Search results for: older adult
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 1956

Search results for: older adult

1356 Social Ties and the Prevalence of Single Chronic Morbidity and Multimorbidity among the Elderly Population in Selected States of India

Authors: Sree Sanyal

Abstract:

Research in ageing often highlights the age-related health dimension more than the psycho-social characteristics of the elderly, which also influences and challenges the health outcomes. Multimorbidity is defined as the person having more than one chronic non-communicable diseases and their prevalence increases with ageing. The study aims to evaluate the influence of social ties on self-reported prevalence of multimorbidity (selected chronic non-communicable diseases) among the selected states of elderly population in India. The data is accessed from Building Knowledge Base on Population Ageing in India (BKPAI), collected in 2011 covering the self-reported chronic non-communicable diseases like arthritis, heart disease, diabetes, lung disease with asthma, hypertension, cataract, depression, dementia, Alzheimer’s disease, and cancer. The data of the above diseases were taken together and categorized as: ‘no disease’, ‘one disease’ and ‘multimorbidity’. The predicted variables were demographic, socio-economic, residential types, and the variable of social ties includes social support, social engagement, perceived support, connectedness, and importance of the elderly. Predicted probability for multiple logistic regression was used to determine the background characteristics of the old in association with chronic morbidities showing multimorbidity. The finding suggests that 24.35% of the elderly are suffering from multimorbidity. Research shows that with reference to ‘no disease’, according to the socio-economic characteristics of the old, the female oldest old (80+) from others in caste and religion, widowed, never had any formal education, ever worked in their life, coming from the second wealth quintile standard, from rural Maharashtra are more prone with ‘one disease’. From the social ties background, the elderly who perceives they are important to the family, after getting older their decision-making status has been changed, prefer to stay with son and spouse only, satisfied with the communication from their children are more likely to have less single morbidity and the results are significant. Again, with respect to ‘no disease’, the female oldest old (80+), who are others in caste, Christian in religion, widowed, having less than 5 years of education completed, ever worked, from highest wealth quintile, residing in urban Kerala are more associated with multimorbidity. The elderly population who are more socially connected through family visits, public gatherings, gets support in decision making, who prefers to spend their later years with son and spouse only but stays alone shows lesser prevalence of multimorbidity. In conclusion, received and perceived social integration and support from associated neighborhood in the older days, knowing about their own needs in life facilitates better health and wellbeing of the elderly population in selected states of India.

Keywords: morbidity, multi-morbidity, prevalence, social ties

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1355 Sublethal Effects of Clothianidin and Summer Oil on the Demographic Parameters and Population Projection of Bravicoryne Brassicae(Hemiptera: Aphididae)

Authors: Mehdi Piri Ouchtapeh, Fariba Mehrkhou, Maryam Fourouzan

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The cabbage aphid, Bravicoryne brassicae (Hemiptera: Aphididae), is known as an economically important and oligophagous pest of different cole crops. The polyvolitine characteristics of B. brassicae resulted in resistance to insecticides. For this purpose, in this study, the sub-lethal concentration (LC25) of two insecticides, clothianidin and summer oil, on the life table parameters and population projection of cabbage aphid were studied at controlled condition (20±1 ℃, R.H. 60 ±5 % and a photoperiod of 16:8 h (L:D). The dipping method was used in bioassay and life table studies. Briefly, the leaves of cabbage containing 15 the same-aged (24h) adults of cabbage aphid (four replicates) were dipped into the related concentrations of insecticides for 10 s. The sub-lethal (LC25) obtained concentration were used 5.822 and 108.741 p.p.m for clothianidin and summer oil, respectively. The biological and life table studies were done using at least 100, 93 and 82 the same age of eggs for control, summer oil and clothianidin treatments respectively. The life history data of the greenhouse whitefly cohorts exposed to sublethal concentration of the aforementioned insecticides were analyzed using the computer program TWOSEX–MSChart based on the age-stage, two-sex life table theory. The results of this study showed that the used insecticides affected the developmental time, survival rate, adult longevity, and fecundity of the F1 generation. The developmental time on control, clothianidin and summer oil treatments was obtained (5.91 ± 0.10 days), (7.64 ± 0.12 days) and (6.66 ± 0.10 days), respectively. The sublethal concentration of clothianidin resulted in decreasing of adult longevity (8.63 ± 0.30 days), fecundity (14.14 ± 87 nymphs), survival rate (71%) and the life expectancy (10.26 days) of B. brassicae, as well. Additionally, usage of LC25 insecticides led to decreasing of the net reproductive rate (R0) of the cabbage aphid compared to summer oil and control treatments. The intrinsic rate of increase (r) (day-1) was decreased in F1 adults of cabbage aphid compared with other treatments. Additionally, the population projection results were accordance with the population growth rate of cabbage aphid. Therefore, the findings of this research showed that, however, both of the insecticides were effective on cabbage aphid population, but clothianidin was more effective and could be consider in the management of aforementioned pest.

