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Compared to Houkai Gakuen , the development time of Houkai Gakuen 2 was shorter because it used the underlying data, art assets, and core gameplay of the previous game, thus shortening the research and development needed. The content taken from Houkai Gakuen got expanded with the addition of new characters, weapons, and clothing sets.

The testing came on January 26, , and then the game got released in March on the Bilibili platform. Though the game had some financial success, it had many technical problems such as top-up failure and server downtime. For a team only composed of seven people, this was hard. Later, the company ended up employing its players as staff. The Honkai Impact 3rd project began in June In March , miHoYo started developing its engines for the game. They created a physics-based animation system; it can simulate the performance of various bodies based on physical formulas, showing more realistic character movements and destructive scene effects.

It can also correct abrupt transitions between animations, making the animations smoother and more natural. In addition, miHoYo developed its technologies for 3D modeling, light mapping, and real-time and pre-rendering systems.

Content production for the game began in October Since no member on the team knew how to do 3D projects, transitioning from 2D to 3D was a challenge. Creating the artwork, model, and animation of Kiana Kaslana took six months.

After a test run, the team discarded the work and restarted from scratch to establish the current system. Honkai Impact 3rd had its internal iOS beta in March , [29] launched in September, [9] publicly tested, and then released in October. Its gameplay involves role play and hack-and-slash action and also features gacha mechanics. In addition to the game, it got followed by multiple supplementary media such as an anime series, graphic novels, comics, and promotional videos.

Though miHoYo's early titles were successful within Asia, the company would not reach global success until the release of Honkai Impact 3rd.

After being a mobile-exclusive game, Honkai Impact 3rd was made available for PC three years later on December 26, Within two years after the release, the seven-person company grew to include around employees.

During the process, several concerns were under attention, including the company's dependence on a single intellectual property, the Honkai series. The risk is that the company may not be able to continue to launch new products to meet the needs of players or update the content of their games, and they could face the loss of users.

Another issue is that the company might fail to grasp changes in preferences, and the Honkai series loses appeal. It also serves as a content creation platform for players. It got announced as the official forum for Genshin Impact. The idea of creating an open-world game came out of that. During the next seven months, the team tried several prototypes. After Cai played Nintendo 's The Legend of Zelda: Breath of the Wild , the team took inspiration from the game's world exploration experience.

The production team initially had people. They underestimated the difficulty of creating an open world, so it grew to people by mid, [45] then by April , [46] and then by February Genshin Impact had its first beta testing in June , focused on core gameplay mechanisms and the Mondstadt region.

Development also got delayed by a month as working from home was almost impossible, and employees could not access office equipment. The game got released on September 28, At age five, he accessed a computer and played games to his mother's surprise. His parents honed his interest in computers by creating systematic exercises for him. At age seven, he owned a PC, which was relatively advanced in the s. At age eight, Cai won second place in a computer animation competition. Teachers spoke of Cai as a smart and knowledgeable student who could provide multiple solutions to a single problem.

Their angel investor, Hangzhou Miyi Investment Co. Their shared interest in the series greatly influenced the creation of miHoYo's games. According to Liu in an interview, Cai would wear an Evangelion -themed shirt every summer. Due to the Global Financial Crisis , he stayed in Shanghai. Adobe After Effects CS 9. Adobe After Effects CS5 Adobe After Effects CS5. Adobe After Effects CS6 Adobe After Effects CC Adobe After Effects CC This is a guide to After Effects Versions.

Here we discuss all the versions of after effect upgraded till now, including their developer and features explanation. You can also go through our other related articles to learn more —. By signing up, you agree to our Terms of Use and Privacy Policy. Forgot Password? This website or its third-party tools use cookies, which are necessary to its functioning and required to achieve the purposes illustrated in the cookie policy. Retrieved March 10, October 16, Retrieved October 27, Retrieved Retrieved March 19, May 18, Adobe Creative Suite and Creative Cloud.

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Download as PDF Printable version. Wikimedia Commons. Company of Science and Art. January ; 29 years ago Windows 10 x64 only v and later, macOS Visual effects , Motion graphics , Compositing , Computer animation.

Trialware , software as a service SaaS. Time Layout window, image sequence support, motion blur, multi-machine rendering, frame blending, proxies. Power Macintosh version PPC [6]. File formats, multiprocessing; last Mac x0 version. Flowchart view, watch folder, 3D channel effects, collect files command, auto deinterlacing, sequence layers, save favorite effects. January 7, [9]. Advanced 3D renderer, multiple 3D views, import camera data, colored shadows, projection layers, effects palette, post render actions, advanced lightning, adjustment layer lights, smart mask, looping via expressions, RealMedia output, expression controllers, Zaxwerks 3D Invigorator Classic bundled; first OS X version.

