Overview of Sarcopenia

Overview of Sarcopenia Background Sarcopenia is age related disease with symptoms of loss of muscle mass, strength and function. Elderly over the age of 65 years are vulnerable to sarcopenia [6]. It is estimated that approximated 5-13% of older people aged 60–70 years are suffered from sarcopenia [8]. The proportion is about twice higher among elderly at the age of 80 or above [8]. Studies also found that sarcopenia is more likely seen in older men than older women [16,26]. Sarcopenia gains intensive attention from public and increasing researches indicated that it is a major clinical problem for older people. Risk factors of sarcopenia Current research found that lifestyle factors, including physical inactivity, smoking and alcohol consuming [3]; and biological factors, including older age, gender, decreased hormone level, motor unit remodeling and reduced protein synthesis [3,25], contribute to development of sarcopenia. Motor unit remodeling comes up of age and leads to replacement of fast twitch motor neuron[22,25] which results in less precise control of movements, less force production and slowing of muscle mechanics[22,23,25] as remodeled motor unit are smaller in size and slower to contract. Therefore, loss of fast twitch fibers increases risk of having sarcopenia. In addition, protein synthesis, growth hormone (GH), testosterone (T) and insulin-like growth factor (IGF-1) are considered to be associated with sarcopenia as well [25]. It is well known that protein is important in muscle repairmen. And GH, T and IGF-1 are involved in protein metabolism and maintenance [23]. Different studies agreed that protein synthesis rate decreases throughout the natural aging process [24] and leads to loss of muscle mass. Thus, low protein synthesis rate, along with decrease in these hormones level provide possible occurrence of sarcopenia [25]. Consequences of sarcopenia Sarcopenia causes serious consequences not only at individual level but also at societal level. On the one hand, loss of muscle mass, strength and function lead to adverse health outcome in terms of frailty, disability, morbidity and mortality [8]. Essentially, sarcopenia is about twice as common as frailty [9]. Also, sarcopenia occurs with other morbidity in some times. Some of the co-morbidity are obesity [4,13], hypertension, osteoporosis [12] and type II diabetes [5,14,15]. Moreover, research suggests that loss of skeletal muscle strength may predict future mortality in middle-aged and elderly [2]. On the other hand, sarcopenia is linked with increased healthcare expenditure. In United States, the estimated direct healthcare attributable to sarcopenia represented about 1.5% of total healthcare expenditure in 2000 [21]. Diagnosis of sarcopenia according to different consensus panels Although research working in the area of sarcopenia is expanding exponentially, a universal definition is still under development. On average, current definitions are including muscle mass, muscle strength or even physical function. In 2010, the European Working Group on Sarcopenia in Older People (EWGSOP) published guidelines to help identify sarcopenia [1,9]. According to the EWGSOP, a person will be classified as having sarcopenia when two of three follow criteria were statisfied: (A) low muscle mass and (B) low muscle strength and/or (C) low physical performance [1]. Low muscle mass is defined as muscle mass ≠¥2 standard deviations below the mean of reference population [8], calculating by equipment such as DEXA-scanners. Low physical performance is defined as gait speed ≠¤ 0.8 m/s in the 4 meters walk test for both males and females [8]. International Working Group on Sarcopenia (IWGS) suggested diagnosing sarcopenia when the following criteria are fulfilled: (a) gait speed was < 1 m/s and (b) low muscle mass (cutoff value is similar to EWGSOP) [8]. The European Society of Parenteral and Enteral Nutrition Special Interest Groups carried out that the cut off values for low muscle mass is defined as percentage of muscle mass > 2 SDs below the mean of reference individuals; for walking speed is < 0.8 m/s in the 4 meters walk test [1]. Measurement of muscle mass and muscle strength Muscle strength is mainly assessed by handgrip. While physical performance can be measured using simple tests such as the short physical performance battery test, usual gait speed or the timed get-up-and-go test; it is difficult to assess muscle mass in practice. Dual-energy X-ray absorptiometry (DEXA) is recently proposed as the gold standard for muscle mass measurement. Other methods include bioelectrical impedance, computed tomography, magnetic resonance imaging, urinary excretion of creatinine, anthropometric assessments, and neutron activation assessments can be used for measurement of muscle mass as well [8]. The process is complicated and need participation of professionals. Prevalence of sarcopenia varies as use of cut-off points relies on different instruments used for assessing muscle mass and strength and function. SARC-F, a newly developed simple questionnaire, has been regarded as rapid diagnosis test for sarcopenia. It contains five components: strength, assistance in walking, rise from a chair, climb stairs and falls. A question will be asked to assess each component variable. Scores range from 0-10, with 0-2 for each component [7]. Details of SARC-F are shown in table 1. Cut-off score A research conducted in Hong Kong tests the validation of SARC-F as a screening tool for sarcopenia in community. It found that SARC-F is able to predict future adverse outcomes with comparable power to other criteria. It also found that SARC-F has excellent specificity (94.4%) and negative predictive value but poor sensitivity. With high specificity, SARC-F is useful for screening out older adults with sarcopenia. Poor sensitivity may due to the number of participants classified as having sarcopenia represent only a small proportion of the total population studied [10]. Another research applied SARC-F in mainland China to screen sarcopenia and physical disability. It published that poor physical performance and grip strength were associated with SARC-F defined sarcopenia. But there was a very weak correlation to muscle mass in physically active outpatients. It pointed out potential explanation that the weak correlation may partly due to only small sample measured by DXA or BIA [11]. Relevance to Public Health Sarcopenia is coming of age. Elderly population is expected to remain on a rising trend in most of developed countries. In Hong Kong the proportion of the population aged 65 and over is projected to rise markedly from 13% in 2012 to 30% in 2041 []. It means that increasing population will suffer from sarcopenia. It is not surprise that sarcopenia increase the risk of physical disability. The risk of disability is 1.5 to 4.6 times higher in older persons with sarcopenia than in older persons with normal muscle. Men are at greater risk of sarcopenia related disability than women [16]. Recent estimates indicate that approximately 45% of the older U.S. population is sarcopenic and that approximately 20% of the older U.S. population is functionally disabled [21]. It is important to note that physical disability is associated with an increased risk of nursing home placement, home healthcare and hospital use [21]. And these healthcare services need extra healthcare expenditure to support. To sum up with information above, sarcopenia is becoming big challenge in public along with the rise of older population. It is cause serious health consequences in persons and make economic burden in countries.

