restricting breathlessness) during the last year of life. DESIGN: Secondary data-analysis SETTING: General community PARTICIPANTS: 754 non-disabled persons, aged 70 and older. Monthly telephone interviews were conducted to determine the occurrence of restricting breathlessness. The primary outcome was the percentage of months with restricting breathlessness reported during the last year of life. RESULTS: Data regarding breathlessness were available for 548/589 (93.0%) decedents (mean age 86.7 years (range 71 to 106; males 38.8%). 311/548 (56.8%) reported restricting breathlessness at some time-point during the last year of life but no-one reported this every month. Frequency increased in the months closer to death irrespective of cause. Restricting breathlessness was associated with anxiety, (0.25 percentage point increase in months breathlessness per percentage point months reported anxiety, 95% CI 0.16 to 0.34, P<0.001), depression (0.14, 0.05 to 0.24, P=0.002) and mobility problems (0.07, 0.03 to 0.1, P=0.001). Percentage months of restricting breathlessness increased if chronic lung disease was noted at the most recent comprehensive assessment (6.62 percentage points, 95% CI 4.31 to 8.94, P<0.001), heart failure (3.34, 0.71 to 5.97, P<0.01), and ex-smoker status (3.01, 0.94 to 5.07, P=0.002), but decreased with older age (─0.19, ─0.37 to ─0.02, P=0.03). CONCLUSION: Restricting breathlessness increased in this elderly population in the months preceding death from any cause. Breathlessness should be assessed and managed in the context of poor prognosis

Trends in Drug Utilization, Glycemic Control, and Rates of Severe Hypoglycemia, 2006-2013.

ObjectiveTo examine temporal trends in utilization of glucose-lowering medications, glycemic control, and rate of severe hypoglycemia among patients with type 2 diabetes (T2DM).Research design and methodsUsing claims data from 1.66 million privately insured and Medicare Advantage patients with T2DM from 2006 to 2013, we estimated the annual 1) age- and sex-standardized proportion of patients who filled each class of agents; 2) age-, sex-, race-, and region-standardized proportion with hemoglobin A1c (HbA1c) <6%, 6 to <7%, 7 to <8%, 8 to <9%, ≥9%; and 3) age- and sex-standardized rate of severe hypoglycemia among those using medications. Proportions were calculated overall and stratified by age-group (18-44, 45-64, 65-74, and ≥75 years) and number of chronic comorbidities (zero, one, and two or more).ResultsFrom 2006 to 2013, use increased for metformin (from 47.6 to 53.5%), dipeptidyl peptidase 4 inhibitors (0.5 to 14.9%), and insulin (17.1 to 23.0%) but declined for sulfonylureas (38.8 to 30.8%) and thiazolidinediones (28.5 to 5.6%; all P < 0.001). The proportion of patients with HbA1c <7% declined (from 56.4 to 54.2%; P < 0.001) and with HbA1c ≥9% increased (9.9 to 12.2%; P < 0.001). Glycemic control varied by age and was poor among 23.3% of the youngest and 6.3% of the oldest patients in 2013. The overall rate of severe hypoglycemia remained the same (1.3 per 100 person-years; P = 0.72), declined modestly among the oldest patients (from 2.9 to 2.3; P < 0.001), and remained high among those with two or more comorbidities (3.2 to 3.5; P = 0.36).ConclusionsDuring the recent 8-year period, the use of glucose-lowering drugs has changed dramatically among patients with T2DM. Overall glycemic control has not improved and remains poor among nearly a quarter of the youngest patients. The overall rate of severe hypoglycemia remains largely unchanged

Conservation planning in an uncertain climate: Identifying projects that remain valuable and feasible across future scenarios

Conservation actors face the challenge of allocating limited resources despite uncertainty about future climate conditions. In many cases, the potential value and feasibility of proposed projects vary across climate scenarios. A key goal is to identify areas where conservation outcomes can balance both environmental and human needs. We developed a conservation prioritization framework that jointly considers the value and feasibility of candidate projects across future climate scenarios. We then applied this framework to the challenge of meeting environmental flow targets across the Red River basin of the south-central United States. To estimate the conservation feasibility of meeting environmental flow goals in a river reach in each climate scenario, we used a basin-wide hydrologic planning tool to quantify the reduction in societal water usage needed to meet environmental flow targets. To estimate the biodiversity value of each river reach in each climate scenario, we used climate-driven species distribution models and species’ conservation status. We found that river reaches in the east-central portion of the basin may be good candidates for conservation investments, because they had high biodiversity value and high sociopolitical feasibility in all future climate scenarios. In contrast, sites in the arid western reaches of the basin had high biodiversity value, but low feasibility of achieving environmental flow goals. Our framework should have broad applicability given that the value and feasibility of conservation projects vary across climate scenarios in ecosystems around the world. It may serve as a coarse filter to identify sites for more detailed analyses and could be integrated with complementarity-based approaches to conservation planning to balance species’ representation across projects. A free Plain Language Summary can be found within the Supporting Information of this article

A nearly complete foot from dikika, Ethiopia and its implications for the ontogeny and function of australopithecus afarensis

The functional and evolutionary implications of primitive retentions in early hominin feet have been under debate since the discovery of Australopithecus afarensis. Ontogeny can provide insight into adult phenotypes, but juvenile early hominin foot fossils are exceptionally rare. We analyze a nearly complete, 3.32-million-year-old juvenile foot of A. afarensis (DIK-1-1f). We show that juvenile A. afarensis individuals already had many of the bipedal features found in adult specimens. However, they also had medial cuneiform traits associated with increased hallucal mobility and a more gracile calcaneal tuber, which is unexpected on the basis of known adult morphologies. Selection for traits functionally associated with juvenile pedal grasping may provide a new perspective on their retention in the more terrestrial adult A. afarensis

Corrections to and Discussion of "Implementation and Evaluation of Mixed-criticality Scheduling Approaches for Sporadic Tasks"

The AMC-IA mixed-criticality scheduling analysis was proposed as an improvement to the AMC-MAX adaptive mixed-criticality scheduling analysis. However, we have identified several necessary corrections to the AMC-IA analysis. In this letter we motivate and describe those corrections, and discuss and illustrate why the corrected AMC-IA analysis cannot be shown to outperform AMC-MAX

Fitting Event-History Models to Uneventful Data

Data with which to study disability dynamics usually take the form of successive current-status measures of disability rather than a record of events or spell durations. One recent paper presented a semi-Markov model of disability dynamics in which spell durations were inferred from sequences of current-status measures taken at 12-month intervals. In that analysis, it was assumed that no unobserved disablement transitions occurred between annual interviews. We use data from a longitudinal survey in which participants\u27 disability was measured at monthly intervals, and simulate the survival curves for remaining disabled that would be obtained with 1- and 12-month follow-up intervals. The median length of an episode of disability based on the 12-month interval data is over 22 months, while the true median, based on the 1-month interval data, is only one month