Shape layers, puppet tool, brainstorm, clip notes, Photoshop vanishing point import, adaptive motion blur, per character 3D text animation, real-time audio playback, simultaneous multi-frame rendering, SWF vector import, bit linear blending, full color management; first Universal Binary Intel Mac version.

October 6, [11]. Fixes "locking existing frames" message delay at start of RAM preview, decreased performance due to Wacom driver conflict, aerender not shutting down background processes, and miscellaneous crashes especially on Mac OS X April 30, [12]. September 3, [14]. April 8, [15]. Fixes an "Unexpected data type" error opening project with missing effects, a crash with Directional Blur and other effects on computers with 16 or more logical processors, and a crash opening a composition created by Automatic Duck Pro Import AE.

April 11, [16]. June 30, [17]. Fixes for delay when typing in a text layer if mouse pointer was above the Composition panel, and inability to use an upgrade serial number. April 23, [18]. Live PSD 3D layer import was removed. May 25, [19]. October 12, [20]. June 17, [21]. October 31, [22].

   

 

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Windows Windows. Most Popular. New Releases. Desktop Enhancements. Networking Software. Software Coupons. Download Now. Premium Upgrade. Clicking on the Download Now Visit Site button above will open a connection to a third-party site. Developer's Description By Adobe Systems. The After Effects CC This full update makes it unnecessary to install the previous After Effects CC Unlike the After Effects CC Full Specifications.

What's new in version Release December 16, Date Added December 16, Version Operating Systems. Additional Requirements None.

Total Downloads 8, Downloads Last Week 4. Report Software. Related Software. GoPro Studio Free. In these instances, plasma blood glucose fingerstick and sensor glucose readings should be used for goal setting Table There are few long-term studies in older adults demonstrating the benefits of intensive glycemic, blood pressure, and lipid control. Patients who can be expected to live long enough to realize the benefits of long-term intensive diabetes management, who have good cognitive and physical function, and who choose to do so via shared decision-making may be treated using therapeutic interventions and goals similar to those for younger adults with diabetes Table As with all patients with diabetes, diabetes self-management education and ongoing diabetes self-management support are vital components of diabetes care for older adults and their caregivers.

In addition, declining or impaired ability to perform diabetes self-care behaviors may be an indication that a patient needs a referral for cognitive and physical functional assessment, using age-normalized evaluation tools, as well as help establishing a support structure for diabetes care 3 , For patients with advanced diabetes complications, life-limiting comorbid illnesses, or substantial cognitive or functional impairments, it is reasonable to set less-intensive glycemic goals Table Factors to consider in individualizing glycemic goals are outlined in Fig.

Based on concepts of competing mortality and time to benefit, these patients are less likely to benefit from reducing the risk of microvascular complications In addition, these patients are more likely to suffer serious adverse effects of therapeutics, such as hypoglycemia However, patients with poorly controlled diabetes may be subject to acute complications of diabetes, including dehydration, poor wound healing, and hyperglycemic hyperosmolar coma.

Glycemic goals should, at a minimum, avoid these consequences. While Table Ongoing empiric research on the classification of older adults with diabetes based on comorbid illness has repeatedly found three major classes of patients: a healthy, a geriatric, and a cardiovascular class 9 , The geriatric class has the highest prevalence of obesity, hypertension, arthritis, and incontinence, and the cardiovascular class has the highest prevalence of myocardial infarctions, heart failure, and stroke.

Compared with the healthy class, the cardiovascular class has the highest risk of frailty and subsequent mortality. Additional research is needed to develop a reproducible classification scheme to distinguish the natural history of disease as well as differential response to glucose control and specific glucose-lowering agents For patients receiving palliative care and end-of-life care, the focus should be to avoid hypoglycemia and symptomatic hyperglycemia while reducing the burdens of glycemic management.

Thus, as organ failure develops, several agents will have to be deintensified or discontinued. For the dying patient, most agents for type 2 diabetes may be removed There is, however, no consensus for the management of type 1 diabetes in this scenario See the section end-of-life care , below, for additional information. Although hyperglycemia control may be important in older individuals with diabetes, greater reductions in morbidity and mortality are likely to result from a clinical focus on comprehensive cardiovascular risk factor modification.