Keywords: the cabbage aphid, sublethal effects, survival rate, population projection, life expectancy

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1354 Comparison of Computerized Dynamic Posturography and Functional Head Impulse Test Scores after of Hatha Yoga Practice and Resistance-Based Aerobic Exercise in Adult Female Yoga Practitioners

Authors: Çağla Aras, Kübra Bi̇nay, Aysberg Şamil önlü, Mine Baydan Aran, Dicle Aras

Abstract:

The purpose of the present research was to investigate the acute effects of 30-min hatha yoga and 30-min resistance-based aerobic exercise (RBAE) on computerized dynamic posturography (CDP) and functional head impulse test (fHIT) scores in adult female yoga practitioners. To reach this aim, ten participants executed CDP and fHIT three times in total: at rest, after yoga, and after RBAE. The yoga practice lasted a total of 30 minutes, including 25 min of asanas and 5 minutes of savasana. RBAE lasted a total of 30 minutes with an intensity of 70-75% of the heart rate reserve method. When the results were examined, no change was observed in any parameters of the fHIT scores due to resting or exercise implementation. On the contrary, some changes were observed in CDP test results depending on the type of exercise. The post-RBAE somatosensory and visual systems values were higher than resting (p<0.05). The composite balance score derived after RBAE was found to be improved when compared to post-yoga and resting values (p<0.01). Lastly, the post-RBAE vestibular system score was found to be statistically significantly higher than the post-Yoga values. In addition, it was observed that body composition parameters, especially decreasing BW, LBM, PBF, MBF and TBW, were associated with improved postural stability values. According to the results, it can be stated that neither hatha yoga nor resistance-based aerobic exercise has an acute effect on functional vestibulo-ocular reflex. In addition, although there was no change in balance level after yoga, it was observed that RBAE performed at 70-75% of the heart rate reserve and for 30 minutes had positive acute effects on postural stability and balance.

Keywords: hatha yoga, resistance training, aerobic training, high intensity training, computerized dynamic posturography, functional head impulse test

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1353 As Evolved Mechanisms and Cultural Modeling Affect Child Gender Attribution

Authors: Stefano Federici, Alessandro Lepri, Antonella Carrera

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Kessler and McKenna in the seventies, and recently Federici and Lepri investigated how an individual attributes gender to a person. By administering nudes of human figures, the scholars have found that the penis more than the vagina and the male sexual characteristics more than the female ones are significantly more salient in the gender attribution process. Federici and Lepri suggested that the asymmetrical salience of sexual characteristics is attributable to evolved decision-making processes for the solution of gender attribution problems to avoid the greatest danger of an (angry) adult male. The present study has observed the behaviour of 60 children, aged between 3 and 6 years, and their parents verifying whether the child gender attribution mechanisms are permeable to cultural stereotypes. The participating children were asked to make a male or a female on a tablet by combining 12 human physical characteristics (long hair, short hair, wide hips, narrow hips, breasts, flat chest, body hair, hairless body, penis, vagina, male face, and female face) and four cloths (male t-shirt, female t-shirt, pants, and skirt) by superimposing one or more of them on a sexually neutral manikin. On the tablet was installed an App, created by authors, to replicate the Kessler and McKenna and Federici and Lepri previous studies. One of the parents of each of the participating children was asked to make a male or a female using the same apparatus used by children. In addition, the participating parents were asked to complete a test, as proposed by Federici and Lepri in their previous study, to compare adult and child processes of gender attribution. The results suggested that children are affected both by evolved mechanisms as adults were (e.g., taking less time to make a male than a female, using the penis more often than the vagina), and by cultural modeling of parental and environmental gender stereotypes (e.g., the genitals were often covered with pants in case the delivery was to make a male and a skirt in the case was to make a female).

