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A LITERATURE REVIEW OF HEALTHY AGING TRAJECTORIES THROUGH QUANTITATIVE AND QUALITATIVE STUDIES: A PSYCHO-EPIDEMIOLOGICAL APPROACH ON COMMUNITY-DWELLING OLDER ADULTS
A. Zamudio-Rodríguez1, J.-F. Dartigues1, H. Amieva1, K. Pérès1
1. University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France.
Corresponding author: Alfonso Zamudio Rodríguez. Centre de recherche Inserm, UMR 1219. Rue Léo Saignat, 33076 Bordeaux cedex, France. Phone: +33 (5) 57.57.11.73. Fax: +33 (5) 57.57.14.86, E-mail: alfonso.zamudio-rodriguez@u-bordeaux.fr
J Frailty Aging 2020;in press
Published online November 24, 2020, http://dx.doi.org/10.14283/jfa.2020.62
The population of older adults over 60 years is growing faster than any other age group and will more than double between 2020 and 2050. This increase has led to clinical, public health, and policy interest in how to age "successfully". Before the Rowe and Kahn's model proposed thirty years ago, aging was seen as a process of losses associated with diseases and disability. However, since the emergence of this model, there has been a shift towards a more positive view, serving for promoting diverse medical or psychosocial models, and personal perspectives. Several technical terms of "success" (e.g. "successful aging", "healthy aging", "active aging", "aging well"…) coexist and compete for the meaning of the concept in the absence of a consensual definition. Our literature review article aims to study discrepancies and similarities between the main technical terms through quantitative or qualitative studies. A literature review using PubMed, SCOPUS, PsycINFO, Psycarticles, Psychology, and Behavioral Sciences Collection, Cochrane database, and clinicaltrials.gov databases was conducted. A total of 1057 articles were found and finally, 43 papers were selected for full extraction. We identified several components in these definitions, which reveal considerable inconsistency. The results particularly suggest that lay personals perspectives could bridge the gap between biomedical and psychosocial models in successful aging. In conclusion, an optimal definition would be a multidimensional one that could combine functional capacities, psychosocial abilities, environmental factors and subjective assessments of one's own criteria to discriminate older adults at potential risk of "unsuccessful" aging to healthy aging trajectories.
Key words: Healthy aging, public health, review, successful aging, theorical models.
More people than ever before are reaching older ages. The proportion of people over 60 years is growing faster than any other age group due to both increasing longevity and declining fertility rates. Furthermore, in many industrialized countries, the first generations after the Second World War are currently reaching old age, the so-called baby boomers. The current aging population will more than double between 2020 and 2050, whereas the oldest old one –those aged over 80 years- should be multiplied by 5 in the same period (1). This demographic revolution has led to clinical, public health, policy, and individual interest regarding how to age "successfully". The first key element in order to determine this "success" was established in 1948 when the World Health Organization (WHO) Member States adopted a new definition of health as "a state of complete physical, mental, and social well-being and not merely the absence of diseases" (2). However, despite this framework, the conception of aging was viewed as a period of degradation associated with disease and dependency, where little attention was given to people with healthy trajectories.
In 1961, the introduction of the term "Successful Aging" (SA) induced a fundamental shift, even though the consensus over the definition of this new concept and the way to measure it was (and to a certain extent still is) far from being reached (3). Actually, the word "successfully" is commonly used in the literature as a universal reference term for older people with healthy trajectories. Moreover, this concept brought a step that fostered the development of a positive view of aging and promoted research in order to demonstrate a possibly high level of functioning across several domains in old age. Consequently, different technical terms have emerged. These terms co-exist and compete to define this concept, including successful, healthy, active, well-being and others; terms that are often overlapping (4).
In 1987, Rowe and Kahn proposed in the normal category of aging, an additional distinction between usual and SA as nonpathological states. Eventually, ten years later, they summarized the central findings of that work, proposing the first model of "SA", which was defined as "a low probability of disease and disability, high cognitive and physical functioning, as well as productive activity and activity involving relations with others" (5). This model has been essential in our understanding of the healthy aging process. Nonetheless, this model mainly relied on a biomedical approach underestimating the contribution of psychosocial, or personal perspectives on the aging process.
On the other hand, after Rowe and Kahn's model of SA, numerous holistic theories have been proposed to improve the concept using different approaches involving environmental factors, security, and social active engagement models (6), until more recently ones based on subjective criteria, such as life-satisfaction or well-being (7, 8). These theories suggest a shift to a more holistic vision of SA (9, 10). In this vein, the WHO introduced in 2002 the concept of "active aging", defined as: "Process of optimizing opportunities of health, participation, and security, seeking to improve life quality as people get older. Active aging consists of a health policy, influenced by gender and culture, and that is composed of behavioral, personal, physical, social, and economic determinants, as well as health and social service" (4).
Even though, more than half a century has passed since the introduction of the different technical terms of SA ("healthy", "active", "successful", "well-being", …), no universal operationalization or standardized definition has emerged (11). A variety of objective and subjective measures have been proposed in order to operationalize it (12) and several essential components have been identified, such as cognitive, physical, psychosocial, or environmental dimensions (13–15). Our literature review article aims to identify discrepancies and convergences between the main technical terms of SA through quantitative or qualitative or mixed methodology.
A literature review through PubMed, SCOPUS, PsycINFO, Psycarticles, Psychology and Behavioral Sciences Collection, Cochrane database, and clinicaltrials.gov databases was conducted. The comprehensive research strategy included six successful technical terms: "successful aging", "healthy aging", "active aging", "aging well", "self-perceived successful aging", and "subjective well-being in late life".
These terms were used in orthography conventions of both "aging" and "ageing". In addition, where possible, some restrictions were used in the database such as "original articles" type of publication, "English" language, articles involving only "humans", and the age of the participants "65 years and older" at the time of assessment of SA. This process was replicated where possible through the seven databases mentioned above by using the successful technical terms sequentially followed by the three keywords: "Definition" OR "concept" OR "determinant". A wildcat operator, i.e. "*", was inserted as a suffix to capture all permutations. The research included all the articles published before July 2019. A total of 1,057 articles were found, of which 650 were screened after deleting 407 duplicates.
Study inclusion
Peer-reviewed research articles on the SA concept, conducted through quantitative, qualitative, or mixed methodology in community-dwelling older adults, were included. When an author published several articles with the same techical term, the most relevant ones were taken into account according to the inclusion criteria. Included articles were then rated for relevance to our study objective.
We excluded book reviews, short comments, letters, and papers which had a specialized focus solely on biology, physiology, immunology, genetics, laboratory or animal research, practical therapy, etc. Studies conducted in older adults with specific pathological conditions (e.g., HIV, frailty, cancer, Alzheimer's disease) were excluded since the perspective of this review is the SA in the general older population.
The title (first) and abstract (second) of each article were reviewed in order to identify relevancy for full-text extraction. Forty-three articles were selected for full extraction (Figure 1).
Inclusion flowchart of the screening process for study inclusion
*Specific subject on biology, physiology, immunology, genetics, laboratory or animal research, practical therapy, odontology, nutrition, etc. †Specific pathological conditions e.g., HIV, frailty, cancer, Alzheimer's disease.
Included studies
The global search strategy identified 1,057 articles. After exclusion of the duplicates, the screening on title (n=650) and abstract (n=218) finally led to 43 studies that met inclusion criteria for full-text extraction (Figure 1). We distinguished 19 quantitative, 23 qualitative and 1 mixed-method studies that are summarized in tables 1 and 2 displaying: Authors, year, country, age population, study design (cross-sectional/longitudinal), sample size, models, operational definition, and main results.
As may be seen in tables 1 and 2, the majority of the studies (19 of the 43 studies) were conducted in the United States. The sample size ranged widely from 15 to 17,886 and the age of participants from 15 to 102 years. Nearly half of the studies used quantitative methods and half qualitative methods (one study used mixed). Interestingly, the two thirds were published in the last ten years.
Operationalization of SA and the Outcome Measures of Quantitative Studies
OR= odds ratio; IC= confidence interval; Non-standardized coefficients; HR: hazard ratio; SA=Successful Aging, QoL= quality of life; RR= relative risk; MCI= mild cognitive impairment; Receiver operating characteristic= ROC; AUC = Area Under the ROC Curve
The Conception of SA by Integrating Older People's Views in Qualitative Studies
A healthy aging trajectory could be more than only "successfully"?
Our literature review highlighted three main approaches of successful aging: 1) The biomedical models "focusing largely in terms of absence of disease, frailty or dependence and the continued maintenance of the physical and cognitive functions" as the main elements; 2) The psychosocial perspectives which emphasize the quality of life, engagement in social activities, and personal or community support; 3) The laypersons' perspectives models which refers to people's conceptions regarding what it means to age well.
Models mainly biomedical
The biomedical models of SA are mainly based on "the optimization of life expectancy, taking into account high physical and mental functional performance, mobility, and high levels of independence" (16, 17).
In this sense, an approach combining both mortality and morbidity would be relevant to define SA, such as the Disability-Free Life Expectancy, the Disability-Adjusted Life Years (DALYs) (18) or the Disability-Adjusted Life Expectancy (DALE) (19) (Table 3). Those global measures of population health provide a useful assessment of the impact of premature death and disability and other non-fatal health outcomes in the short and long term, but these indicators are probably not subtle enough to cover all the dimensions of SA.
This multidimensionality is proposed in the Rowe and Kahn's model which is a reference in the literature of SA. It relies on disease and disability, cognitive and physical functioning, and participation in social activities (5). Even though this model has been widely applied, it has several important limitations. First of all, on "normal" aging (non-pathological) the model distinguishes "usual" or "successful" aging, excluding aging people with diseases (pathological aging) from SA. Considering SA as disease-free is quite unrealistic and too restrictive. Indeed, as recently underlined by the WHO (20), above a certain age category, most of older persons have one or more diseases, which, when well controlled, have no or little influence on their wellbeing. This approach which only considers two non-pathologic groups of older people, i.e. "usual" or "successful", does not reflect the considerable heterogeneity among older adults (21). The group called "usual" (non-pathologic but at high risk) involves people presenting a normal decrease in physical, cognitive, and social functioning concerning age whereas the group called "successful" (at low risk and high functioning) refers to high levels of physiological and cognitive functioning. Finally, this model does not take into account the self-perceived dimension of SA, making it primarily medical and objective (22) (Table 3).
Multiple models of technical terms in Successful Aging with respect to operationalizations and outcomes
Note: LY= year prevalence; Q= disability weight; PYLL= years of life lost due to premature death; BWB: Physical well-being; RMSEA= Root mean square error of approximation. *=Weights closer to 1 imply that a year spent in that condition is perceived as being more equivalent to death than to a state of health; †=Percentage of Participants Aging. Successfully by Definition of Successful Aging and Individual Characteristics for; ‡= These five domains are each individually well documented in the research literature; §= Percentages are weighted; **= p<0.001 for age groups. 1= Northern: Denmark, Sweden, Estonia; 2= Western: Austria, Belgium, France, Germany, Luxembourg, Holland /The Netherlands, Switzerland; 3= Southern: Italy, Spain; 4= Eastern: Czech Republic, Slovenia
Towards a more holistic approach: the introduction of psychosocial and environment factors
The current view relies on an holistic conception of SA that encompasses physical and cognitive functioning (23, 24), autonomy (25), independence (26), environment factors (living environment) (27), financial security (28), social, family and couple relationships (29, 30).
In this context, an initiative emerged from the 21st-century aging research agenda developed by the United Nations and the International Association of Gerontology and Geriatrics in 2004, the Global Research Network on Ageing (GARNet) (31) (Table 3). GARNet is a collaborative project of "aging-well" which uses the GARNet index that measures the five following domains: physical health and dependency; mental/cognitive effectiveness; social support resources; daily life activity (engagement), and material security. This initiative promotes the adoption of aging-well strategies that enable health and well-being, which is essential for extending life span and quality of life. Aging-well, it relies on individual behaviors and life-course material and social environments that limit functional decline (mainly caused by chronic conditions) to help older adults maintaining their independence and health (31). In this sense, it progressively decenters the approach from pure health; well-being becoming the central goal of the model along with quality of life, which increases the scope for enjoying the additional years of life. Showing high levels of well-being in older adults should not be overlooked since it is becoming an increasingly important goal for older adults themselves, caregivers, and also physicians (15). In fact, it has been shown that up to 45-50% of older people express satisfaction with their aging process even though they are poorly performing on objective measures (6). This finding can be seen at first sight as a paradox since with advancing age, older adults experience higher levels of well-being, until about 3-5 years near the end of life (26). Well-being is an integral component of adding life to years in an increasing longevity context, emphasizing the need for a multidimensional definition of SA (32).
In 2014, the WHO's term proposed in a policy framework such as Active and Healthy Aging (AHA), as "the process of optimizing opportunities for health, participation and security in order to enhance quality of life as people age" (33) which became widely accepted, but without general agreement on what its application really means. So, the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) provided the use of operational tools to serve this purpose (34) with a focus on the relationship between activity and health. Since then, the concept was enriched with the addition of "active" as an extension of the concept for "healthy aging" being still more holistic and inclusive, encompassing different domains (e.g. social, economic, cultural, spiritual and civic affairs) (35) (Table 3). The AHA aims to lengthen life expectancy and delay functional dependency, thus preserving autonomy. The AHA working definition lists several steps to achieve these goals: 1) a multilevel approach of the AHA is necessary in order to determine the different items that must be considered; 2) it is necessary to find the tools that allow achieving the multilevel definition; 3) tools should be used in a single questionnaire; and 4) psychometric measurement capacities should be evaluated. However, at the same time, the AHA definition raises fundamental concerns both on structural and economic barriers. In addition, active aging and SA focuses on "youthful" activities that emphasize health and independence in a very ambitious way, which could lead to a form of stigmatization, i.e. "youthism", if this level of activity is not reached. On the other hand, the economic downturn in different parts of the world could lead to material difficulties and with the resulting loss of opportunities for activity.