Macbook Air About Essay

MacBook Air is unbelievably thin and light. But it’s designed to be powerful, capable, durable, and enjoyable to use, with enough battery life to get you through the day. That’s the difference between a notebook that’s simply thin and light and one that’s so much more. Even at less than an inch thin, MacBook Air sets a pretty high standard — by making flash storage standard. Flash chips are very compact, allowing MacBook Air to be incredibly thin and light. Flash is also solid state, meaning there are no moving parts. Which makes it reliable, durable, and quiet. And it takes up much less space — about 90 percent less, in fact. That creates room for other important things, like a bigger battery. So you have a notebook that weighs almost nothing and runs for hours on a single charge. That’s mobility mastered. Multi-Touch technology is part of practically every Apple product. It’s the best and most personal way to interact with your devices. And the optimal way to experience Multi-Touch on a notebook is through a trackpad. That’s precisely the case with MacBook Air. The trackpad’s spacious, all-glass surface doesn’t have a button because the whole thing is the button. And with Multi-Touch gestures in OS X Mountain Lion, you can interact with MacBook Air in ways that feel more intuitive and responsive than ever before. Anyone can try to make a notebook that’s thin and light. Success comes in doing it without cutting corners. That’s why MacBook Air features a full-size keyboard, not a condensed version of what you’re used to. When you type on the MacBook Air, it’s just as comfortable as typing on a desktop keyboard. And the keyboard is backlit, so you can type comfortably even in low-light conditions. A built-in sensor detects changes in the ambient lighting and adjusts the keyboard and display brightness automatically, giving you the perfect illumination in any environment. If you looked inside MacBook Air, you’d see something remarkable: how much space we devoted to the battery. That’s thanks to smaller components such as flash storage. And when the goal is to design the perfect notebook for everyday use, giving priority to the battery just makes sense. With MacBook Air, you can get up to 5 hours of battery life on the 11-inch model and up to 7 hours on the 13-inch model. Put MacBook Air to sleep for more than an hour, and it enters what’s called standby mode. That means you can come back to MacBook Air a day, a week — even up to an entire month — later, and it wakes in an instant. Time is on your side, courtesy of MacBook Air. MacBook Air features a unibody design for both the main enclosure and the display. Unibody construction means a higher-precision, less complex design with fewer parts. And that translates to a notebook that’s exceptionally thin and light, yet durable enough to handle the rigors of everyday use.