Keywords: biological sex, cognitive biases, cultural modeling, gender attribution, evolved decision-making processes

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1352 Exploring the Neural Mechanisms of Communication and Cooperation in Children and Adults

Authors: Sara Mosteller, Larissa K. Samuelson, Sobanawartiny Wijeakumar, John P. Spencer

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This study was designed to examine how humans are able to teach and learn semantic information as well as cooperate in order to jointly achieve sophisticated goals. Specifically, we are measuring individual differences in how these abilities develop from foundational building blocks in early childhood. The current study adopts a paradigm for novel noun learning developed by Samuelson, Smith, Perry, and Spencer (2011) to a hyperscanning paradigm [Cui, Bryant and Reiss, 2012]. This project measures coordinated brain activity between a parent and child using simultaneous functional near infrared spectroscopy (fNIRS) in pairs of 2.5, 3.5 and 4.5-year-old children and their parents. We are also separately testing pairs of adult friends. Children and parents, or adult friends, are seated across from one another at a table. The parent (in the developmental study) then teaches their child the names of novel toys. An experimenter then tests the child by presenting the objects in pairs and asking the child to retrieve one object by name. Children are asked to choose from both pairs of familiar objects and pairs of novel objects. In order to explore individual differences in cooperation with the same participants, each dyad plays a cooperative game of Jenga, in which their joint score is based on how many blocks they can remove from the tower as a team. A preliminary analysis of the noun-learning task showed that, when presented with 6 word-object mappings, children learned an average of 3 new words (50%) and that the number of objects learned by each child ranged from 2-4. Adults initially learned all of the new words but were variable in their later retention of the mappings, which ranged from 50-100%. We are currently examining differences in cooperative behavior during the Jenga playing game, including time spent discussing each move before it is made. Ongoing analyses are examining the social dynamics that might underlie the differences between words that were successfully learned and unlearned words for each dyad, as well as the developmental differences observed in the study. Additionally, the Jenga game is being used to better understand individual and developmental differences in social coordination during a cooperative task. At a behavioral level, the analysis maps periods of joint visual attention between participants during the word learning and the Jenga game, using head-mounted eye trackers to assess each participant’s first-person viewpoint during the session. We are also analyzing the coherence in brain activity between participants during novel word-learning and Jenga playing. The first hypothesis is that visual joint attention during the session will be positively correlated with both the number of words learned and with the number of blocks moved during Jenga before the tower falls. The next hypothesis is that successful communication of new words and success in the game will each be positively correlated with synchronized brain activity between the parent and child/the adult friends in cortical regions underlying social cognition, semantic processing, and visual processing. This study probes both the neural and behavioral mechanisms of learning and cooperation in a naturalistic, interactive and developmental context.

Keywords: communication, cooperation, development, interaction, neuroscience

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1351 Modeling Generalization in the Acquired Equivalence Paradigm with the Successor Representation

Authors: Troy M. Houser

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The successor representation balances flexible and efficient reinforcement learning by learning to predict the future, given the present. As such, the successor representation models stimuli as what future states they lead to. Therefore, two stimuli that are perceptually dissimilar but lead to the same future state will come to be represented more similarly. This is very similar to an older behavioral paradigm -the acquired equivalence paradigm, which measures the generalization of learned associations. Here, we test via computational modeling the plausibility that the successor representation is the mechanism by which people generalize knowledge learned in the acquired equivalence paradigm. Computational evidence suggests that this is a plausible mechanism for acquired equivalence and thus can guide future empirical work on individual differences in associative-based generalization.