There is strong evidence from clinical trials of the value of treating hypertension in older adults 56 , 57 , with treatment of hypertension to individualized target levels indicated in most. There is less evidence for lipid-lowering therapy and aspirin therapy, although the benefits of these interventions for primary and secondary prevention are likely to apply to older adults whose life expectancies equal or exceed the time frames of the clinical trials In the case of statins, the follow-up time of clinical trials ranged from 2 to 6 years.

While the time frame of trials can be used to inform treatment decisions, a more specific concept is the time to benefit for a therapy. For statins, a meta-analysis of the previously mentioned trials showed that the time to benefit is 2. Lifestyle management in older adults should be tailored to frailty status.

Diabetes is also recognized as an independent risk factor for frailty. Frailty is characterized by decline in physical performance and an increased risk of poor health outcomes due to physiologic vulnerability and functional or psychosocial stressors. Inadequate nutritional intake, particularly inadequate protein intake, can increase the risk of sarcopenia and frailty in older adults.

Management of frailty in diabetes includes optimal nutrition with adequate protein intake combined with an exercise program that includes aerobic, weight-bearing, and resistance training.

The benefits of a structured exercise program as in the Lifestyle Interventions and Independence for Elders [LIFE] study in frail older adults include reducing sedentary time, preventing mobility disability, and reducing frailty 62 , The goal of these programs is not weight loss but enhanced functional status.

For nonfrail older adults with type 2 diabetes and overweight or obesity, an intensive lifestyle intervention designed to reduce weight is beneficial across multiple outcomes. It enrolled people between 45 and 74 years of age and required that they be able perform a maximal exercise test 64 , While the Look AHEAD trial did not achieve its primary outcome of reducing cardiovascular events, the intensive lifestyle intervention had multiple clinical benefits that are important to the quality of life of older adults.

Benefits included weight loss, improved physical fitness, increased HDL cholesterol, lowered systolic blood pressure, reduced A1C levels, reduced waist circumference, and reduced need for medications Risk factor control was improved with reduced utilization of antihypertensive medications, statins, and insulin In age-stratified analyses, older patients in the trial 60 to early 70s had similar benefits compared with younger patients 69 , In addition, lifestyle intervention produced benefits on aging-relevant outcomes such as reductions in multimorbidity and improvements in physical function and quality of life 71 — Special care is required in prescribing and monitoring pharmacologic therapies in older adults Cost may be an important consideration, especially as older adults tend to be on many medications and live on fixed incomes Accordingly, the costs of care and insurance coverage rules should be considered when developing treatment plans to reduce the risk of cost-related nonadherence 77 , See Table 9.

It is important to match complexity of the treatment regimen to the self-management ability of older patients and their available social and medical support. Many older adults with diabetes struggle to maintain the frequent blood glucose monitoring and insulin injection regimens they previously followed, perhaps for many decades, as they develop medical conditions that may impair their ability to follow their regimen safely. Individualized glycemic goals should be established Fig.

Intensive glycemic control with regimens including insulin and sulfonylureas in older adults with complex or very complex medical conditions has been identified as overtreatment and found to be very common in clinical practice 79 — For those seeking to simplify their diabetes regimen, deintensification of regimens in patients taking noninsulin glucose-lowering medications can be achieved by either lowering the dose or discontinuing some medications, as long as the individualized glycemic targets are maintained.

When patients are found to have an insulin regimen with complexity beyond their self-management abilities, lowering the dose of insulin may not be adequate There are now multiple studies evaluating deintensification protocols in diabetes as well as hypertension, demonstrating that deintensification is safe and possibly beneficial for older adults Table Algorithm to simplify insulin regimen for older patients with type 2 diabetes.

Adapted with permission from Munshi and colleagues 85 , , Treatment regimen simplification refers to changing strategy to decrease the complexity of a medication regimen e. Metformin is the first-line agent for older adults with type 2 diabetes. However, it is contraindicated in patients with advanced renal insufficiency and should be used with caution in patients with impaired hepatic function or heart failure because of the increased risk of lactic acidosis.

Metformin may be temporarily discontinued before procedures, during hospitalizations, and when acute illness may compromise renal or liver function. Additionally, metformin can cause gastrointestinal side effects and a reduction in appetite that can be problematic for some older adults. Reduction or elimination of metformin may be necessary for patients experiencing persistent gastrointestinal side effects. For those taking metformin long-term, monitoring for vitamin B12 deficiency should be considered Lower doses of a thiazolidinedione in combination therapy may mitigate these side effects.