More recently, in 2016, the World Health Assembly reframed the components of healthy aging as part of the global strategy and plan of action on aging and health. This framework views healthy aging from a functional rather than a disease-based perspective as "the process of developing and maintaining functional ability that leads to well-being in old age" (20). Functional ability is determined by the person's intrinsic capacity (i.e. all the individual physical and mental capacities that a person can draw on in daily life), the relevant environmental factors (i.e., all the resources or barriers that will determine whether a person can engage him/herself in activities or not) and the interaction between the two. Functional ability is defined as the health-related attributes that enable people to be and do what they have reason to value (i.e., meeting basic needs; learning, growing and making decisions; moving around; building and maintaining relationships; and contributing). Using the International Classification of Functioning, Disability and Health (ICF) (36) framework as background in order to facilitate the translation of the current theoretical model into practice, it is important to identify the inner nature of its constituting constructs, in particular, the constituent elements of the central construct of intrinsic capacity (i.e. locomotion, vitality, cognition, psychological, vision or hearing) (Table 3).to know where to observe, what to measure and how to monitor. Consequently, healthy aging shows the continuous interaction between intrinsic capacity of individuals in link with the environments they inhabit (supportive or barrier): appropriate and integrated care (technical and medical products, artificial replacements, transplants…), technical aids (auxiliary device, such as a walking stick, wheelchair…), social resources on which the older person can rely on, the use of technologies or support for multiple services (accessible stores, banks and professional services) (20, 37). The health policy of the Global Strategy and Action in this area is generally in the framework of the notion of age-friendly environments, involving both physical and social components (20).
Laypersons' perspectives
Qualitative research contributed to improving the conception of SA by integrating older people's views (38) which have essential implications of what individuals consider as SA for complementing traditional models (39), which are predominantly studied by models based on quanlitative approach.
Lay perspectives include a broad framework of criteria that combine basic resources (Table 2 and 3) (functioning (23), social health (40), financial security (41), family and intergenerational care (42) psychological factors (mental) (29), personal attitudinal (43), life satisfaction (35), positive outlook (44), self-consciousness (45), behavioral strategies (resilience (42), coping (44), contribution to life (26), accomplishments (29), productivity (35), learning new things (46), adaptation to an aging body (28) and beliefs (spirituality (27), having a sense of purpose (47), cultural variations (9), among others.
On the one hand, studies suggest that lay perspectives in SA give a great value to the importance of the psychological aspects of older adults, as accepting oneself, including the development of a realistic self-appraisal and a review of one's past experiences "I've never felt more authentically me, ever, than I do right now. And it's just so cool…" (45). On the other hand, this approach also focuses on social environments of older adults, the importance of active engagement with life and growth, including novel, productive, and social engagement, and the value of a positive attitude: "Keep your old friends, make some new ones, don't isolate yourself" (45, 48). As a result of these model, the concept of SA is explored across cultures experiences and values that the population can express, as individuals provided with a conscience, language, and will (what is capable of value).
To illustrate the complementarity of older people's perspectives with other traditional approaches of SA. A Dutch research on octogenarians with qualitative interviews compared the meaning of SA between two approaches; one based on laypersons' perspectives and the other on the bio-psychosocial approach (major disability, cognitive impairment, depression, and regular social activities). According to this latter definition, only 10% of the participants were categorized as SA, compared to 81% of the participants as SA rated by laypersons' perspectives definition. As a conclusion of this study, older persons view SA as a process of adaptation (e.g., thanks to strategy of coping or resilience) and maintain high levels of well-being despite disease or disability (42). Rather than a state of sole physical or mental efficiency, where the presence of a disease in old age excludes from successful aging. SA should also integrate laypersons' perspectives, as recently recommended by the WHO (20), where healthy aging is based on what people have reason to value and not the absence of disease. According to this approach, more persons could be considered to be successfully aged.
An essential resource for both personal and community development is the aspects of sustainability, which promote a more dynamic process of well-being in aging, such as financial security, which allows the use of resources such as health services, social activity, and civic participation (49).
However, despite its increasing importance in the literature, limited evidence has been provided to assess how the views of laypeople on SA brings added value to the concept of SA.
Our literature review aims to identify divergences and convergences from different technical terms of "successful aging" across quantitative and qualitative studies. This review confirms that since the initial coining of the term SA more than 50 years ago, the conceptualization and operationalization of the concept remains controversial and tricky to achieve. Many definitions of SA emerged and with them, multiple research methods, including unidimensional (14) or multidimensional (32) approaches, models based on objective or subjective (50)criteria, with qualitative or quantitative or mixed methodology, following a continuum (51) or through dichotomous profiles.
One of the lessons learned is the increasing importance given to the personal perspectives of the older persons. A recent review of operational definitions of SA reveals that there are more than twice as many studies that postulate operational definitions of SA as studies that examine lay perspectives of SA (52). As recommended in the Healthy Aging concept proposed by the WHO (20),the SA approach should be centered on what is important to the person and the ways (medical and environmental) to reach this goal. As they age, individual's place a high value in the achievement of social goals, frequently related to family (partner, children and brothers/sisters) and leisure activities, or receiving emotional care (e.g. the care of the partner) (28, 43, 53, 54). In this sense, SA needs to be multi-dimensional and be seen as a continuum instead of dichotomized (successful versus unsuccessful) category, and needs to incorporate layperson's perspectives for social significance, to be sensitive to differences in opportunities to age successfully and to variations in values between cultures (29, 55, 56).
This review also evidences the profound heterogeneity in the operationalization of the SA concept. The activity and social engagement elements (6) were identified as those reported most frequently. In addition, elements as economy and nature are absent in most conceptualizations of the SA. In this field, many authors addressed the topic of SA with their own outcome measures, assuming an adequate approach without much attempt at conceptual or theoretical definition. The SA models vary from pure biomedical (57, 58) (solely based on physical and cognitive parameters -e.g., studies on healthy life expectancy-) (59), to pure psychosocial (holistic conception –e.g., age-friendly environments-) or the lay models (older people's views), while, some others, postulate intrinsic interactions among the different dimensions, which evidence the complexity of the term "successfully" in the aging process. Finally, another issue results from the fact that some parameters are used to define SA in some studies, whereas in others they are considered as outcomes. For instance, life satisfaction is assumed to be an essential predictor of SA while it is also defined as a significant outcome of SA (35).
This review has limitations. First, it was not possible to classify studies by technical term, due to the wide overlapping of the approaches used and the lack of clarity regarding the theoretical definitions, as mentioned above. We also limited our research after 65 years of age and only focused on the most frequently used models of the literature (limiting our research on six successful technical terms).
The main strength of our review is that it included both quantitative and qualitative studies. Considering such a range of studies allowed highlighting significant divergences between biomedical conceptualizations of SA and layperson's perspectives approaches.
Healthy aging is an interrelated multidimensional process profoundly heterogeneous, with significant variations between individuals in the experiences lived. For healthy aging trajectories, an optimal approach should be one's in terms of functional capacity, psychosocial abilities, environmental factors across the life course and also subjective assessments of one's own criteria. This operationalized definition is crucial to provide pragmatic tools able to identify older adults with potential risk of "unsuccessful" aging and also ways to improve healthy aging trajectories of individuals. Therefore, the need for a consensual and operational definition is becoming a necessity not to say an emergency to face the public health, social, economic and individual challenges induced by our fast-aging populations.
Acknowledgments: The authors thank Coralie Thore for providing assistance with documentary support. AZR in appreciation of Mr. Pierre and Mrs. Aline Costet for your splendid hospitality during the summer of 2020.
Author Contributions: AZR and KP planned the review and search protocol; AZR wrote the paper review and conducted the data extraction. KP contributed to draft revisions. JFD and HA reviewed this paper.
Funding: The Fondation pour la Recherche Médicale (DOC20161136217 to AZR) supported this work. Funding has no role in the design, analysis, or preparation of this manuscript.
Ethical approval: Not required.
Data sharing statement: No additional data are available.
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THE USE OF FIGURATIVE LANGUAGE TO DESCRIBE FRAILTY IN OLDER ADULTS
B. BUTA1,2, D. LEDER3, R. MILLER1, N.L. SCHOENBORN2, A.R. GREEN2, R. VARADHAN1,4
1. Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland, USA; 2. Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore Maryland, USA; 3. Department of Philosophy, Loyola University of Maryland, Baltimore, Maryland, USA; 4. Division of Biostatistics and Bioinformatics, Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA
Corresponding author: Brian Buta, MHS, 2024 E. Monument St., Suite 2-700, Baltimore, Maryland. Phone: 410-502-3412. Email: bbuta@jhu.edu
J Frailty Aging 2018;7(2):127-133
Published online March 7, 2018, http://dx.doi.org/10.14283/jfa.2018.9
Introduction: Frailty affects 15% of non-institutionalized older adults in the United States, yet confusion remains in defining and, in turn, assessing frailty. Figurative language, such as metaphor, can help to explain difficult scientific concepts and to form new theories. We aimed to examine the use of figurative language to describe frailty and to identify themes in the way figurative expressions are used. Understanding how frailty is described figuratively may offer insights for developing useful communication approaches in research settings. Methods: We performed a comprehensive review of editorials in the scientific literature to explore figurative language used to describe frailty in older adults. We categorized themes among the figurative expressions, which may help to inform how to effectively communicate about frailty. Results: We found 24 editorials containing 32 figurative expressions. The figurative expressions conceptualized frailty in six ways: 1) a complex, multifaceted concept; 2) an important issue in health and medicine; 3) indicative of something that is failing or faulty; 4) indicative of fragility; 5) representative of vulnerable, ignored persons; and 6) an opportunity for self-awareness and reflection. Discussion: Our review highlights the heterogeneity in depictions of frailty, which is consonant with the lack of a standardized definition of frailty. We also found a novel aspect to the concept of frailty, which merits attention: frailty characterized as an opportunity for self-awareness and reflection. Figurative language, which often juxtaposes familiar with challenging, complex concepts, can offer insights on issues in frailty research and holds potential as a tool for researchers to improve communication about this important and debated medical condition.
Key words: Frailty, review, health communication and language.
Frailty is a recognized public health problem that has been estimated to impact nearly one out of every six non-institutionalized older adults in the United States (1). Research over the past two decades has led to a refined conceptualization of frailty as a state of physiological dysregulation that can lead to catastrophic health declines for persons encountering a stressor event (2, 3). However, the lack of an accepted working definition of frailty has led to complications for the field, most notably an ongoing confusion about the meaning of the word 'frailty' when used in research and scientific writing. While sometimes specifically defined, frailty is also used as a general synonym for vulnerability, poor health, functional decline, or old age (4). Part of this lack of clarity is due to the choice of the word itself; the term "frailty" is vague and difficult to precisely pinpoint (4, 5). Even when defined, confusion persists as to whether frailty should be assessed as a unified, biologically-driven phenomena (i.e., frailty phenotype) versus a cumulative effect of aging-related signs and symptoms (i.e., deficit accumulation index) (6). Frailty holds significant potential for risk prediction and clinical-decision making (7), though more guidance is needed on how to best incorporate it, and which measure(s) to use, in clinical settings (8).
The communication of scientific and medical concepts, such as frailty, is an important component of the research process, as well as clinical practice (9, 10). In scientific discourse, figurative language can serve as a communication tool for the purposes of pedagogy and critical explanation, and for theoretical and constructive conceptualization (11, 12). Figurative comparisons, such as metaphor, often use a familiar concept to help explain or theorize on a complex or lesser known concept. Using these techniques can help to make abstract concepts tangible and describe novel hypotheses in familiar terms. For example, a metaphor of war has often been used when depicting the scientific enterprise to understand the complicated mechanisms of cancer and its potential cures —a "battle against cancer" in which the patient must fight an invasive enemy (13, 14). In another example, discoveries in genetics have led to changes in the use of figurative expressions over time: first, a "blueprint of life" to give an architectural tangibility to the human genome; and, later, "pianists" that "play" the static genetic information in DNA to describe epigenetic processes (15). Figurative comparisons may sometimes oversimplify, be reductionist, or even misshape and inhibit a more accurate understanding of scientific phenomena (16-18); for example, there are limitations to the utility of the war metaphor in cancer, especially given that surviving cancer may depend on many factors outside of how hard a patient "fights" (13, 19). Yet, the ability for figurative language to provide a view of one concept through comparisons to another holds value: these expressions can "often transcend the merely descriptive to yield profoundly enlightening insights" (20). Figurative techniques may offer novel and unexpected comparisons, and can also allow for relatable descriptions free of scientific jargon. Through such insights, figurative language may help to improve understanding and communication about complex scientific concepts – here, frailty – and may resonate more readily in research and in clinical practice.
In the following review, we identified figurative language that has been used to describe frailty in editorials among the academic research literature. Figurative expressions are more often found in editorials than in standard investigational articles, due to the typically unstructured and opinion-based nature of the editorial (21). We aimed to categorize the purposes of these figurative expressions, and to consider whether the use of figurative language can help to highlight common themes and provide insight into the ways researchers conceptualize and communicate about frailty.
We performed a comprehensive literature review to examine if and how figurative language has been used in editorials to describe frailty in older adults. We limited our search to editorials for two reasons: 1) editorials are typically opinion-based and may contain language with more "literary flair" (22) (see also Segal (21)); and 2) feasibility in terms of search size. Our search was conducted from the start of the following databases through December 31, 2016: PubMed; EMBASE/MEDLINE; and CINAHL Plus/CINAHL/MEDLINE/PsycINFO combined. Please see the supplementary file (Appendix 1) for the specific search terms used in each database.
Citation files from each database were combined in EndNote X7, where de-duplication was performed. The first author (BB) reviewed the titles/abstracts of these articles and removed articles that did not focus on frailty. The full texts of the remaining articles were reviewed by two authors (BB, RM) to identify examples of figurative language, such as metaphor, simile, analogy, and other figurative techniques (23). See supplemental file, Appendix 2, for definitions.
Once identified, we analyzed the content to determine the purposes of the figurative language used, and classified expressions into categories that were generated inductively from this review. These categories, their definitions, and examples are described in the results section.
Our search identified 703 unique editorials (see Figure 1). After cursory review of titles and abstracts, 427 records were excluded for non-relevance. The remaining editorials were retrieved to review for the use of figurative language to describe frailty; 37 articles were further excluded for being unavailable or only in a non-English language. Of the reviewed 239 editorials, we found 24 editorials that included figurative language used to describe frailty. Table 1 summarizes these editorials, which were published between 1983 and 2016.
Systematic literature search for editorials on frailty