1967 Six Day War Essay

Assess the consequences of the 1967 (Six Day) War for Arab–Israeli relations On the 23rd May 1967, the Israelis declared war on the Arabs due to the blocking of the straits to Israeli shipping. The 1967 Six Day War had a major impact on Arab-Israeli relations. This is due to Israel gaining control over the occupied territories, large increases of Jewish settlement in the occupied territories, the increase of Israeli military in the Middle East. The Israeli occupation of Arab territories had a large impact on Arab-Israeli relations. Through the dominancy of the Israeli army during the Six Day War, they were able to capture the Sinai Peninsula, the Gaza Strip from Egypt, East Jerusalem, the West Bank from Jordon and the Golan Heights from Syria. In addition, Israel controlled the Sharm el-Sheik and the Gulf of Aqaba. This was significant as Israel stopped Jordanian ships from entering the Red Sea and closed the Gulf of Aqaba to Arab shipping increasing the tensions between Israel and its neighbouring Arab States. In November 1967, UN Resolution 242 called for ‘the withdrawal of Israeli armed forces from the territories occupied in the recent conflict’ and the right of all countries ‘to live in peace with secure and recognised boundaries’. Even though, UN Resolution 242 favoured both parties, the Arabs did not regain their territories as Israel debated the resolution did not specify the withdrawal from all territories and they claimed that the Occupied Territories were vital to its security. However, Israel did emphasis the second measure of the resolution claiming their right to exist, but the Arabs ignored it implying that Israel would first have to withdraw from the occupied territories. By both Arabs and Israelis not accepting UN resolution 242 and the continual Israeli control over the occupied territories, the tension between Arab-Israeli relations had increased. Also, the large increases of Jewish settlement into the Occupied Territories had a major impact on Arab-Israeli relations. Between 1975 -1977, Israel had made 75 settlements in the West Bank as they offered people cheap housing and necessities such as employment and appliances. The Gaza Strip contained approximately 300,000 Arabs and the Israelis had settled 3000 Jews in the area creating tension between Arabs and Israelis as evident through the ‘Intifada’ from 1987 to 1993 which killed thousands of people. By Israel creating large settlements in the Occupied Territories, it would be an obvious obstacle to any future peace negotiations over withdrawal from the Occupied Territories. The large group of Jewish immigrants also produced conflict in the Occupied Territories creating hardship for the Israeli Army as they continually had to stop violent raids. The Arabs argue that Jewish settlements should not occur in the Occupied Territories as it was Arab land; however the Jews argue that this land religiously belonged to them as through the biblical names of the West Bank, â€Å"Judea† and â€Å"Samaria†. By Israel increasing Jewish settlements in the Occupied Territories, the Arab-Israeli relations had deteriorated as it was now difficult to organise a Jewish withdrawal. Furthermore, the increase in the Israeli reputation and the decrease in military strength of the Arabs heavily impacted Arab-Israeli relations. On the 5th June 1967, the Israelis launched a pre-emptive strike on the Arabs as 180 Israeli warplanes attacked the airfields of Egypt, Syria and Jordon destroying 400 military planes ultimately deciding the fate of the Six Day War. There is a general agreement amongst historians â€Å"that although Israel struck first, this pre-emptive strike was defensive in nature†. As a consequence of the war, 12,000 Arabs had died with only 338 Israeli casualties. Historian Avner Cohen writes, â€Å"In the end Israel launched a pre-emptive aerial attack in which most of the Egyptian air force was destroyed, virtually deciding the Six Day War. Through Israel’s dominance they were regarded as the ‘strongest military power in the Middle East’. Also, the Arabs had become severely weakened as a result of the Six Day War, as they had lost a high amount of casualties and the relations between Syria, Jordon and Egypt declined as evident through Syria not accepting UN Resolution 242 while Egypt and Jordon did. Through Israel’s superiority, their relations with Egypt had improved as highlighted through Egypt recognising Israel as a state in 1979. Nevertheless, Israel’s dominancy also stresses its improvement in its relations with Jordan signing a peace treaty in 1994, and Iran signing a peace treaty in 1979. Even though, certain relations improved the Arabs would turn to terrorism and the Israeli army would be seen as the aggressor. By Israel dominating the Six Day War and establishing itself as the ‘strongest military power in the Middle East, its relations with other Arab countries had dramatically improved. In conclusion, the 1967 Six Day War had a major impact on Arab-Israeli relations. Due to Israel gaining control over the occupied territories and increasing its settlement, the Arab-Israeli relations had declined as the Arabs were livid that Israel would not withdraw from the Occupied Territories and further complicate the situation by increasing Jewish settlement. Also, the Israeli’s had become maddened as most Arab countries continued not to recognise Israel as a state. However, as the reputation of the Israelis became high and the military strength of the Arabs declined, Arab-Israeli relations improved as evident through the peace treaties of Jordan, Egypt and Iran.