Keywords: acquired equivalence, successor representation, generalization, decision-making

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1350 A Case Study on How Biomedical Engineering (BME) Outreach Programmes Serve as An Alternative Educational Approach to Form and Develop the BME Community in Hong Kong

Authors: Sum Lau, Wing Chung Cleo Lau, Wing Yan Chu, Long Ching Ip, Wan Yin Lo, Jo Long Sam Yau, Ka Ho Hui, Sze Yi Mak

Abstract:

Biomedical engineering (BME) is an interdisciplinary subject where knowledge about biology and medicine is applied to novel applications, solving clinical problems. This subject is crucial for cities such as Hong Kong, where the burden on the medical system is rising due to reasons like the ageing population. Hong Kong, who is actively boosting technological advancements in recent years, sets BME, or biotechnology, as a major category, as reflected in the 2018-19 Budget, where biotechnology was one of the four pillars for development. Over the years, while resources in terms of money and space have been provided, there has been a lack of talents expressed by both the academia and industry. While exogenous factors, such as COVID, may have hindered talents from outside Hong Kong to come, endogenous factors should also be considered. In particular, since there are already a few local universities offering BME programmes, their curriculum or style of education requires to be reviewed to intensify the network of the BME community and support post-academic career development. It was observed that while undergraduate (UG) studies focus on knowledge teaching with some technical training and postgraduate (PG) programmes concentrate on upstream research, the programmes are generally confined to the academic sector and lack connections to the industry. In light of that, a “Biomedical Innovation and Outreach Programme 2022” (“B.I.O.2022”) was held to connect students and professors from academia with clinicians and engineers from the industry, serving as a comparative approach to conventional education methods (UG and PG programmes from tertiary institutions). Over 100 participants, including undergraduates, postgraduates, secondary school students, researchers, engineers, and clinicians, took part in various outreach events such as conference and site visits, all held from June to July 2022. As a case study, this programme aimed to tackle the aforementioned problems with the theme of “4Cs” (connection, communication, collaboration, and commercialisation). The effectiveness of the programme is investigated by its ability to serve as an adult and continuing education and the effectiveness of causing social change to tackle current societal challenges, with the focus on tackling the lack of talents engaging in biomedical engineering. In this study, B.I.O.2022 is found to be able to complement the traditional educational methods, particularly in terms of knowledge exchange between the academia and the industry. With enhanced communications between participants from different career stages, there were students who followed up to visit or even work with the professionals after the programme. Furthermore, connections between the academia and industry could foster the generation of new knowledge, which ultimately pointed to commercialisation, adding value to the BME industry while filling the gap in terms of human resources. With the continuation of events like B.I.O.2022, it provides a promising starting point for the development and relationship strengthening of a BME community in Hong Kong, and shows potential as an alternative way of adult education or learning with societal benefits.

Keywords: biomedical engineering, adult education for social change, comparative methods and principles, lifelong learning, faced problems, promises, challenges and pitfalls

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1349 Application of an Artificial Neural Network to Determine the Risk of Malignant Tumors from the Images Resulting from the Asymmetry of Internal and External Thermograms of the Mammary Glands

Authors: Amdy Moustapha Drame, Ilya V. Germashev, E. A. Markushevskaya

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Among the main problems of medicine is breast cancer, from which a significant number of women around the world are constantly dying. Therefore, the detection of malignant breast tumors is an urgent task. For many years, various technologies for detecting these tumors have been used, in particular, in thermal imaging in order to determine different levels of breast cancer development. These periodic screening methods are a diagnostic tool for women and may have become an alternative to older methods such as mammography. This article proposes a model for the identification of malignant neoplasms of the mammary glands by the asymmetry of internal and external thermal imaging fields.

Keywords: asymmetry, breast cancer, tumors, deep learning, thermogram, convolutional transformation, classification

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1348 Lightweight Synergy IoT Framework for Smart Home Healthcare for the Elderly

Authors: Huawei Ma, Wencai Du, Shengbin Liang

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Smart Home Healthcare technologies for the elderly represent a transformative paradigm that leverages emerging technologies to provide the elderly’ health indicators and daily life monitoring, emergency calls, environmental monitoring, behavior perception, and other services to ensure the health and safety of the elderly who are aging in their own home. However, the excessive complexity in the main adopted framework has affected the acceptance and adoption of the elderly. Therefore, this paper proposes a lightweight synergy architecture of IoT data and service for elderly home smart health environment. It includes the modeling of IoT applications and their workflows, data interoperability, interaction, and storage paradigms to meet the growing needs of older people so that they can lead an active, fulfilling, and quality life.