We identified 32 examples of figurative language used to describe frailty in these 24 articles. The most common figurative technique was metaphor, followed by analogy, simile, allusion, and allegory (see Appendix 2). After identifying figurative depictions of frailty, the purposes of the language used were classified into the following six categories:
(1) Frailty as a complex, multifaceted concept: figurative language used to describe the complicated, intricate, sometimes evasive, nature of frailty, its etiology, ascertainment, and/or treatment;
(2) Frailty as an important issue in health and medicine: figurative language used to highlight the significance of frailty identification or treatment;
(3) Frailty as indicating something that is failing or faulty: figurative language used to compare a frail person to a broken or decaying object or process;
(4) Frailty as indicating fragility: figurative language used to compare a frail person to a fragile or delicate object, which can be easily broken;
(5) Frailty as representative of vulnerable but ignored persons: figurative language used to equate frail persons with images of neglect.
(6) Frailty as an opportunity for self-awareness and reflection: figurative language used to describe the potential of the (physically) frail state to facilitate a greater attention to non-physical, spiritual, or self-reflections.
See Table 1 for information on the identified articles and figurative expressions, organized by category. Out of six categories, figurative language was most commonly utilized to discuss frailty as a complex, multifaceted concept. The complicated nature of understanding, measuring, and treating frailty was presented with comparisons to hard-to-define concepts such as beauty (24), and emergent, hard-to-predict phenomena such as the weather (25). In terms of taking a measurement of frailty, necessarily a dynamically changing process, a figurative comparison was made to the difficulty of predicting the future speed of a car based on its characteristics at a stoplight (26). The treatment of frailty was compared to: the use of complex military strategies (27); a metaphor that frailty treatment may never have a "one-size-fits-all" solution (28); and an allegory of the Greek myth of Eos to question whether or not extending life span will simply extend frailty (29, 30). Other expressions depicted frailty as something that we are only beginning to recognize but still need to understand fully; in these examples, frailty was compared to a "figure in the stone" that is being carved out (31), or the "underwater part of the iceberg of aging" (32). These examples of figurative language all represent attempts to illustrate frailty as a complex, hard-to-define state.
Figurative language used to describe frailty, organized by six categorical purposes of use
The importance of frailty was evident in metaphors that compared it to one of the "cornerstones of contemporary health care for older people" (33) and a "public health time bomb" (34). Both the importance of frailty and the elusiveness around it are well-summarized by comparing frailty to the "Holy Grail" (35, 36).
Regarding properties or characteristics of those who are frail, we found comparisons of frailty to a failing or faulty entity. A frail person was compared to a "rickety car running out of gas" (37). In another example, a frail body was described as "irrational, the transient…the testimony to finitude, imperfection, and eventual death" (38).
A fourth category of expressions depicted frail persons as fragile, comparing them to delicate objects or as caught in vulnerable scenarios. Surgery in frail patients was described as like "knocking a porcelain figure off a table" (39), and treating frail patients was compared to "balancing on a tightrope" (40).
Frail patients were also depicted as a vulnerable but overlooked population in the health care system. Expressions within this category included describing frail persons as a "footnote" (41), "missing from the medical radar" (42), a "'lost tribe'" (43), and an "elephant in the operating room" that is under-recognized and under-treated (44).
Lastly, frailty was described as an opportunity for self-awareness and reflection, using comparisons to a "lens" and "mirror" (42). One example described frailty as one "color of existence" that is "especially strong", suggesting it may impact or strengthen one's sense of self (38). Another example characterized frailty as an important, even positive, part of the human experience – "a limit and a freedom… a beloved whose so-called imperfections are an essential part of the whole" (38).
To our knowledge, this is the first literature review of the uses of figurative language to describe frailty in older adults. We found 32 examples in two dozen editorials that used figurative techniques to depict frailty. We identified six categories in which figurative expressions have been used to describe frailty, and found the most frequent purpose was to describe frailty as a complex, multifaceted, and often elusive concept.
In our first category, frailty was figuratively compared to complex and evasive concepts, which may reflect, or even result from, a lack of operational agreement and the numerous definitions used in research and clinical practice (45). Figurative language about frailty was also used to discuss key conceptual issues, such as: a) whether frailty measures should be dynamic versus static (5) in the figurative example of predicting the future speed of resting car (26); and b) whether the underlying primary and secondary causes of frailty can be better understood (46) in the metaphor of the submerged ice below an iceberg's tip (32). From examples in our categories related to faulty or fragile objects, figurative language has also depicted a conceptual distinction between frail persons as those who are already presenting with evident symptoms and health problems – the "rickety cars" – versus those who are fragile, delicate and vulnerable of being easily overcome by stressors – the "porcelain figures". This type of debate has ensued for more than a decade (47).
We would argue that figurative depictions, such as an easily relatable metaphor, can be helpful to the field by using commonly-understood comparisons to elucidate and speculate on unresolved topics in frailty research. To begin, metaphoric language can highlight and clarify a known problem with a new and unexpected comparison. For example, it has been argued that frailty assessments that focus solely on the static characteristics of a patient may not provide the information needed to understand the risk for serious declines and adverse outcomes; this critique of static measures has not been widely addressed beyond acknowledgment that collecting dynamic measures is more challenging. By figuratively comparing this issue to the clear difficulty of estimating the probable speed of car at rest, the point becomes more salient and relatable, despite the challenges involved with dynamic measurements.
Additionally, figurative language can add an emotional context that may highlight the severity or importance of an issue. A striking example is the statement "our gerontological souls are still bleeding" in the editorial by Ferrucci and colleagues, a comment that the existing definitions of frailty feel incomplete (30). The description of frailty as a "public health time bomb" is another dramatic example (34).
Some figurative and metaphoric language can exacerbate ageist stereotypes and make it challenging to communicate about frailty, especially to patients. In response to this type of concern, the Journal of the American Geriatrics Society recently changed its author guidelines to curb the use of negative, even catastrophic, aging-related terms (such as the common metaphor of the silver "tsunami"), which have been determined to be damaging to perceptions of aging (48). In our study, the metaphor of a "rickety car running out of gas" (37) to describe a person who is frail depicted undesirable, body-centric traits of deterioration. Also, certain metaphors seem to depict frailty as potentially insurmountable; the allusion to the Holy Grail, the iceberg metaphor, and the "public health time bomb" all describe frailty in fatalistic and overwhelming terms. Though many challenges remain, much progress has been made in understanding the etiology, measurement and treatment of frailty during the past two decades. A more apt metaphor, therefore, can be seen with the analogy to sculpting, which states that approaches toward studying underlying causes of frailty «will begin to make the figure in the stone visible» (31) and that through rigorous, often time-consuming scientific investigations, answers to presently daunting questions can be reached.
Our finding that frailty may be characterized as an opportunity for self-awareness and reflection is unique and differs from the conventional medical view of successful aging (e.g., without physical declines). Frail patients have expressed that issues of spirituality and meaningful activities are lacking in the existing definitions of frailty, and that the ability to maintain a sense of self in spite of losses can foster frail older adults' well-being (49, 50). Aging and frailty have been proposed as providing an opportunity for the significant development of understanding and embrace of change, letting go, and loss (51, 52). In the "spiritual model" of aging outlined by Leder, aging itself can awaken a time of profound meaning in the lives of older, frail adults: "the very losses of aging can be recontextualized as modes of liberation. They awaken us to what was insubstantial in our previous lives. They allow the time and focus to re-form the self" (51). In this regard, frailty need not always be associated with that which is fragile and/or broken: rather, individuals can be strengthened by meeting the challenges of a frail body. Our findings provide examples for language that could help communicate a more positive and holistic concept of frailty, such as frailty as "a lens, through which differences can be appreciated" (42). Given a lack of evidence regarding what older adults know or want to know about frailty, this may offer an interesting new model to discuss some of the more positive, reflective aspects of aging and frailty.
The word "frailty" has given rise to many connotations, as depicted by the variety of figurative language found in this review, and evinced by the numerous definitions of frailty in the literature (45). This conceptual confusion about frailty has likely contributed to the proliferation of definitions and assessment instruments, as well as a variety of figurative expressions. The multiplicity of definitions has arguably hampered progress in research and clinical translation, especially by creating uncertainty about how to optimally assess frailty, and by conflating findings when frailty is measured with different instruments without consideration of the differing components of each assessment method. Also troubling, the terms "frail" and "frailty" continue to be used in research as catch-all adjectives for decline or old age with no specific meaning provided (4). Therefore, the use of the term and the figurative language used to characterize "frailty" must be done with thoughtfulness and precision; otherwise, alternative terms to capture the notion of critical declines in age-related physical and cognitive functions may be warranted. The following passage reinforces this idea:
"A new metaphor dramatically shifts perceptions of aging… by comparing the process of aging to building momentum, researchers as communicators can open a new way to thinking and talking about aging—something counter to currently available cultural idioms such as "fighting" aging or the importance of "staying young." An innovative test of how messaging can affect people's implicit associations showed that this metaphor reduced ageist attitudes by a remarkable 30%." (48).
This supports the need for being more thoughtful about how we use figurative language to describe frailty. There appears to be room for improvement based on some of the metaphors identified, e.g., "rickety cars", "lost tribe", or frailty as a "testimony to… eventual death".
In reviewing figurative language used to describe frailty in editorials, we identified categories that represent issues facing frailty research. Figurative language allows one to "test" concepts by using real-world comparisons; and it offers communication pathways that can function across disciplines. Creative comparisons that elucidate key problems facing the field may provide insights into evolving areas of frailty research and potentially point toward solutions to the lingering questions of how to meaningfully communicate about frailty. Frailty characterized as an opportunity for self-awareness and reflection is one such novel model of communication that merits serious consideration.
Acknowledgments: We thank the members of the Johns Hopkins Frailty & Multisystem Dysregulation Working Group for ongoing intellectual stimulation on the topic of frailty; the leaders of the Older Americans Independence Center (Drs. Walston and Bandeen-Roche) for their support; and Qian-Li Xue, PhD, and Michael B. Tager, MFA, for reviewing an early version of this manuscript and providing helpful input on the frailty-related content, and on definitions and classifications of figurative language, respectively. We thank the reviewers for their insightful comments.
Funding: This work was supported by the National Institute on Aging [P30AG021334 to B.B., R.V.]; the National Center for Advancing Translational Sciences [KL2TR001077 to N.L.S.]; from the American Cancer Society [CCCDA-16-002-01 to N.L.S.]; and American Geriatrics Society's Health in Aging Foundation [T. Franklin Williams Scholarship Award to N.L.S.].
Conflict of interest: None.
Supplementary materials: Online
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With Thanos having become the snappiest dresser in all of Marvel, thanks to Infinity Gauntlet in the recent Avengers: Infinity War movie, it only makes sense that we look back to his origins with an article. His comic origin is actually really bizarre. You see, he didn't start out as an Avengers villain. Or a Guardians of the Galaxy villain. His first appearance was in February 1973's The Invincible Iron Mab #55, though he's not the only major player to make a first appearance.
Guest-starring Drax the Destroyer as the Kool-Aid Man!
The Blood Brothers! Yes, the newest stars of the Marvel Cinematic Universe and the deadliest enemies of the universe, Gary and Ross Blood!
Ok, you got me. It's not the Blood Brothers, though they're still around to this day (and yes, that was their real names). As you can plainly see, Drax of the Guardians of the Galaxy is proudly showing up in the background of the cover, making like a wrecking ball. He looks a little different from his recent appearances in the MCU. This is thanks to body reboot that Drax went through in 2005 that also rebooted his mind. Because comics are nothing if not convoluted.
Today's story, "Beware the… Blood Brothers!" has some unique credits. This is one of Jim Starlin's first works for Marvel as an artist, and his first writing credit. As such, Jim Starlin gets credited as responsible for "Plot, Pencils, and Character Concepts." Mike Friedrich, who was the main writer on Iron Man at the time, also got credited as a scripter (meaning he supplied the dialogue after Starlin crafted the plot and penciled the story). Mike Esposito applied the inks, but there's no one listed for the colors. This is typical for the era, which is a shame considering how awesomely 1970s the whole thing is.
Starlin begins his story with the dramatic introduction of Drax the Destroyer, chained up and surrounded by Kirby krackle. He shouts with a gravelly voice a warning for Iron Man. He begs that Iron Man beware the Blood Brothers! However, his warning seems to have come a little late.
Just another day in the office, eh Tony? Luckily, Tony built his suit to take a pounding, and is able to escape the armlock, only to be pounded on worse, crushed under his office desk, and then knocked out by a punch to the jaw. The Blood Brothers then summon their spaceship and take him offworld for… reasons.
We cut over to Drax being interrogated by Thanos, a being sitting in a comfortable looking techno-chair. He is, however, a little more energetic in his speech.
Drax thinks back to earlier in the day, when he reached out mentally to talk with Tony Stark across the cosmos. Why Tony, we never really find out. Tony ditches the important business meeting going on, and he suits up as Iron Man to figure out what was going on.
So Drax mind-blasts him a second time. Class act, that Drax. This time, though, he performs an awesome infodump into Tony's brain.
Drax fills Tony's head with images of Titan, also Saturn's largest moon. Of science, of beauty, of purple people. Amusingly, this would later be retconned that only Thanos would be purple, and later reprints would try to ignore it. Long story short, all was happy until Thanos made weapons. Since this was a bad thing, he was kicked offworld, and subsequently vowed revenge.
Mentor, Thanos' dad, wanted assistance. So he basically asked God to make something that would kill Thanos: Drax the Destroyer!
...and was promptly defeated. Thus, he called for Iron Man because reasons, and brought Tony into his current predicament. It's still not explained at all, but Iron Man is able to escape the Blood Brothers by shooting them with repulsor rays and fleeing. Tony also tries to free Drax, but Thanos then makes his grand appearance to everyone by stomping on Tony's hand as he lies on the ground.
Thanos believes in no-pants Friday at the workplace, I see. He calls for the Blood Brothers to take Tony away once more, but Iron Man strikes out with his Uni-Beam and frees Drax from his bonds. A fast fight scene ensues, with the cover-advertised foes being beaten in a mere two pages.
Thanos himself then approaches the heroes, making grandiose threats. In this case, should he throw a large switch, the fortress they're all in will explode. Drax shoots Thanos with an energy blast from his hand (which he used to do all the time) while Tony Stark comes in for a left hook to the jaw. Which makes Thanos' head explode.
Because he's a robot, of course. The real Thanos ran off and left a booby trap behind to try and kill anyone who remained. Of course, it didn't work.
Thanos' first appearance is surprisingly boring compared to what he would become. He doesn't do much, sn't te big threat of the comic, and doesn't even stay to fight the good guys. However, there's something undeniably cool about Thanos, even back when, and Jim Starlin would write the hell out of him over the following decades.
Also, at one point, Thanos got a helicopter with his name on the side.