Sulfonylureas and other insulin secretagogues are associated with hypoglycemia and should be used with caution. If used, sulfonylureas with a shorter duration of action, such as glipizide or glimepiride, are preferred. Glyburide is a longer-acting sulfonylurea and should be avoided in older adults Oral dipeptidyl peptidase 4 DPP-4 inhibitors have few side effects and minimal risk of hypoglycemia, but their cost may be a barrier to some older patients. DPP-4 inhibitors do not reduce or increase major adverse cardiovascular outcomes Across the trials of this drug class, there appears to be no interaction by age-group 95 — A challenge of interpreting the age-stratified analyses of this drug class and other cardiovascular outcomes trials is that while most of these analyses were prespecified, they were not powered to detect differences.

GLP-1 receptor agonists have demonstrated cardiovascular benefits among patients with established atherosclerotic cardiovascular disease ASCVD and those at higher ASCVD risk, and newer trials are expanding our understanding of their benefits in other populations In a systematic review and meta-analysis of GLP-1 receptor agonist trials, these agents have been found to reduce major adverse cardiovascular events, cardiovascular deaths, stroke, and myocardial infarction to the same degree for patients above and below 65 years of age While the evidence for this class for older patients continues to grow, there are a number of practical issues that should be considered for older patients.

These drugs are injectable agents with the exception of oral semaglutide 99 , which require visual, motor, and cognitive skills for appropriate administration. Agents with a weekly dosing schedule may reduce the burden of administration. GLP-1 receptor agonists may also be associated with nausea, vomiting, and diarrhea.

Given the gastrointestinal side effects of this class, GLP-1 receptor agonists may not be preferred in older patients who are experiencing unexplained weight loss. SGLT2 inhibitors are administered orally, which may be convenient for older adults with diabetes.

This class of agents has also been found to be beneficial for patients with heart failure and to slow the progression of chronic kidney disease. The stratified analyses of the trials of this drug class indicate that older patients have similar or greater benefits than younger patients — While understanding of the clinical benefits of this class is evolving, side effects such as volume depletion, urinary tract infections, and worsening urinary incontinence may be more common among older patients.

The use of insulin therapy requires that patients or their caregivers have good visual and motor skills and cognitive ability. Insulin therapy relies on the ability of the older patient to administer insulin on their own or with the assistance of a caregiver. Insulin doses should be titrated to meet individualized glycemic targets and to avoid hypoglycemia.

Once-daily basal insulin injection therapy is associated with minimal side effects and may be a reasonable option in many older patients When choosing a basal insulin, long-acting insulin analogs have been found to be associated with a lower risk of hypoglycemia compared with NPH insulin in the Medicare population. Multiple daily injections of insulin may be too complex for the older patient with advanced diabetes complications, life-limiting coexisting chronic illnesses, or limited functional status.

The needs of older adults with diabetes and their caregivers should be evaluated to construct a tailored care plan. Social and instrumental support networks e. The need for ongoing support of older adults becomes even greater when transitions to acute care and long-term care LTC become necessary.

Unfortunately, these transitions can lead to discontinuity in goals of care, errors in dosing, and changes in diet and activity Older adults in assisted living facilities may not have support to administer their own medications, whereas those living in a nursing home community living centers may rely completely on the care plan and nursing support. Those receiving palliative care with or without hospice may require an approach that emphasizes comfort and symptom management, while de-emphasizing strict metabolic and blood pressure control.

Due in part to the success of modern diabetes management, patients with type 1 diabetes are living longer, and the population of these patients over 65 years of age is growing — Many of the recommendations in this section regarding a comprehensive geriatric assessment and personalization of goals and treatments are directly applicable to older adults with type 1 diabetes; however, this population has unique challenges and requires distinct treatment considerations Insulin is an essential life-preserving therapy for patients with type 1 diabetes, unlike for those with type 2 diabetes.

To avoid diabetic ketoacidosis, older adults with type 1 diabetes need some form of basal insulin even when they are unable to ingest meals. Insulin may be delivered through an insulin pump or injections. In the older patient with type 1 diabetes, administration of insulin may become more difficult as complications, cognitive impairment, and functional impairment arise.

This increases the importance of caregivers in the lives of these patients. Many older patients with type 1 diabetes require placement in LTC settings i. Some staff may be less knowledgeable about the differences between type 1 and type 2 diabetes. Education of relevant support staff and providers in rehabilitation and LTC settings regarding insulin dosing and use of pumps and CGM is recommended as part of general diabetes education see Recommendations Management of diabetes in the LTC setting is unique.

Individualization of health care is important in all patients; however, practical guidance is needed for medical providers as well as the LTC staff and caregivers Training should include diabetes detection and institutional quality assessment. LTC facilities should develop their own policies and procedures for prevention and management of hypoglycemia.

