Academic literature on the topic 'HEALTH MOBILITY INDEX'

The health shocks caused by air pollution seriously interfere with people’s economic life. Based on the air pollution index and health shock index calculated by the principal component entropy weight method, this article analyzes the impact of air pollution on labor mobility, and adopts the mediation effect model to test the mediation effect of health shocks, using the threshold model to analyze the time and the health shocks threshold effect of air pollution on labor mobility. Its conclusions are as follows: (1) Air pollution has a negative impact on the net inflow of labor mobility, and the net inflow of labor mobility decreases between 24.9% and 44.7% on average for each unit increase in the health shocks of air pollution. (2) The impact of air pollution on labor mobility is all caused by health shocks; the health shocks are also an important factor influencing the decrease in the labor mobility supply across provinces, and the different health levels of the migrating individuals due to air pollution. (3) The health shocks of air pollution have a single-time threshold effect on labor mobility, and the health shocks of air pollution in China have intensified after 2010, confirming that China’s Lewis turning point was 2010. (4) The attraction effect of stable and higher regional real income will partially offset the repulsion effect of health shocks of air pollution on labor mobility, when the health-shocks index of air pollution exceeds the threshold value of 1.9873. Finally, the policy implications of the health shocks of air pollution on labor mobility are also formulated.

Determining mobility status is an important component of any health assessment for older adults. In order for a mobility measure to be relevant and meaningful, normative data are required for comparison to a healthy reference population. The DEMMI is the first mobility instrument to measure mobility across the spectrum from bed bound to functional levels of independent mobility. In this cross-sectional observational study, normative data were obtained for the DEMMI from a population of 183 healthy, community-dwelling adults age 60+ who resided in Vancouver, Canada and Melbourne, Australia. Older age categories had significantly lower DEMMI mobility mean scores (P<0.05), as did individuals who walked with a mobility aid or lived in semi-independent living (assisted living or retirement village), whereas DEMMI scores did not differ by sex (P=0.49) or reported falls history (P=0.21). Normative data for the DEMMI mobility instrument provides vital reference scores to facilitate its use across the mobility spectrum in clinical, research, and policymaking settings.

A contextual age construct was developed and examined as a transactional, life-position index of aging. The eighteen-item contextual age index included six interrelated dimensions: physical health, interpersonal interaction, mobility, life satisfaction, social activity, and economic security. In addition to the development of the index, associations among contextual age and sociodemographic characteristics were examined for a sample of 640 persons. Chronological age was correlated negatively with mobility and physical health, and positively with economic security, life satisfaction, and interpersonal interaction. Mobility, economic security, life satisfaction, physical health, and interpersonal interaction discriminated between chronological age groups. Interpersonal interaction, economic security, physical health, and social activity were predictors of life satisfaction. The contextual age construct raises questions concerning several negative myths about aging. The findings reflect the weak validity of chronological age as a unidimensional indicator of life-position and well-being.

Objective: To assess the outcomes in patients wearing particularly designed acrylic removable partial dentures at different time intervals. Study Design: Descriptive Case Series Study. Setting: Department of Prosthodontics, FMH College of Dentistry, Lahore. Period: October 2017 to April, 2018. Material & Methods: Sixty five (65) abutments of acrylic removable partial denture wearers were included in the study for assessment of Mean Clinical Attachment Level (CAL), Tooth Mobility (TM) and Mean Gingival Index (GI). These periodontal parameters were clinically assessed at the day of insertion, 30th day and 60th day of insertion. Mean Clinical Attachment Level (CAL) was measured by William’s Probe. Tooth Mobility (TM) was assessed using Miller’s Classification. Gingival health was evaluated using the Gingival Index (GI) of Loe and Silness. Mean and standard deviation were calculated for patient’s age and all the periodontal scores of abutment teeth. Data was stratified for age and gender to identify the effect modifiers. Pearson chi-square test was used for Mean Gingival Index, and Mean Tooth Mobility. Post-stratification student t-test for Mean Clinical Attachment Level was used to compare the results with p ≤ 0.05 considered as significant. Results: Sstatistically insignificant results for all the periodontal parameters, i.e. the Mean Gingival Index (GI), Tooth Mobility (TM) and Mean Clinical Attachment Loss (CAL) were observed, age being not influencing the periodontal health of abutments. The only statistically significant (p= 0.01) result was observed for the Tooth Mobility (TM) in gender categories at the day of insertion and the 30th day of insertion. Conclusion: All the periodontal parameters, except tooth mobility (TM) assessed in the study, were not affected by the acrylic removable partial denture wearing.

ABSTRACTOptimal mobility is fundamental for healthy ageing and quality of life. This study is part of a cross-sectional population-based study of 85-year-old people residing in Linköping municipality, Sweden. The purpose was to describe 85-year-old peoples' health-related quality of life (HRQoL) in relation to mobility and fall risk while adjusting for gender and body mass index. Data collection included a postal questionnaire, a home visit and a reception visit. HRQoL was assessed with EQ-5D-3L, mobility with the Timed Up and Go test (TUG) and fall risk with the Downton Fall Risk Index (DFRI). All those who completed the DFRI, TUG and EQ-5D-3L were included in the present study (N = 327). Lower HRQoL was associated with longer time taken to complete TUG and higher fall risk in both genders but not with body mass index. Women had higher risk of falling, took a longer time to complete TUG and reported less physical activity compared with men. Health-care professionals should address mobility capacity and fall risk in order to maintain quality of life in elderly people. This is of utmost importance, especially for elderly women because impaired mobility, high risk of falling and occurrence of pain are common among women, and related to lower HRQoL.