Keywords: smart home healthcare, IoT, independent living, lightweight framework

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1347 A Longitudinal Exploration into Computer-Mediated Communication Use (CMC) and Relationship Change between 2005-2018

Authors: Laurie Dempsey

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Relationships are considered to be beneficial for emotional wellbeing, happiness and physical health. However, they are also complicated: individuals engage in a multitude of complex and volatile relationships during their lifetime, where the change to or ending of these dynamics can be deeply disruptive. As the internet is further integrated into everyday life and relationships are increasingly mediated, Media Studies’ and Sociology’s research interests intersect and converge. This study longitudinally explores how relationship change over time corresponds with the developing UK technological landscape between 2005-2018. Since the early 2000s, the use of computer-mediated communication (CMC) in the UK has dramatically reshaped interaction. Its use has compelled individuals to renegotiate how they consider their relationships: some argue it has allowed for vast networks to be accumulated and strengthened; others contend that it has eradicated the core values and norms associated with communication, damaging relationships. This research collaborated with UK media regulator Ofcom, utilising the longitudinal dataset from their Adult Media Lives study to explore how relationships and CMC use developed over time. This is a unique qualitative dataset covering 2005-2018, where the same 18 participants partook in annual in-home filmed depth interviews. The interviews’ raw video footage was examined year-on-year to consider how the same people changed their reported behaviour and outlooks towards their relationships, and how this coincided with CMC featuring more prominently in their everyday lives. Each interview was transcribed, thematically analysed and coded using NVivo 11 software. This study allowed for a comprehensive exploration into these individuals’ changing relationships over time, as participants grew older, experienced marriages or divorces, conceived and raised children, or lost loved ones. It found that as technology developed between 2005-2018, everyday CMC use was increasingly normalised and incorporated into relationship maintenance. It played a crucial role in altering relationship dynamics, even factoring in the breakdown of several ties. Three key relationships were identified as being shaped by CMC use: parent-child; extended family; and friendships. Over the years there were substantial instances of relationship conflict: for parents renegotiating their dynamic with their child as they tried to both restrict and encourage their child’s technology use; for estranged family members ‘forced’ together in the online sphere; and for friendships compelled to publicly display their relationship on social media, for fear of social exclusion. However, it was also evident that CMC acted as a crucial lifeline for these participants, providing opportunities to strengthen and maintain their bonds via previously unachievable means, both over time and distance. A longitudinal study of this length and nature utilising the same participants does not currently exist, thus provides crucial insight into how and why relationship dynamics alter over time. This unique and topical piece of research draws together Sociology and Media Studies, illustrating how the UK’s changing technological landscape can reshape one of the most basic human compulsions. This collaboration with Ofcom allows for insight that can be utilised in both academia and policymaking alike, making this research relevant and impactful across a range of academic fields and industries.

Keywords: computer mediated communication, longitudinal research, personal relationships, qualitative data

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1346 The Effect of LEADER and Community-Led Local Development in Spanish Municipal Unemployment: A Difference-in-Difference Approach

Authors: Miguel A. Borrella, Ana P. Fanjul, Suca Munoz, Liliana Herrera

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This paper evaluates the impact of LEADER, a remarkable Community-Led Local Development (CLLD) approach of the European Program for Rural Development applied to rural municipalities of Spain in 2018 and 2019. Using a difference-in-difference estimation strategy and a newly-constructed database, results show that aided municipalities have significantly lower unemployment levels than non-aided municipalities. Results are significant for the decrease in unemployment for both women and people younger than 25 years old, two of the target groups of the policy. Nevertheless, they are larger for male and older workers. Therefore, findings suggest that LEADER 2017-2018 was successful in reducing unemployment in rural areas.

Keywords: community-led local development, ex-post evaluation, LEADER, rural development

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1345 A Multilevel Approach for Stroke Prediction Combining Risk Factors and Retinal Images

Authors: Jeena R. S., Sukesh Kumar A.

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Stroke is one of the major reasons of adult disability and morbidity in many of the developing countries like India. Early diagnosis of stroke is essential for timely prevention and cure. Various conventional statistical methods and computational intelligent models have been developed for predicting the risk and outcome of stroke. This research work focuses on a multilevel approach for predicting the occurrence of stroke based on various risk factors and invasive techniques like retinal imaging. This risk prediction model can aid in clinical decision making and help patients to have an improved and reliable risk prediction.