I've never really made New Years resolutions, and certainly not food centered resolutions. I think they are cursed and doomed to failure simply because of all the inflated build-up. So how did I find myself making a "January challenge"?After reading an article in Bon Appetite about this big wig food critic who eats vegetarian for the month of January as a way to cleanse his pallet so to speak and give himself a break to start out the new year. It kind of resonated with me and got me thinking. In the summer it is easy to eat "mostly plants" and have meat as a side dish but as soon as the days get short and cold and the only moderately local thing is kale it gets hard. I realized that we ate almost exclusively meat, carbs and starches with a little kale thrown in for good measure. I started to notice how heavy I felt all the time. So, a January Challenge. We challenged ourselves to eat vegetarian for the month of January, not to lose weight or as some lofty goal for 2011 but as a way to challenge us to get our nourishment from food other than meat. To force us to incorporate more fruits, vegetables and whole grains. To really make me think about what I am cooking and eating every day.
Its been challenging, the first few days we ate pizza (whole wheat crust with veggies!), take-out (with tofu instead of chicken), and quiche (without bacon). Humm… I've got to put some thought into dinner for a change. Last night I searched the vegetarian food blogs and cookbooks and came up with a list of things to try, starting with a tempeh curry. It was really good, and a great quick dinner. We had it over couscous with some Trader Joe's Naan. Definitely one to add to the dinner rotation even after our January Challenge.
My other "not-a-resolution" resolution is to effectively and consistently use social networking and media for the blog. What does that mean? I'm actually going to post updates, photos, and engage in discussions using Facebook and Twitter. So, you should click on the link up there on the right to "like" our Facebook and "follow" our Twitter.
The original recipe calls for tempeh, which I found quite bitter (is this normal or just the brand I bought??), so in the future I will swap it out for chickpeas. You could also add carrots or cauliflower. Come to think of it, sweet potatoes might be really good too. If you want a vegan meal you can replace the cream with coconut milk. Also, the spices listed below make a pretty spicy curry, I dialed them back when I made it and it was plenty spicy.
Toss the potatoes with a splash of olive oil, salt and Garam Masala. Lay out on a baking sheet and roast in the oven for about 20-30 minutes, until the potatoes are slightly crispy and cooked all the way through.
While the potatoes cook, heat oil and butter in skillet, add onions and cook on medium-low heat until soft. Stir in cumin seeds, curry powder, turmeric, and cayenne powder. Stir to mix and cook until aromatic, about 30 seconds. Add the tomatoes, water, and 1 teaspoon salt. Stir to mix. Remove from heat.
Once the potatoes are done, remove from the oven and allow to cool slightly. Add cream to sauce and stir to mix. Return to heat and add chickpeas and potatoes. Heat through. Add more tomatoes, water, or cream to taste or to adjust thickness of the sauce.
This entry was posted in entree, Quick dinner, Vegetarian, Winter and tagged Main Dish, Recipe, Vegetarian. Bookmark the permalink.
I'm going to show this to an Indian friend of mine at work. Maybe he'll make it for me, I love Indian cuisine!
What an interesting way of preparing potatoes. Yummy!
by waxy potatoes do you mean ones that don't fall apart…say yukon or yellow finn? and not something like…russets?
Yeah, both of those are good. They need to have structure and a tender skin to be good for roasting since you don't peel them.