Abstract Background This study examined whether aspects of diet and nutrition risk explain variance in physical capacity and general health, after controlling for covariates, in Canadian adults with osteoarthritis (OA). Methods This was a cross-sectional study of baseline data from the Canadian Longitudinal Study on Aging (CLSA). Data from 1,404 participants with hand, hip, and/or knee OA were included. A series of regression analyses were conducted with independent variables of food intake (fiber and high calorie snack intake) and nutrition risk; and dependent variables of physical capacity and general health. Physical capacity was characterized through grip strength and a pooled index of four mobility tests. General health was characterized through an index of self-reported general health, mental health, and healthy aging. Results Higher fiber intake was related to greater mobility (p = .01). Food intake was not related to any other outcome. Nutrition risk was significantly associated with mobility (p &lt; .001) and general health (p &lt; .001); those with a high nutrition risk classification had poorer general health (p &lt; .001, d = 0.65) than those at low nutrition risk. As well, those with moderate nutrition risk had poorer general health than those with low nutrition risk (p = .001, d = 0.31). Conclusions Nutrition risk screening for older adults with OA provides insight into behavioral characteristics associated with reduced mobility and poorer general health. Also, those consuming greater amounts of fiber demonstrated better mobility. Thus, this research suggests that quality of diet and nutritional behaviors can impact both physical and mental aspects of health in those with OA.

Objectives: Physical distancing is a control measure against coronavirus disease 2019 (COVID-19). Lockdowns are a strategy to enforce physical distancing in urban areas, but they are drastic measures. Therefore, we assessed the effectiveness of the lockdown measures taken in the world’s second-most populous country, India, by exploring their relationship with community mobility patterns and the doubling time of COVID-19.Methods: We conducted a retrospective analysis based on community mobility patterns, the stringency index of lockdown measures, and the doubling time of COVID-19 cases in India between February 15 and April 26, 2020. Pearson correlation coefficients were calculated between the stringency index, community mobility patterns, and the doubling time of COVID-19 cases. Multiple linear regression was applied to predict the doubling time of COVID-19.Results: Community mobility drastically fell after the lockdown was instituted. The doubling time of COVID-19 cases was negatively correlated with population mobility patterns in outdoor areas (r = –0.45 to –0.58). The stringency index and outdoor mobility patterns were also negatively correlated (r = –0.89 to –0.95). Population mobility patterns (R2 = 0.67) were found to predict the doubling time of COVID-19, and the model’s predictive power increased when the stringency index was also added (R2 = 0.73).Conclusions: Lockdown measures could effectively ensure physical distancing and reduce short-term case spikes in India. Therefore, lockdown measures may be considered for tailored implementation on an intermittent basis, whenever COVID-19 cases are predicted to exceed the health care system’s capacity to manage.

Preventive policies and mobility restrictions are believed to work for inhibiting the growth rate of COVID-19 cases; however, their effects have rarely been assessed and quantified in Southeast Asia. We aimed to examine the effects of the government responses and community mobility on the COVID-19 pandemic in Southeast Asian countries. The study extracted data from Coronavirus Government Response Tracker, COVID-19 Community Mobility Report, and Our World in Data between 1 March and 31 December 2020. The government responses were measured by containment, health, and economic support index. The community mobility took data on movement trends at six locations. Partial least square structural equation modeling was used for bi-monthly analyses in each country. Results show that the community mobility generally followed government responses, especially the containment index. The path coefficients of government responses to community mobility ranged from −0.785 to −0.976 in March to April and −0.670 to −0.932 in May to June. The path coefficients of community mobility to the COVID-19 cases ranged from −0.058 to −0.937 in March to April and from −0.059 to −0.640 in September to October. It suggests that the first few months since the mobility restriction implemented is the optimal time to control the pandemic.

Considered the king of poisons, arsenic occurs naturally in the environment being present in air, soil, water and food. Its presence in drinking water is of global concern. Initial chronic exposure is manifested by skin lesions. Additionally, arsenic consumption impairs certain visceral organs: bladder, liver, prostate, etc. More over, arsenic is a recognized carcinogenic substance.When in Bangladesh started the program to lead safe drinking water in the 60’s, they never imagined the catastrophic consequences. Water wells were drilled in the whole country. The arsenic problem was recognized recently in the 90’s.  In order to understand the nature of arsenic  in the environment and how it could possibly reach groundwater in Bangladesh, this work explains some chemical characteristics of arsenic, the geological formation of the basin, and its mobility.The origin of arsenic contamination in the Bangladesh Delta is due to the geologic nature of the basin rather than the possibility of an arsenic rich mineral. The profile of sediments shows that the Delta is not homogeneous, but rather heterogeneous even in closer areas. The driving process for arsenic mobility is mainly the reduction by iron oxyhydroxides coupled with organic matter, including other factors such as particle size, depth, morphology, metal content, as well

By using panel data from SHARE this thesis shows, that retirement has a negative effect on indicators of physical and mental health. Results from using fixed effects models suggest that retirement leads to 0,85 points increase in chronic diseases, 0,3 points increase in difficulties associated with mobility and 0,07 points increase in body mass index. Also retirement increases the level of depression by 0,5 points. According to the results, the effect of retirement on memory is also negative.

OBJECTIVE: To investigate the cross-cultural validity of international Dutch-English comparisons when using the Dutch Rivermead Mobility Index (RMI), and the intra-test reliability and construct validity of the Dutch RMI. METHODS: Cross-cultural validity was studied in a combined data-set of Dutch and English patients undergoing rehabilitation after stroke, who were assessed with the Dutch version of the RMI and the original English RMI, respectively. Mokken scale analysis was used to investigate unidimensionality, monotone homogeneity model fit, and differential item functioning between the Dutch and the English RMI. Intra-test reliability and construct validity were studied in the Dutch patients by calculating the reliability coefficient and correlating the Dutch RMI and the Dutch Barthel Index. RESULTS: The RMI was completed for Dutch (n = 200) and English (n = 420) patients after stroke. The unidimensionality and monotone homogeneity model fit of the RMI were excellent: combined Dutch-English data-set (coefficient H = 0.91); Dutch data-set (coefficient H = 0.93); English data-set (coefficient H = 0.89). No differential item functioning was found between the Dutch and the English RMI. The intra-test reliability of the Dutch RMI was excellent (coefficient rho = 0.97). In a sub-sample of patients (n = 91), the Dutch RMI correlated strongly with the Dutch Barthel Index (Spearman's correlation coefficient rho = 0.84). CONCLUSION: The Dutch RMI allows valid international Dutch-English comparisons, and has excellent intra-test reliability and construct validity.