Keywords: prediction, retinal imaging, risk factors, stroke

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1344 The Inception: A University-Wide Research on Alcohol Consumption

Authors: Robi Lou Logarta, Meliz Ann Marilag, Kristyl Lee Nisnisan, Felipe Lula Jr.

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Nowadays, alcohol is consumed widely around the globe for plenty of reasons. College years are the time that the students really decide if whether they will or will not engage into alcohol, although alcohol drinking begins before students arrive at college. The reasons on why college students consume alcohol vary in many categories. The norms on alcohol drinking are addiction, emotional pain reliever, popularity purposes, socialization, and a medium of euphoria for most students; college students in particular are most likely to feel this need. After tons of requirements to be complied and courses to be reviewed, they felt a need for celebration and relaxation which ends up in drinking with college mates and a few old friends. A lot of reasons consist the consumption of alcohol and this research determined the reasons behind the students’ onset for alcohol consumption; the main reason for such action and the experiences they encountered after in-take, furthermore, the correlation of alcohol drinking to the average allowance of the involved participants; Mindanao State University-Iligan Institute of Technology Students whether it affects their spending towards alcohol or not. This study assumes that alcohol drinking for MSU-IIT students’ is done to relieve emotional pain caused by flunking in particular subjects as well as dealing with romance, as part of the student body, these acts are noticeable enough which made this hypothesis be formulated. Selected MSU-IIT students were asked about their opinions regarding reasons of alcohol consumption. There were 100 respondents consisting of first year to fifth-year students aging 17-23 years old. Choices were given to the students to mark their most favorable reason for drinking that is adult influence, curiosity, family/personal problems, peer pressure, stress. Using the bar and pie chart illustrations, the collected data was then analyzed and among the given choices, the result has invalidated the hypothesis. The outcome shows that curiosity is the topmost reason why students start to drink and not due to emotional pain. With this, another hypothesis is formulated stating that millennial is a curious generation; this generation has changed the norm of drinking. One of the characteristics of the Y generation is being adventurous which correlates to how they get curious about things and the same goes for alcohol consumption, compared to the latter, this generation can be considered early drinkers in this manner. Therefore, it is concluded that MSU-IIT students which are part of the generation Y are adventurous enough to try unfamiliar beverages to satisfy their curious minds.

Keywords: adult influence, curiosity, family/personal problems, peer pressure, stress

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1343 The Neuroscience Dimension of Juvenile Law Effectuates a Comprehensive Treatment of Youth in the Criminal System

Authors: Khushboo Shah

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Categorical bans on the death penalty and life-without-parole sentences for juvenile offenders in a growing number of countries have established a new era in juvenile jurisprudence. This has been brought about by integration of the growing knowledge in cognitive neuroscience and appreciation of the inherent differences between adults and adolescents over the last ten years. This evolving understanding of being a child in the criminal system can be aptly reflected through policies that incorporate the mitigating traits of youth. First, the presentation will delineate the structures in cognitive neuroscience and in particular, focus on the prefrontal cortex, the amygdala, and the basal ganglia. These key anatomical structures in the brain are linked to three mitigating adolescent traits—an underdeveloped sense of responsibility, an increased vulnerability to negative influences, and transitory personality traits—that establish why juveniles have a lessened culpability. The discussion will delve into the details depicting how an underdeveloped prefrontal cortex results in the heightened emotional angst, high-energy and risky behavior characteristic of the adolescent time period or how the amygdala, the emotional center of the brain, governs different emotional expression resulting in why teens are susceptible to negative influences. Based on this greater understanding, it is incumbent that policies adequately reflect the adolescent physiology and psychology in the criminal system. However, it is important to ensure that these views are appropriately weighted while considering the jurisprudence for the treatment of children in the law. To ensure this balance is appropriately stricken, policies must incorporate the distinctive traits of youth in sentencing and legal considerations and yet refrain from the potential fallacies of absolving a juvenile offender of guilt and culpability. Accordingly, three policies will demonstrate how these results can be achieved: (1) eliminate housing of juvenile offenders in the adult prison system, (2) mandate fitness hearings for all transfers of juveniles to adult criminal court, and (3) use the post-disposition review as a type of rehabilitation method for juvenile offenders. Ultimately, this interdisciplinary approach of science and law allows for a better understanding of adolescent psychological and social functioning and can effectuate better legal outcomes for juveniles tried as adults.