In part one of this four-part series, we'll be using Neutron 2 as an all-in-one dynamics processing tool for vocals. In parts two, three, and four, we'll be using Neutron 2 for mixing guitars, mixing bass, and mixing drums.
One equalizer, two compressors, an exciter, a gate, and the list goes on… there's a lot to Neutron 2. Don't feel bad if you feel a little intimidated by all the options and are unsure of how to use them all. A fantastic way to save time and learn about the functionality and settings of Neutron's modules is to use the Track Assistant.
Once that process is complete, you can look through the modules it activated and see how it applied various processes. You can learn a lot from this and still have the ability to completely change what the Track Assistant did for you. So, if you decide that you want the vocal to be brighter than the Track Assistant made it, you can immediately start tweaking the EQ!
Already own an iZotope product? You may be eligible for a special crossgrade offer to Neutron 2 or the O8N2 Bundle (including Tonal Balance Control!).
There's something aurally pleasing about the harmonic distortion that tubes can impart; it's no surprise why tube mics, tube compressors, and tube amps are so widely popular and highly desired.
Neutron 2's Exciter provides a cool X-Y adjustment to quickly achieve tube-like harmonic distortion or a blend of saturation styles not possible with a single piece of analog equipment.
As is the case when dealing with a real tube, you might regret pushing it too hard. Drive it too much and your consequence will be distortion that may be uncalled for. In the image below, notice the simple controls: Drive (amount of excitation), Blend (wet/dry mix), and X-Y (blend between types of harmonic distortion). Also noteworthy are the pre-emphasis modes (Full, Defined, and Clear), which allow mild changes to the low-mids (vocal thickness or body) or high-mids (vocal presence).
When singers get too close to the mic, low frequencies get boosted and strong sibilant consonant sounds become more pronounced. Since this problem rises and falls based upon the singer's distance from the mic, you don't necessarily want to use a static EQ to deal with the varying problem.
Dynamic equalization can attenuate different frequency bands with different settings and be triggered by different thresholds. Each band in Neutron 2's Equalizer can be set to Dynamic mode. The first image below shows band 1 in Dynamic mode configured to attenuate approximately 150 Hz, while the second image shows band 7 in Dynamic mode configured to attenuate approximately 7 kHz. Notice that each band can utilize different Q, gain, threshold, and more.
During a vocal recording session, the headphone bleed and room ambience can still be audible when the vocalist isn't singing. Sure, you could highlight and delete each of those sections from the region, but the result might sound a bit jarring.
Instead of completely removing it, consider turning it down to a more subtle level. The ratio control in Neutron 2's gate allows you to decide how much gain reduction will be applied during the times when the vocalist is just breathing.
Unlike most gates, this one has a real-time scrolling waveform display with a separate line indicating the attenuation. In the image below, the pinkish red line between the waveforms shows activity of the gate.
In many genres, it is routine to layer vocal parts in doubles, triples, and more. If all those layers are sung by the same person or by vocalists with similar tone, it often becomes difficult to distinguish the different vocal parts. A vocal track can easily be masked by other similar sounding vocals. In Neutron 2's Equalizer, the Masking function allows you to reference another instance of Neutron 2 to see if and how it masks your current signal.
For example, imagine that there are two instances of Neutron 2—one on the Lead Vox track and another on the Backing Vox track. The first image below shows the instance of Neutron 2 on the Backing Vox. You can see that the Lead Vox is selected as the masking source. As a result, the EQ display is split to show the Backing Vox on top and the Lead Vox on bottom. The pinkish red bar in the Masking Meter (above the EQ curves and below the "Masking" drop-down menu) indicates a problem area where masking is likely and might be a good place to start EQing. In the second image below, an EQ cut has been applied to the Backing Vox in the frequency area indicated by the Masking Meter.
If undesired frequencies in a signal are fed into a compressor, they can impact how the compressor reacts and sometimes cause overactive gain reduction. By using Neutron 2's EQ module followed by a compressor, you can EQ out the frequencies that bother you before they affect the compressor. Make sure that the compressor is second in the module order so that it receives the EQ'd signal.
The stock configuration of Neutron 2 has two active modules—the Equalizer and Compressor 1—already in the right order for this style of processing. So, it's fast to set up and all that's left to do is fine tune the parameters. The images below show that the EQ was used to cut some low frequencies and boost some upper midrange frequencies, while the compressor was set to Vintage mode to get some character inspired by classic analog compressors. This arrangement is how many analog consoles were and are used, with EQ occurring before inserted outboard compressors.
It's common to hear mix engineers rave about the qualities of different compressors, the benefits of using them in parallel, and the control they're able to achieve by doing so. In Neutron 2, there are two completely customizable compressors; you can use one or both, change their order, and even adjust the wet/dry mix (for parallel compression) for each one.
In the example shown in the images below, Compressor 1 is operating as a multi-band compressor in Digital mode, while Compressor 2 is operating as a single-band compressor in Vintage mode. Compressor 1 is set to 100% wet and is configured for transparently evening out the vocal dynamics. Compressor 2 is set to 60% wet (for parallel compression) and is configured to color the sound that the first compressor leveled out.
Neutron 2 is complex in its capabilities, yet thankfully simple in its operations and functionality. Dive into it, experiment!