OBJECTIVE: To enable improved interpretation of the total score and faster scoring of the Rivermead Mobility Index (RMI) by studying item ordering or hierarchy and formulating start-and-stop rules in patients after stroke. DESIGN: Cohort study. SETTING: Rehabilitation center in the Netherlands; stroke rehabilitation units and the community in the United Kingdom. PARTICIPANTS: Item hierarchy of the RMI was studied in an initial group of patients (n=620; mean age +/- SD, 69.2+/-12.5y; 297 [48%] men; 304 [49%] left hemisphere lesion, and 269 [43%] right hemisphere lesion), and the adequacy of the item hierarchy-based start-and-stop rules was checked in a second group of patients (n=237; mean age +/- SD, 60.0+/-11.3y; 139 [59%] men; 103 [44%] left hemisphere lesion, and 93 [39%] right hemisphere lesion) undergoing rehabilitation after stroke. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Mokken scale analysis was used to investigate the fit of the double monotonicity model, indicating hierarchical item ordering. The percentages of patients with a difference between the RMI total score and the scores based on the start-and-stop rules were calculated to check the adequacy of these rules. RESULTS: The RMI had good fit of the double monotonicity model (coefficient H(T)=.87). The interpretation of the total score improved. Item hierarchy-based start-and-stop rules were formulated. The percentages of patients with a difference between the RMI total score and the score based on the recommended start-and-stop rules were 3% and 5%, respectively. Ten of the original 15 items had to be scored after applying the start-and-stop rules. CONCLUSIONS: Item hierarchy was established, enabling improved interpretation and faster scoring of the RMI.

Obesity is defined as an excess of body fat that is sufficient to affect health adversely. While the quantification of fat mass is usually only performed in the research setting, body mass index (weight in kg/height in metres²) is a useful surrogate marker for fat mass. Using the World Health Organization definition of a body mass index more than 30 kg/m² to define obesity, 30% of Americans and 10–20% of Europeans are classified as obese, with the prevalence rising in many developing countries. As body mass index increases, so does the relative risk of type 2 diabetes, hypertension, and cardiovascular disease. As such, obesity is associated with disability, mortality, and substantial health costs. At an individual level, severe obesity can be associated with sleep disturbance and respiratory difficulties, joint and mobility disorders, as well as considerable social stigma which can affect quality of life, educational attainment, and employment opportunities.

Humankind is on the move all the time, but in the past few decades this movement has become massive in different parts of the world. We are living in an era of unprecedented mobility of ideas, technology, money, and people. Globalization has changed the world and is continuing to change the relationships between nation-states, corporations, and international organizations. By 2030, 80% of the world’s poor will be living in an area defined as ‘fragile’—a status that may reflect any number of political, social, security, economic, or environmental causes, forcing millions who are suffering to flee their country and homes. The CAPE Vulnerability Index tool helps assess the causes of violent conflict, terrorism, climate change, poverty, inequality and injustice, migration and displacement through this new axis of geopolitical determinants of health rather than focusing disproportionately on the effects. Leaders across the globe have a moral imperative to provide security, economic prosperity, and well-being to their people, but the policy needs to be fit for the local environment, be it geographical, political, or cultural, to help people to function well.

Batteries are being seen as a key technology for battling CO2 emissions from the transport, power, and industry sectors. However, to reach the sustainability goals, they must exhibit ultrahigh performance beyond their capabilities today. So, it is becoming crucial to develop advanced diagnostic/prognostic tools injected into the battery that could nonintrusively track in time and space its physical and chemical parameters, for ensuring a greater lifetime and therefore lower its CO2 footprint. In this context, a smart battery sensing system with high performance and easy implementation is critically needed for the vital importance of safety and reliability in all batteries. Parameters like temperature (heat flow), strain, pressure, electrochemical events from electrode lithiation to gassing production, refractive index, and SoX battery indicators are of high importance to monitor. Recently, optical fiber sensors (OFS) have shown to be a feasible, accurate, and useful tool to perform this sensing, due to their intrinsic advantages and capabilities (lower invasiveness, multipoint and multiparameter detection, capability of multiplexing being embedded in harsh environments, and fast response). This chapter presents and discusses the studies published regarding the different types of OFS, which were developed to track several critical key parameters in Li-ion batteries, since the first study was reported in 2013.

The basic function of the adrenal glands is to protect the organism against acute and chronic stress, a concept popularized as the fight-or-flight response for the medulla and as the alarm reaction for the cortex. The steroid hormones of the cortex and the catecholamines of the medulla probably developed as protection against immediate stress or injury and more prolonged deprivation of food and water. In acute stress, catecholamines mobilize glucose and fatty acids for energy and prepare the heart, lungs, and muscles for action, while glucocorticoids protect against overreactions from the body’s responses to stress. In the more chronic stress of food and fluid deprivation, adrenocortical steroid hormones stimulate gluconeogenesis to maintain the supply of glucose and increase sodium reabsorption to maintain body fluid volume. Based on the widespread effects of its secreted products in multiple tissues, adrenal dysfunction is associated with protean manifestations. Diseases associated with adrenocortical hypofunction are relatively rare, while those associated with adrenocortical hyperfunction are slightly more common. However, both of these conditions are life threatening if untreated, and a high index of suspicion must therefore be maintained. Subtle increases in cortisol secretion or tissue sensitivity to glucocorticoids may be involved in many of the devastating effects of chronic stress, including visceral obesity, hypertension, diabetes mellitus, dyslipidemia, infertility, and depression. Moreover, exogenous glucocorticoids are widely used to treat numerous diseases and, when used in supraphysiological doses, can induce all of the manifestations of glucocorticoid excess. Perhaps because the adrenal medulla accounts for only 10 % of total sympathetic nervous activation, we can live quite well without it, and syndromes due to hypofunction are not clinically significant. However, conditions of excess catecholamine output due to tumors called pheochromocytomas are a rare but potentially life-threatening cause of secondary hypertension.