With the increased longevity of populations, the care of people with diabetes and its complications in LTC is an area that warrants greater study. Staff of LTC facilities should receive appropriate diabetes education to improve the management of older adults with diabetes. Treatments for each patient should be individualized. Special management considerations include the need to avoid both hypoglycemia and the complications of hyperglycemia 2 , An older adult residing in an LTC facility may have irregular and unpredictable meal consumption, undernutrition, anorexia, and impaired swallowing.

Furthermore, therapeutic diets may inadvertently lead to decreased food intake and contribute to unintentional weight loss and undernutrition.

It may be helpful to give insulin after meals to ensure that the dose is appropriate for the amount of carbohydrate the patient consumed in the meal. Older adults with diabetes in LTC are especially vulnerable to hypoglycemia.

They have a disproportionately high number of clinical complications and comorbidities that can increase hypoglycemia risk: impaired cognitive and renal function, slowed hormonal regulation and counterregulation, suboptimal hydration, variable appetite and nutritional intake, polypharmacy, and slowed intestinal absorption Oral agents may achieve glycemic outcomes similar to basal insulin in LTC populations 80 , Another consideration for the LTC setting is that, unlike in the hospital setting, medical providers are not required to evaluate the patients daily.

According to federal guidelines, assessments should be done at least every 30 days for the first 90 days after admission and then at least once every 60 days. Although in practice, the patients may actually be seen more frequently, the concern is that patients may have uncontrolled glucose levels or wide excursions without the practitioner being notified. Providers may make adjustments to treatment regimens by telephone, fax, or in person directly at the LTC facilities provided they are given timely notification of blood glucose management issues from a standardized alert system.

Strict glucose and blood pressure control are not necessary E , and simplification of regimens can be considered. Similarly, the intensity of lipid management can be relaxed, and withdrawal of lipid-lowering therapy may be appropriate. The management of the older adult at the end of life receiving palliative medicine or hospice care is a unique situation. Overall, palliative medicine promotes comfort, symptom control and prevention pain, hypoglycemia, hyperglycemia, and dehydration , and preservation of dignity and quality of life in patients with limited life expectancy , In the setting of palliative care, providers should initiate conversations regarding the goals and intensity of diabetes care; strict glucose and blood pressure control may not be consistent with achieving comfort and quality of life.

Avoidance of severe hypertension and hyperglycemia aligns with the goals of palliative care. In a multicenter trial, withdrawal of statins among patients in palliative care was found to improve quality of life — The evidence for the safety and efficacy of deintensification protocols in older adults is growing for both glucose and blood pressure control 88 , and is clearly relevant for palliative care.

A patient has the right to refuse testing and treatment, whereas providers may consider withdrawing treatment and limiting diagnostic testing, including a reduction in the frequency of blood glucose monitoring , Glucose targets should aim to prevent hypoglycemia and hyperglycemia. Treatment interventions need to be mindful of quality of life.

Careful monitoring of oral intake is warranted. The decision process may need to involve the patient, family, and caregivers, leading to a care plan that is both convenient and effective for the goals of care The pharmacologic therapy may include oral agents as first line, followed by a simplified insulin regimen.

If needed, basal insulin can be implemented, accompanied by oral agents and without rapid-acting insulin. Agents that can cause gastrointestinal symptoms such as nausea or excess weight loss may not be good choices in this setting.

As symptoms progress, some agents may be slowly tapered and discontinued. Different patient categories have been proposed for diabetes management in those with advanced disease There is no role for A1C monitoring. A patient with organ failure: Preventing hypoglycemia is of greatest significance. Dehydration must be prevented and treated. In people with type 1 diabetes, insulin administration may be reduced as the oral intake of food decreases but should not be stopped.

For those with type 2 diabetes, agents that may cause hypoglycemia should be reduced in dose. The main goal is to avoid hypoglycemia, allowing for glucose values in the upper level of the desired target range.

A dying patient: For patients with type 2 diabetes, the discontinuation of all medications may be a reasonable approach, as patients are unlikely to have any oral intake.

In patients with type 1 diabetes, there is no consensus, but a small amount of basal insulin may maintain glucose levels and prevent acute hyperglycemic complications. Older adults: Standards of Medical Care in Diabetes— Diabetes Care ;45 Suppl. Sign In or Create an Account. Search Dropdown Menu. Advanced Search. User Tools Dropdown. Sign In. Skip Nav Destination Article Navigation. Close mobile search navigation Article navigation. Previous Article Next Article. Neurocognitive Function.

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