World War I And The Great War - 2441 Words

Background info - World War 1 began in the early 20th century from the year 1914 to the year 1918. The period covered over four months with many changes which came with it besides many lives being lost. World War I began as a European conflict, only gradually did it develop into a world war. The growing tensions between the European countries were caused by militarism, alliances, imperialism, and nationalism. Also involving conflicts of the Balkan wars and the assassination of Archduke Ferdinand. World War 1 began in the early 20th century from the year 1914 to the year 1918. The period covered over four months with many changes which came with it besides many lives being lost. World War I began as a European conflict, only gradually did it develop into a world war (Ross, 6). The growing tensions between the European countries were caused by militarism, alliances, imperialism, and nationalism. World War I was often referred to as The Great War. It began in 1914 and ended in 1918. Ame rica witnessed much devastation in this time period. In these four years alone nearly 9 million people died and millions more were maimed, crippled, grief stricken, or psychologically scarred (Coetzee, 11). World War I is considered by some, the first man-made catastrophe of the twentieth century. Hypothesis - What might have been the most significant factor or event to have contributed to the outbreak of a world war in 1914? COULD THE ASSASSINATION OF ONE MAN BE ENOUGH TO CAUSE A WAR? TheShow MoreRelatedThe Great War : World War I894 Words   |  4 Pages The Great War: World War I World War I, otherwise known as the Great War, began as a small battle that eventually developed into a prodigious uproar between several countries. WWI’s beginnings are controversial and historians throughout the world have several theories about the destructive event. Said to be one of the most disastrous and ruinous struggles between nations, The Great War lasted from July 1914 until November 1918. Referred to as a World War because of the global participation andRead MoreWorld War I And The Great War1472 Words   |  6 PagesWorld War I was usually suggested to as The Great War. The war began sometime in 1914 and lasted four years, ending in 1918. America endorsed, in this era, a great amount of devastation. Throughout those four years alone approximately nine million casualties occurred and in addition millions more were mutilated, grief-stricken, handicapped, or traumatized. World War I is referred to by some, the first catastrophe, man-made, of the twentieth century. Many historians continue to contemplate the essentialRead MoreThe Great War Of World War I1490 Words   |  6 PagesThe Great War also considered to be World War I, although not initially named that due to not knowing that there would have been a second one. The war lasted from 1914-1918 and was one of the most violent wars known to history. 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World War I, also known as the Great War was the outcome of many tensions and a sequence of calamitous incidents that plunged Europe into a disaster zone. Due to the use of the machine gun and trench warfare, most of the war was a battle of attrition between the â€Å"Triple Alliance† and the â€Å"Triple Entente†. Millions of people fought and died in this war, among them thousands of Canadians. There have been many attempts to reconstruct experiences and battles of the First World War in prose