As life expectancy increases, the likelihood of more falls and fall-related hospitalizations increases with a significant impact on the health system. Given the high incidence of falls in healthy elderly people, in order to prevent them, it is necessary to identify predisposing risk factors, analyze the specific needs of the subjects and use a targeted preventive strategy. This paper investigates the influence of multidimensional health parameters on the fall risk of community-dwelling older people, living in inner areas of Marche Region (Italy). Multidimensional data on the global health of each individual has been collected among several health domains (i.e., mobility, psychological, nutritional, cardiological, social). Statistical analysis has been applied for the assessment of the relationship among the defined health variables and the influence on the fall risk. The binary logistical regression analysis has produced a statistical model with good characteristics of fit and good predictability. The following features have been proven to be strong predictors of fall: female (OR for Gender, 5.526; 95% CI, 1.49–20.53), limited range of movement (OR 3.278; 95% CI, 1.01-10.68), diabetes (OR 4.487; 95% CI, 1.02-19.80), previous syncope (OR 7.686; 95% CI, 1.01-58.55), and body mass index (OR 1.176; 95% CI, 1.03-1.35). Future work will allow the development of a fall prediction index to have a framework of the elder’s global health status and to define a personalized intervention strategy for any adverse event prevention.

In most of the cases, canal network in Greater Colombo region work as the drainage system of the urban area and as the backyard of the city. Therefore, there is a lack of attention to the canal waterfronts by the government and by the public. Hence, this research was to find out and evaluate the factors, which will affect the quality of life of people along urban canal waterfronts. It has been discussed in terms of liveability through a series of carefully selected indicators. Liveability surveys were conducted along five canal waterfronts and the participants’ perceptions were taken. Every canal waterfront was assigned a rating of over 25 qualitative and quantitative factors (set of indicators) across six broad categories (dimensions): safety, comfort, health and wellbeing, mobility, environment, and socio-cultural factors. Each qualitative factor was given a rating from 1(tolerable)-5(intolerable). Qualitative factors were then combined with quantitative factors through a series of equations to form the liveability index. According to the proposed liveability index, transport dimension index is ideal (100), while the health and well-being dimension is the lowest (27). This will help for the creation of government policies, plans, rules and regulations and when implementing projects along urban canal waterfronts.

With the needs for full structural state awareness and health monitoring as well as emerging challenges of Urban Air Mobility (UAV) and Future Vertical Lift (FVL), Health and Usage Monitoring systems (HUMS) need to be more accurate, robust and reliable than ever before. In active-sensing guided-wave networks in particular, conventional Damage Index (DI)-based approaches have been the industry standard for decades because of their computational simplicity and ability to do the damage detection and quantification tasks. However, under specific circumstances, like for specific actuator-sensor paths within a network or due to varying operational conditions, DIs can suffer from various drawbacks that make them prone to inaccurate and/or ineffective damage quantification. This study builds on previous work by the authors where DIs were used to train single-output Gaussian Process regression models (SOGPRMs) for robust damage quantification, and the accuracy limit of SOGPRMs was shown to depend on the evolution of the chosen DI formulation with damage size. In this study, multi-output GPRMs (MOGPRMs) are used instead in order to leverage information about damage size from multiple actuator-sensor path DI values. It is shown that the proposed approach can overcome the different shortcomings of DI evolution with damage size in the different path by capturing the correlation between the DI evolution for different paths. The proposed framework is applied for an Al coupon with simulated damage, and the damage size quantification results are compared with those of SOGPRMs. It is shown that the information fusion approach exhibited by MOGPRMs gives more accurate damage size estimations compared to SOGPRMs.

Summary Late in the life of the Steam Assisted Gravity Drainage (SAGD) process, it has become common practice to drill a single, horizontal infill well (called a “Wedge Well™” by some) in the oil bank located between two mature SAGD well pairs to produce the bitumen that has been heated and mobilized but is unable to be effectively drained by gravity given the largely lateral location relative to that of the SAGD producers. Since this oil bank is surrounded by the large, depleted steam chamber created by the existing well pairs, it requires little heat to mobilize bitumen. One of the challenges, however, in producing infill wells is that non-uniform drainage and local hot spots can be readily created in the first year of their operation, that in many cases require completion retrofits, such as with Flow Control Devices (FCDs), to improve the drainage profile. Installation of FCDs in these wells is quite challenging since the dynamics of the infill wells is changing with time and there is limited time to achieve conformance. To maintain pressure in SAGD chambers the common practice is to inject non-condensable gas (NCG). NCGs, such as methane, which is most common, do not condense in the steam chamber. Some of these NCG can short-cut into the infill through the existing hot-spot. The main reason is that the hot sections of infills are locations that are closer to the SAGD steam chamber, and due to steam condensate encroachment and higher mobility create a pathway for NCG breakthrough. FCDs are designed to promote a more uniform flux distribution along the producer, and exposure to NCG can change the impact of the FCDs. The true hot-spot temperature after NCG injection is decreasing and this can be mistaken as FCD efficiency and steam blocking. In reality, this temperature reduction is due to partial pressure effects associated with NCG encroachment. In this study, a new thermodynamic model is created to explain the NCG encroachment into infill wells, and a new temperature profile along the producer as a function of NCG breakthrough is calculated. The purpose of this work is to create a productivity index (PI) relationship that is fit for purpose for infill wells adjacent to SAGD well-pairs with NCG breakthrough that can primarily be used for analysis and optimization of SAGD FCD completions. This model can also be used to evaluate FCD performance in infill wells pre- and post- NCG breakthrough.