text:
Mohammed Noor-A-Alam, Ph.D.
monoor@iupuc.edu
Division of Mechanical Engineering
AMCE 180
4444 Kelly St
Ph.D., Energy Science and Engineering, University of Texas at El Paso (2012)
M.S., Advanced Materials, Chalmers University of Technology (2007)
B.S., Chemical Technology & Polymer Science, Shahjalal University of Science and Technology (1997)
Nano-structured materials for energy devices
Thermal barrier coatings for next generation gas turbine technology
Computational fluid dynamics and thermal transport phenomena
Nano-composite materials
Biodegradable polymer composites
Vehicle emission monitoring and control using IoT
Mathematical methods for mechanical engineers
C.V. Ramana, M. Vargas, G.A. Lopez, M. Noor-A-Alam, M.J. Hernandez, E.J. Rubio, Effect of Oxygen/Argon Gas Ratio on the Structure and Optical Properties of Sputter-Deposited Nanocrystalline HfO2 Thin Films, Ceramics International, 2015 (41), 6187–6193.
Noor-A-Alam, S. K. Gullapalli, E. J. Rubio, A.R. Choudhuri and C.V. Ramana, Enhanced stability of hafnia based coatings in hot gas environment, RSC Advances 2014(4), 8224–8229
Noor-A-Alam, A.R. Choudhuri and C.V. Ramana, Strucure and thermal conductivity of nanostructured hafnia-based thermal barrier coating grown on SS-403, Journal of Nanotechnology in Engineering and Medicine 4 (2013), 011001-5
S. Kumar, E. Rubio, M. Noor-A-Alam, G. Martinez, S. Manandhar, V. Shutthanandan, S. Thevuthasan and C. V. Ramana, Structure, morphology and optical properties of amorphous and nanocrystalline gallium oxide thin films, The Journal of Physical Chemistry C, 117 (2013), 4194-4200
E.J. Rubio, G. Martinez, M. Noor-A-Alam, S.W. Stafford, V. Shutthanandan, C.V. Ramana, Microstructure and thermal oxidation behavior of yttria-stabilized hafnia nanostructured coatings deposited on alumina, Surface & Coatings Technology, 236, (2013), 142–148
Noor-A-Alam, K. Abhilash and C.V. Ramana; Electrical and optical properties of nanocrystalline yttrium-doped hafnium oxide thin films, Thin Solid Films 520 (2012) 6631–6635
Noor-A-Alam, C.V. Ramana, Structure and thermal conductivity of yttria-stabilized hafnia ceramic coatings grown on nickel-based alloy; Ceramics International, 38 (2012) 2957–2961
K. Kamala Bharathi, M. Noor-A-Alam, R.S. Vemuri and C. V. Ramana; Correlation between microstructure, electrical and optical properties of nanocrystalline NiFe1.925Dy0.075O4 thin films, RSC Advances 2 (2012) 941–948
C. K. Roy, M. Noor-A-Alam, A.R. Choudhuri, C.V. Ramana; Synthesis and microstructure of Gd2O3-doped HfO2 ceramics, Ceramics International, 38 (2012) 1801
K. Kamala Bharathi, R.S. Vemuri, M. Noor-A-Alam, C.V. Ramana; Effect of annealing on the microstructure of NiFe1.925Dy0.075O4 thin films, Thin Solid Films 520 (2012) 1794
C. V. Ramana, M. Noor-A-Alam, Jamie J. Gengler and John G. Jones; Growth, structure, and thermal conductivity of yttria-stabilized hafnia thin films, ACS Applied Materials and Interfaces 4 (2012) 200−204
Haydar U. Zaman, Mubarak A. Khan, Ruhul A. Khan, M. Noor-A-Alam & Z. H. Bhuiyan, Studies of the physico-mechanical, interfacial, and degradation properties of jute fabrics/melamine composites, 61(2012), 748-758
Noor-A-Alam, A.R. Choudhuri, C.V. Ramana; Effect of composition on the growth and microstructure of hafnia–zirconia based coatings; Surface & Coatings Technology, 206 (2011) 1628–1633
R.S. Vemuri, M. Noor-A-Alam, S.K. Gullapalli, M.H. Engelhard, C.V. Ramana; Nitrogen-incorporation induced changes in the microstructure of nanocrystalline WO3 thin films, Thin Solid Films, 520 (2011) 1446-1450
V. H. Mudavakkat, M. Noor-A-Alam, K. Kamala Bharathi, S. Alfaify, A. Dissanayake, A. Kayani, C.V. Ramana; Structure and AC conductivity of nanocrystalline Yttrium oxide thin films; Thin Solid Films 519 (2011) 7947–7950
M. Tipu Sultan, M. Arifur Rahman, Jahid M. M. Islam, Mubarak A. Khan, Nazia Rahman, Noor-A-Alam, A. K. M. A. Hakim, M. Muhibul Alam; Preparation and characterization of an alginate/clay nano-composite for optoelectronic application; Advanced Materials Research, 123-125 (2010) 751-75
Mubarak A. Khan, Ruhul A. Khan, Haydar U. Zaman, M. Noor-A Alam, and M.A. Hoque; Effect of surface modification of jute with acrylic monomers on the performance of polypropylene composite; Journal of Reinforced Plastics and Composites, 29 (2010) 1195-1205
Mubarak A. Khan, Ruhul A. Khan, Farhan G. Noor, M. M. Rahman, M. Noor-A-Alam; Studies on the mechanical properties of gelatin and its blends with vinyltrimethoxysilane: Effect of Gamma Radiation, Polymer Plastic Technology and Engineering, 48 (2009) 808 – 813
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text:
Děčín (in tedesco Tetschen-Bodenbach) è una città della Repubblica Ceca, capoluogo del distretto omonimo, nella regione di Ústí nad Labem.