Abstract The Sparky/General-Petroleum/Rex/Lloydminster formations are subject to a mature waterflood (1300+ vertical/horizontal wells) in Chauvin, Alberta, where permeabilities and viscosities range from 10 to 200 mD and 40 to 150 cp, respectively, and adverse mobility ratio, injection-induced fracturing, and thief zones trigger water channeling. Conformance polymer-gel squeeze is common for alleviating channeling. With sufficient gel (10-25% of channel volume) selectively placed into water-bearing channels, injected water is effectively redistributed to improve sweep efficiency and pressure support. Selective gel squeeze with diverter entails injecting a diverter slug ahead of self-crosslinking gels to divert gels to high-permeability water-bearing channels, avoiding diversion into lower-permeability and/or oil-bearing pores. Selective gel squeezes are complex, costly, and erode profit margins in mature waterfloods. In simpler-to-execute, more-economical non-selective gel squeezes (without diverters), bullhead gel treatments are ‘designed’ to enter higher-permeability zones. In this work, effective, economical conformance control strategies were developed using non-selective gel squeezes. Hall/Chan/Conformance/Heterogeneity-Index Plots were used to identify candidates (26 injectors supporting 300+ producers) and channel volumes. Gel strength of crosslinked acrylamide-polymer (4000-15000 PPM concentrations) was monitored using Sydansk grading. During the treatment, offsets were monitored for polymer breakthrough using flocculation tests. Any offending producer was shut in until resuming water injection. After treatment, water post-flush displaced the gel, and injector was shut in for 1-4 weeks (longer shut-in for lower polymer concentration) to allow gel to set before resuming water injection. Non-selective bullhead gel with low-to-medium strength, lower treatment rate, and extended water post-flush triggers both near-wellbore diversion and protection against crossflow back into offending thief zones deeper in the reservoir, resulting in 40% costs reduction and up to 50% oil rates improvement with lower treatment volumes (5-10% of channel volume). Sufficient low-to-medium strength gel is required for deeper gel placement in the reservoir. Injecting gel in stages of increasing polymer concentration ensures that lower polymer-concentration gels at the leading edge of the treatment occupy rock furthest from the wellbore where they will not require as much strength to resist lower differential pressure to which they will be exposed. Conversely, higher polymer-concentration gels injected at the end of the treatment occupy rock nearest the wellbore where more strength is required to resist higher differential pressure. Furthermore, injecting gel at lower rates ensures that it remains selective to higher-permeability, more-conductive pores (i.e., water flow paths), minimizing gel diversion into oil-bearing pores. Shut-off candidates exhibit out-of-zone injection to adjacent formation(s) because of crossflow. An extended water post-flush pushes high-strength gel deep in the formation to mitigate crossflow. Economical conformance control protocols were developed to selectively heal high-permeability water-bearing channels in comingled injectors using low-rate, low-volume gel squeezes with low-to-medium strength, eliminating the need for diverters and workover rig.

1.1 Macroeconomic summary Economic recovery has consistently outperformed the technical staff’s expectations following a steep decline in activity in the second quarter of 2020. At the same time, total and core inflation rates have fallen and remain at low levels, suggesting that a significant element of the reactivation of Colombia’s economy has been related to recovery in potential GDP. This would support the technical staff’s diagnosis of weak aggregate demand and ample excess capacity. The most recently available data on 2020 growth suggests a contraction in economic activity of 6.8%, lower than estimates from January’s Monetary Policy Report (-7.2%). High-frequency indicators suggest that economic performance was significantly more dynamic than expected in January, despite mobility restrictions and quarantine measures. This has also come amid declines in total and core inflation, the latter of which was below January projections if controlling for certain relative price changes. This suggests that the unexpected strength of recent growth contains elements of demand, and that excess capacity, while significant, could be lower than previously estimated. Nevertheless, uncertainty over the measurement of excess capacity continues to be unusually high and marked both by variations in the way different economic sectors and spending components have been affected by the pandemic, and by uneven price behavior. The size of excess capacity, and in particular the evolution of the pandemic in forthcoming quarters, constitute substantial risks to the macroeconomic forecast presented in this report. Despite the unexpected strength of the recovery, the technical staff continues to project ample excess capacity that is expected to remain on the forecast horizon, alongside core inflation that will likely remain below the target. Domestic demand remains below 2019 levels amid unusually significant uncertainty over the size of excess capacity in the economy. High national unemployment (14.6% for February 2021) reflects a loose labor market, while observed total and core inflation continue to be below 2%. Inflationary pressures from the exchange rate are expected to continue to be low, with relatively little pass-through on inflation. This would be compatible with a negative output gap. Excess productive capacity and the expectation of core inflation below the 3% target on the forecast horizon provide a basis for an expansive monetary policy posture. The technical staff’s assessment of certain shocks and their expected effects on the economy, as well as the presence of several sources of uncertainty and related assumptions about their potential macroeconomic impacts, remain a feature of this report. The coronavirus pandemic, in particular, continues to affect the public health environment, and the reopening of Colombia’s economy remains incomplete. The technical staff’s assessment is that the COVID-19 shock has affected both aggregate demand and supply, but that the impact on demand has been deeper and more persistent. Given this persistence, the central forecast accounts for a gradual tightening of the output gap in the absence of new waves of contagion, and as vaccination campaigns progress. The central forecast continues to include an expected increase of total and core inflation rates in the second quarter of 2021, alongside the lapse of the temporary price relief measures put in place in 2020. Additional COVID-19 outbreaks (of uncertain duration and intensity) represent a significant risk factor that could affect these projections. Additionally, the forecast continues to include an upward trend in sovereign risk premiums, reflected by higher levels of public debt that in the wake of the pandemic are likely to persist on the forecast horizon, even in the context of a fiscal adjustment. At the same time, the projection accounts for the shortterm effects on private domestic demand from a fiscal adjustment along the lines of the one currently being proposed by the national government. This would be compatible with a gradual recovery of private domestic demand in 2022. The size and characteristics of the fiscal adjustment that is ultimately implemented, as well as the corresponding market response, represent another source of forecast uncertainty. Newly available information offers evidence of the potential for significant changes to the macroeconomic scenario, though without altering the general diagnosis described above. The most recent data on inflation, growth, fiscal policy, and international financial conditions suggests a more dynamic economy than previously expected. However, a third wave of the pandemic has delayed the re-opening of Colombia’s economy and brought with it a deceleration in economic activity. Detailed descriptions of these considerations and subsequent changes to the macroeconomic forecast are presented below. The expected annual decline in GDP (-0.3%) in the first quarter of 2021 appears to have been less pronounced than projected in January (-4.8%). Partial closures in January to address a second wave of COVID-19 appear to have had a less significant negative impact on the economy than previously estimated. This is reflected in figures related to mobility, energy demand, industry and retail sales, foreign trade, commercial transactions from selected banks, and the national statistics agency’s (DANE) economic tracking indicator (ISE). Output is now expected to have declined annually in the first quarter by 0.3%. Private consumption likely continued to recover, registering levels somewhat above those from the previous year, while public consumption likely increased significantly. While a recovery in investment in both housing and in other buildings and structures is expected, overall investment levels in this case likely continued to be low, and gross fixed capital formation is expected to continue to show significant annual declines. Imports likely recovered to again outpace exports, though both are expected to register significant annual declines. Economic activity that outpaced projections, an increase in oil prices and other export products, and an expected increase in public spending this year account for the upward revision to the 2021 growth forecast (from 4.6% with a range between 2% and 6% in January, to 6.0% with a range between 3% and 7% in April). As a result, the output gap is expected to be smaller and to tighten more rapidly than projected in the previous report, though it is still expected to remain in negative territory on the forecast horizon. Wide forecast intervals reflect the fact that the future evolution of the COVID-19 pandemic remains a significant source of uncertainty on these projections. The delay in the recovery of economic activity as a result of the resurgence of COVID-19 in the first quarter appears to have been less significant than projected in the January report. The central forecast scenario expects this improved performance to continue in 2021 alongside increased consumer and business confidence. Low real interest rates and an active credit supply would also support this dynamic, and the overall conditions would be expected to spur a recovery in consumption and investment. Increased growth in public spending and public works based on the national government’s spending plan (Plan Financiero del Gobierno) are other factors to consider. Additionally, an expected recovery in global demand and higher projected prices for oil and coffee would further contribute to improved external revenues and would favor investment, in particular in the oil sector. Given the above, the technical staff’s 2021 growth forecast has been revised upward from 4.6% in January (range from 2% to 6%) to 6.0% in April (range from 3% to 7%). These projections account for the potential for the third wave of COVID-19 to have a larger and more persistent effect on the economy than the previous wave, while also supposing that there will not be any additional significant waves of the pandemic and that mobility restrictions will be relaxed as a result. Economic growth in 2022 is expected to be 3%, with a range between 1% and 5%. This figure would be lower than projected in the January report (3.6% with a range between 2% and 6%), due to a higher base of comparison given the upward revision to expected GDP in 2021. This forecast also takes into account the likely effects on private demand of a fiscal adjustment of the size currently being proposed by the national government, and which would come into effect in 2022. Excess in productive capacity is now expected to be lower than estimated in January but continues to be