La città di Děčín si trova sulla via commerciale tra la Repubblica Ceca e la Germania. Le merci trasportate su gomma, rotaia o via fiume passano tutte attraverso la città che è situata nel punto in cui il fiume Elba e il Ploučnice confluiscono. Děčín è attualmente composta di due città, una delle quali sorge su una riva dell'Elba. La città è inoltre un centro di produzione alimentare, tessile e chimico.

Storia
La città di Děčín (Tetschen) è stata fondata attorno al IX secolo quando alcune tribù slave guidate dal condottiero Děčané, da cui deriva il suo nome, si insediarono nell'area. In un primo momento l'insediamento fu costruito sulla riva sinistra dell'Elba, ma dopo un diluvio fu ricostruito sulla riva destra nel 1059. La città è poi stata sotto il controllo dei signori di Wartenberg dal 1305 fino al 1534, quando fu acquistata da Lord Rudolf von Bünau. Questa famiglia introdusse il protestantesimo nella regione, professione che venne poi abbandonata dopo la cacciata dei Bünau nel 1620. I Bünau vendettero la città nel 1628 al barone di Thun.

Nel XVIII secolo, Děčín divenne un importante centro termale sotto il dominio del Barone Johann Joseph Thun. Il centro di un importante crocevia economico non è stato, tuttavia, il posto ideale per costruire un centro termale, e l'idea è stata poi definitivamente abbandonata 1922. Oggi il passato termale della città è stato in gran parte dimenticato.