significant and affected by high levels of uncertainty, as reflected in the wide forecast intervals. The possibility of new waves of the virus (of uncertain intensity and duration) represents a significant downward risk to projected GDP growth, and is signaled by the lower limits of the ranges provided in this report. Inflation (1.51%) and inflation excluding food and regulated items (0.94%) declined in March compared to December, continuing below the 3% target. The decline in inflation in this period was below projections, explained in large part by unanticipated increases in the costs of certain foods (3.92%) and regulated items (1.52%). An increase in international food and shipping prices, increased foreign demand for beef, and specific upward pressures on perishable food supplies appear to explain a lower-than-expected deceleration in the consumer price index (CPI) for foods. An unexpected increase in regulated items prices came amid unanticipated increases in international fuel prices, on some utilities rates, and for regulated education prices. The decline in annual inflation excluding food and regulated items between December and March was in line with projections from January, though this included downward pressure from a significant reduction in telecommunications rates due to the imminent entry of a new operator. When controlling for the effects of this relative price change, inflation excluding food and regulated items exceeds levels forecast in the previous report. Within this indicator of core inflation, the CPI for goods (1.05%) accelerated due to a reversion of the effects of the VAT-free day in November, which was largely accounted for in February, and possibly by the transmission of a recent depreciation of the peso on domestic prices for certain items (electric and household appliances). For their part, services prices decelerated and showed the lowest rate of annual growth (0.89%) among the large consumer baskets in the CPI. Within the services basket, the annual change in rental prices continued to decline, while those services that continue to experience the most significant restrictions on returning to normal operations (tourism, cinemas, nightlife, etc.) continued to register significant price declines. As previously mentioned, telephone rates also fell significantly due to increased competition in the market. Total inflation is expected to continue to be affected by ample excesses in productive capacity for the remainder of 2021 and 2022, though less so than projected in January. As a result, convergence to the inflation target is now expected to be somewhat faster than estimated in the previous report, assuming the absence of significant additional outbreaks of COVID-19. The technical staff’s year-end inflation projections for 2021 and 2022 have increased, suggesting figures around 3% due largely to variation in food and regulated items prices. The projection for inflation excluding food and regulated items also increased, but remains below 3%. Price relief measures on indirect taxes implemented in 2020 are expected to lapse in the second quarter of 2021, generating a one-off effect on prices and temporarily affecting inflation excluding food and regulated items. However, indexation to low levels of past inflation, weak demand, and ample excess productive capacity are expected to keep core inflation below the target, near 2.3% at the end of 2021 (previously 2.1%). The reversion in 2021 of the effects of some price relief measures on utility rates from 2020 should lead to an increase in the CPI for regulated items in the second half of this year. Annual price changes are now expected to be higher than estimated in the January report due to an increased expected path for fuel prices and unanticipated increases in regulated education prices. The projection for the CPI for foods has increased compared to the previous report, taking into account certain factors that were not anticipated in January (a less favorable agricultural cycle, increased pressure from international prices, and transport costs). Given the above, year-end annual inflation for 2021 and 2022 is now expected to be 3% and 2.8%, respectively, which would be above projections from January (2.3% and 2,7%). For its part, expected inflation based on analyst surveys suggests year-end inflation in 2021 and 2022 of 2.8% and 3.1%, respectively. There remains significant uncertainty surrounding the inflation forecasts included in this report due to several factors: 1) the evolution of the pandemic; 2) the difficulty in evaluating the size and persistence of excess productive capacity; 3) the timing and manner in which price relief measures will lapse; and 4) the future behavior of food prices. Projected 2021 growth in foreign demand (4.4% to 5.2%) and the supposed average oil price (USD 53 to USD 61 per Brent benchmark barrel) were both revised upward. An increase in long-term international interest rates has been reflected in a depreciation of the peso and could result in relatively tighter external financial conditions for emerging market economies, including Colombia. Average growth among Colombia’s trade partners was greater than expected in the fourth quarter of 2020. This, together with a sizable fiscal stimulus approved in the United States and the onset of a massive global vaccination campaign, largely explains the projected increase in foreign demand growth in 2021. The resilience of the goods market in the face of global crisis and an expected normalization in international trade are additional factors. These considerations and the expected continuation of a gradual reduction of mobility restrictions abroad suggest that Colombia’s trade partners could grow on average by 5.2% in 2021 and around 3.4% in 2022. The improved prospects for global economic growth have led to an increase in current and expected oil prices. Production interruptions due to a heavy winter, reduced inventories, and increased supply restrictions instituted by producing countries have also contributed to the increase. Meanwhile, market forecasts and recent Federal Reserve pronouncements suggest that the benchmark interest rate in the U.S. will remain stable for the next two years. Nevertheless, a significant increase in public spending in the country has fostered expectations for greater growth and inflation, as well as increased uncertainty over the moment in which a normalization of monetary policy might begin. This has been reflected in an increase in long-term interest rates. In this context, emerging market economies in the region, including Colombia, have registered increases in sovereign risk premiums and long-term domestic interest rates, and a depreciation of local currencies against the dollar. Recent outbreaks of COVID-19 in several of these economies; limits on vaccine supply and the slow pace of immunization campaigns in some countries; a significant increase in public debt; and tensions between the United States and China, among other factors, all add to a high level of uncertainty surrounding interest rate spreads, external financing conditions, and the future performance of risk premiums. The impact that this environment could have on the exchange rate and on domestic financing conditions represent risks to the macroeconomic and monetary policy forecasts. Domestic financial conditions continue to favor recovery in economic activity. The transmission of reductions to the policy interest rate on credit rates has been significant. The banking portfolio continues to recover amid circumstances that have affected both the supply and demand for loans, and in which some credit risks have materialized. Preferential and ordinary commercial interest rates have fallen to a similar degree as the benchmark interest rate. As is generally the case, this transmission has come at a slower pace for consumer credit rates, and has been further delayed in the case of mortgage rates. Commercial credit levels stabilized above pre-pandemic levels in March, following an increase resulting from significant liquidity requirements for businesses in the second quarter of 2020. The consumer credit portfolio continued to recover and has now surpassed February 2020 levels, though overall growth in the portfolio remains low. At the same time, portfolio projections and default indicators have increased, and credit establishment earnings have come down. Despite this, credit disbursements continue to recover and solvency indicators remain well above regulatory minimums. 1.2 Monetary policy decision In its meetings in March and April the BDBR left the benchmark interest rate unchanged at 1.75%.

Macroeconomic summary Several factors contributed to an increase in projected inflation on the forecast horizon, keeping it above the target rate. These included inflation in December that surpassed expectations (5.62%), indexation to higher inflation rates for various baskets in the consumer price index (CPI), a significant real increase in the legal minimum wage, persistent external and domestic inflationary supply shocks, and heightened exchange rate pressures. The CPI for foods was affected by the persistence of external and domestic supply shocks and was the most significant contributor to unexpectedly high inflation in the fourth quarter. Price adjustments for fuels and certain utilities can explain the acceleration in inflation for regulated items, which was more significant than anticipated. Prices in the CPI for goods excluding food and regulated items also rose more than expected. This was partly due to a smaller effect on prices from the national government’s VAT-free day than anticipated by the technical staff and more persistent external pressures, including via peso depreciation. By contrast, the CPI for services excluding food and regulated items accelerated less than expected, partly reflecting strong competition in the communications sector. This was the only major CPI basket for which prices increased below the target inflation rate. The technical staff revised its inflation forecast upward in response to certain external shocks (prices, costs, and depreciation) and domestic shocks (e.g., on meat products) that were stronger and more persistent than anticipated in the previous report. Observed inflation and a real increase in the legal minimum wage also exceeded expectations, which would boost inflation by affecting price indexation, labor costs, and inflation expectations. The technical staff now expects year-end headline inflation of 4.3% in 2022 and 3.4% in 2023; core inflation is projected to be 4.5% and 3.6%, respectively. These forecasts consider the lapse of certain price relief measures associated with the COVID-19 health emergency, which would contribute to temporarily keeping inflation above the target on the forecast horizon. It is important to note that these estimates continue to contain a significant degree of uncertainty, mainly related to the development of external and domestic supply shocks and their ultimate effects on prices. Other contributing factors include high price volatility and measurement uncertainty related to the extension of Colombia’s health emergency and tax relief measures (such as the VAT-free days) associated with the Social Investment Law (Ley de Inversión Social). The as-yet uncertain magnitude of the effects of a recent real increase in the legal minimum wage (that was high by historical standards) and high observed and expected inflation, are additional factors weighing on the overall uncertainty of the estimates in this report. The size of excess productive capacity remaining in the economy and the degree to which it is closing are also uncertain, as the evolution of the pandemic continues to represent a significant forecast risk. margin, could be less dynamic than expected. And the normalization of monetary policy in the United States could come more quickly than projected in this report, which could negatively affect international financing costs. Finally, there remains a significant degree of uncertainty related to the duration of supply chocks and the degree to which macroeconomic and political conditions could negatively affect the recovery in investment. The technical staff revised its GDP growth projection for 2022 from 4.7% to 4.3% (Graph 1.3). This revision accounts for the likelihood that a larger portion of the recent positive dynamic in private consumption would be transitory than previously expected. This estimate also contemplates less dynamic investment behavior than forecast in the previous report amid less favorable financial conditions and a highly uncertain investment environment. Third-quarter GDP growth (12.9%), which was similar to projections from the October report, and the fourth-quarter growth forecast (8.7%) reflect a positive consumption trend, which has been revised upward. This dynamic has been driven by both public and private spending. Investment growth, meanwhile, has been weaker than forecast. Available fourth-quarter data suggest that consumption spending for the period would have exceeded estimates from October, thanks to three consecutive months that included VAT-free days, a relatively low COVID-19 caseload, and mobility indicators similar to their pre-pandemic levels. By contrast, the most recently available figures on new housing developments and machinery and equipment imports suggest that investment, while continuing to rise, is growing at a slower rate than anticipated in the previous report. The trade deficit is expected to have widened, as imports would have grown at a high level and outpaced exports. Given the above, the technical staff now expects fourth-quarter economic growth of 8.7%, with overall growth for 2021 of 9.9%. Several factors should continue to contribute to output recovery in 2022, though some of these may be less significant than previously forecast. International financial conditions are expected to be less favorable, though external demand should continue to recover and terms of trade continue to increase amid higher projected oil prices. Lower unemployment rates and subsequent positive effects on household income, despite increased inflation, would also boost output recovery, as would progress in the national vaccination campaign. The technical staff expects that the conditions that have favored recent high levels of consumption would be, in large part, transitory. Consumption spending is expected to grow at a slower rate in 2022. Gross fixed capital formation (GFCF) would continue to recover, approaching its pre-pandemic level, though at a slower rate than anticipated in the previous report. This would be due to lower observed GFCF levels and the potential impact of political and fiscal uncertainty. Meanwhile, the policy interest rate would be less expansionary as the process of monetary policy normalization continues. Given the above, growth in 2022 is forecast to decelerate to 4.3% (previously 4.7%). In 2023, that figure (3.1%) is projected to converge to levels closer to the potential growth rate. In this case, excess productive capacity would be expected to tighten at a similar rate as projected in the previous report. The trade deficit would tighten more than previously projected on the forecast horizon, due to expectations of an improved export dynamic and moderation in imports. The growth forecast for 2022 considers a low basis of comparison from the first half of 2021. However, there remain significant downside risks to this forecast. The current projection does not, for example, account for any additional effects on economic activity resulting from further waves of COVID-19. High private consumption levels, which have already surpassed pre-pandemic levels by a large margin, could be less dynamic than expected. And the normalization of monetary policy in the United States could come more quickly than projected in this report, which could negatively affect international financing costs. Finally, there remains a significant degree of uncertainty related to the duration of supply chocks and the degree to which macroeconomic and political conditions could negatively affect the recovery in investment. External demand for Colombian goods and services should continue to recover amid significant global inflation pressures, high oil prices, and less favorable international financial conditions than those estimated in October. Economic activity among Colombia’s major trade partners recovered in 2021 amid countries reopening and ample international liquidity. However, that growth has been somewhat restricted by global supply chain disruptions and new outbreaks of COVID-19. The technical staff has revised its growth forecast for Colombia’s main trade partners from 6.3% to 6.9% for 2021, and from 3.4% to 3.3% for 2022; trade partner economies are expected to grow 2.6% in 2023. Colombia’s annual terms of trade increased in 2021, largely on higher oil, coffee, and coal prices. This improvement came despite increased prices for goods and services imports. The expected oil price trajectory has been revised upward, partly to supply restrictions and lagging investment in the sector that would offset reduced growth forecasts in some major economies. Elevated freight and raw materials costs and supply chain disruptions continue to affect global goods production, and have led to increases in global prices. Coupled with the recovery in global demand, this has put upward pressure on external inflation. Several emerging market economies have continued to normalize monetary policy in this context. Meanwhile, in the United States, the Federal Reserve has anticipated an end to its asset buying program. U.S. inflation in December (7.0%) was again surprisingly high and market average inflation forecasts for 2022 have increased. The Fed is expected to increase its policy rate during the first quarter of 2022, with quarterly increases anticipated over the rest of the year. For its part, Colombia’s sovereign risk premium has increased and is forecast to remain on a higher path, to levels above the 15-year-average, on the forecast horizon. This would be partly due to the effects of a less expansionary monetary policy in the United States and the accumulation of macroeconomic imbalances in Colombia. Given the above, international financial conditions are projected to be less favorable than anticipated in the October report. The increase in Colombia’s external financing costs could be more significant if upward pressures on inflation in the United States persist and monetary policy is normalized more quickly than contemplated in this report. As detailed in Section 2.3, uncertainty surrounding international financial conditions continues to be unusually high. Along with other considerations, recent concerns over the potential effects of new COVID-19 variants, the persistence of global supply chain disruptions, energy crises in certain countries, growing geopolitical tensions, and a more significant deceleration in China are all factors underlying this uncertainty. The changing macroeconomic environment toward greater inflation and unanchoring risks on inflation expectations imply a reduction in the space available for monetary policy stimulus. Recovery in domestic demand and a reduction in excess productive capacity have come in line with the technical staff’s expectations from the October report. Some upside risks to inflation have materialized, while medium-term inflation expectations have increased and are above the 3% target. Monetary policy remains expansionary. Significant global inflationary pressures and the unexpected increase in the CPI in December point to more persistent effects from recent supply shocks. Core inflation is trending upward, but remains below the 3% target. Headline and core inflation projections have increased on the forecast horizon and are above the target rate through the end of 2023. Meanwhile, the expected dynamism of domestic demand would be in line with low levels of excess productive capacity. An accumulation of macroeconomic imbalances in Colombia and the increased likelihood of a faster normalization of monetary policy in the United States would put upward pressure on sovereign risk perceptions in a more persistent manner, with implications for the exchange rate and the natural rate of interest. Persistent disruptions to international supply chains, a high real increase in the legal minimum wage, and the indexation of various baskets in the CPI to higher inflation rates could affect price expectations and push inflation above the target more persistently. These factors suggest that the space to maintain monetary stimulus has continued to diminish, though monetary policy remains expansionary. 1.2 Monetary policy decision Banco de la República’s board of directors (BDBR) in its meetings in December 2021 and January 2022 voted to continue normalizing monetary policy. The BDBR voted by a majority in these two meetings to increase the benchmark interest rate by 50 and 100 basis points, respectively, bringing the policy rate to 4.0%.