Nell'agosto del 2002, condizioni meteorologiche estreme hanno portato ad ampie inondazioni in tutta l'Europa e anche Děčín è stata duramente colpita. L'acqua è passata dal suo livello abituale di 2 metri a quello di 12 metri. Oltre 1.600 persone sono state evacuate. Fortunatamente, il centro storico e anche molte delle località turistiche sono a altitudini più elevate, per cui sono rimaste integre, ma molti edifici sono andati in rovina.

Děčín è la città natale di Miroslav Tyrš, che insieme a Jindřich Fügner fu il fondatore del Sokol, movimento di ispirazione panslavico ceco.

La città è anche sede universitaria essendo presente la Facoltà di Fisica nucleare e subnucleare quale sede distaccata di quella dell'Università Tecnica Ceca di Praga.

Sport
In città ha sede la squadra di basket B.K. Děčín protagonista nel massimo campionato nazionale.

Amministrazione

Gemellaggi

Note

Altri progetti

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Has anyone had issues withe the auto climate system? I'm not sure where the sensor is - I am guessing they only use 1 sensor.
When I have my system set to 19 degrees and the sun is out (ambient temp say 21) the car is quite warm inside but my fan speed is only going ata minimal speed which makes the cool off process quite long. I have been in other vehicles where the fan will go full speed until the temp starts coming down and then reduces until the set temp is reached.
There is a sunlight sensor on the dash by the passenger side and a temperature sensor just to the right of the steering wheel. My mazda 5 does the same thing under the temperatures that you're describing. I don't think you get maximum fan speed unless it's scorching hot inside. If it's really warm out, I just set my temperature to the lowest setting til I feel comfortable before setting it to my desired temperature setting.


text:
Utilities lead in US decarbonisation, says ClearPath
"The easy part is over" for US emission reductions and the country risks a "flatline" to 2050, Washington DC-based think tank ClearPath has warned in a new report. Utility commitments to net-zero and longer operation for nuclear power plants can help avoid the flatline but public policy is also needed, it said.
(Image: ClearPath)
"Over the coming decades the exhaustion of economic coal-to-gas shifting, existing nuclear plant closures, and continued load growth in states without climate targets will lead to shallow decarbonisation," said ClearPath in its report, Clear Path to a Clean Energy Future. It expects carbon dioxide emissions to stop falling after 2025 and remain roughly flat to 2050 at 96% of today's level - even with recently enacted federal incentives and state-level clean energy standards.
However, a total of 51 utilities representing 71% of customer accounts in the USA have set carbon-free or net-zero goals for 2050. ClearPath's modelling shows their efforts could reduce emissions significantly, and although it did not specify the exact saving it said the cumulative effect would avoid the emission of 4 billion tons of carbon dioxide by 2050.
One effect of the commitments by utilities would be to maintain more of the US nuclear fleet, which today amounts to 96 GWe of installed capacity. Utility commitments could maintain 41 GWe of nuclear through to 2050, more than double the 19 GWe in ClearPath's reference scenario based on policy alone. "Maintaining existing nuclear power plants is one of the cheapest ways to meet clean energy goals," said ClearPath, adding that, "Even more [nuclear capacity] would likely be preserved if more utilities established net- zero commitments." To ensure this outcome, "state and federal support is warranted," it said.
Importantly, the net-zero commitments by utilities are not projected to significantly increase the price of electricity. The average retail price in 2050 was projected to be 10.2 cents per kWh, compared with 9.7 cents per kWh in the more polluting scenario.
ClearPath concludes that, "It is increasingly clear that the United States is hitting the edge of shallow decarbonisation opportunities following initial renewable energy development and a large-scale switch from coal to gas since 2005. Natural gas, solar, and wind are the name of the game, and they are the only new technologies expected to develop for the foreseeable future, unless natural gas prices keep going up or dispatchable clean technologies decrease in cost."
ClearPath describes itself as looking "to advance small government and free market reforms that make an impact." It intends to create a series of Clear Path to a Clean Energy Future reports monitoring utility decarbonisation commitments.
Climate change Energy policy USA
US Nuclear Power Policy


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Top Gear show teaser 'went down a storm'
By Ben Griffin
The BBC provided television bosses with a sneak peek of the revamped Top Gear motoring show as part of its annual programming showcase.
A one minute and 40-second clip was played, in which Chris Evans can be seen feeling sick after a high-speed drive in an Audi R8, Sabine Schmitz races a jet fighter and Matt LeBlanc and Evans race from London to Blackpool in Reliant Rialto three-wheelers.
It also showed Chris Harris driving a Ferrari F12tdf and Rory Reid driving the Ford Mustang in Scotland. All presenters turned up in various supercars, including the Aston Martin DB10 from the James Bond movie Spectre.
One television buyer from the audience at the BBC Worldwide event, which took place at Echo arena in Liverpool, said the 700-plus crowd was impressed: "It went down a storm. The arena was packed and the clip was well received."
The buyer added: "There was a great reaction to it."
The BBC programming showcase had one unexpected guest. David Beckham came on to talk about his new BBC documentary, For The Love Of The Game, which shows him playing a football match on all seven continents.
Meanwhile David Attenborough was another star there to help peddle BBC shows to worldwide buyers. He has been announced as the presenter for Frozen Planet 2, which will air later in 2016.
So far, the full Top Gear roster is yet to be in the same place at the same time. Eddie Jordan welcomed LeBlanc to the team as part of a video message as he was said to be attending a charity event in South Africa.
Speaking at the show, Chris Evans and Matt LeBlanc confirmed they will be Top Gear's main two hosts, with the other four and The Stig making appearances when needed.
The first show will feature the whole team – dubbed the "Magnificent Seven from motoring heaven" by Evans – when it airs in May 2016.
Since Evans took the helm, the show has been plagued by issues including a production team that was said to be lacking in car knowledge and the fact its lead host was unable to talk and drive (a claim later disputed by the Beeb). The show's executive producer, Lisa Clark, also quit.
But one particular onlooker believes it's all part of the plan. Speaking to the Radio Times, ex-Top Gear presenter James May said: "I'd like to see Chris's Top Gear do well. It's a ballsy call to continue it.
"I wouldn't want to be the one presenting it when we'd just finished, but there must be a way of reinventing it. We always said it would survive beyond us.
"I think the stories about Chris's version being in trouble might be an elaborate hoax, before it explodes onto our screens in brilliance."
Jeremy Clarkson, Richard Hammond and James May ended up at Amazon after the Clarkson punch-up 'fracas', where they are working on a new motoring show. The name of the show and release date is still unknown.
You can check out everything worth knowing about each presenter here. For more on Recombu Cars editor-in-chief, Rory Reid, give this a butcher's.