Keywords: criminal law, Juvenile Justice, interdisciplinary, neuroscience

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1342 Assessing the Impact of Frailty in Elderly Patients Undergoing Emergency Laparotomies in Singapore

Authors: Zhao Jiashen, Serene Goh, Jerry Goo, Anthony Li, Lim Woan Wui, Paul Drakeford, Chen Qing Yan

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Introduction: Emergency laparotomy (EL) is one of the most common surgeries done in Singapore to treat acute abdominal pathologies. A significant proportion of these surgeries are performed in the geriatric population (65 years and older), who tend to have the highest postoperative morbidity, mortality, and highest utilization of intensive care resources. Frailty, the state of vulnerability to adverse outcomes from an accumulation of physiological deficits, has been shown to be associated with poorer outcomes after surgery and remains a strong driver of healthcare utilization and costs. To date, there is little understanding of the impact it has on emergency laparotomy outcomes. The objective of this study is to examine the impact of frailty on postoperative morbidity, mortality, and length of stay after EL. Methods: A retrospective study was conducted in two tertiary centres in Singapore, Tan Tock Seng Hospital and Khoo Teck Puat Hospital the period from January to December 2019. Patients aged 65 years and above who underwent emergency laparotomy for intestinal obstruction, perforated viscus, bowel ischaemia, adhesiolysis, gastrointestinal bleed, or another suspected acute abdomen were included. Laparotomies performed for trauma, cholecystectomy, appendectomy, vascular surgery, and non-GI surgery were excluded. The Clinical Frailty Score (CFS) developed by the Canadian Study of Health and Aging (CSHA) was used. A score of 1 to 4 was defined as non-frail and 5 to 7 as frail. We compared the clinical outcomes of elderly patients in the frail and non-frail groups. Results: There were 233 elderly patients who underwent EL during the study period. Up to 26.2% of patients were frail. Patients who were frail (CFS 5-9) tend to be older, 79 ± 7 vs 79 ± 5 years of age, p <0.01. Gender distribution was equal in both groups. Indication for emergency laparotomies, time from diagnosis to surgery, and presence of consultant surgeons and anaesthetists in the operating theatre were comparable (p>0.05). Patients in the frail group were more likely to receive postoperative geriatric assessment than in the non-frail group, 49.2% vs. 27.9% (p<0.01). The postoperative complications were comparable (p>0.05). The length of stay in the critical care unit was longer for the frail patients, 2 (IQR 1-6.5) versus 1 (IQR 0-4) days, p<0.01. Frailty was found to be an independent predictor of 90-day mortality but not age, OR 2.9 (1.1-7.4), p=0.03. Conclusion: Up to one-fourth of the elderly who underwent EL were frail. Patients who were frail were associated with a longer length of stay in the critical care unit and a 90-day mortality rate of more than three times that of their non-frail counterparts. PPOSSUM was a better predictor of 90-day mortality in the non-frail group than in the frail group. As frailty scoring was a significant predictor of 90-day mortality, its integration into acute surgical units to facilitate shared decision-making and discharge planning should be considered.

Keywords: frailty elderly, emergency, laparotomy

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1341 Comparison of Home Ranges of Radio Collared Jaguars (Panthera onca L.) in the Dry Chaco and Wet Chaco of Paraguay

Authors: Juan Facetti, Rocky McBride, Karina Loup

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The Chaco Region of Paraguay is a key biodiverse area for the conservation of jaguars (Panthera onca), the largest feline of the Americas. It comprises five eco-regions, which holds important but decreasing populations of this species. The last decades, the expansion of soybean over the Atlantic Forest, forced the translocation of cattle-ranches towards the Chaco. Few studies of Jaguar's population densities in the American hemisphere were done until now. In the region, the specie is listed as vulnerable or threatened and more information is needed to implement any conservation policy. Among the factors that threaten the populations are land-use change, habitat fragmentation, prey depletion and illegal hunting. Two largest eco-regions were studied: the Wet Chaco and the Dry Chaco. From 2002 more than 20 jaguars were captured and fitted with GPS-collar. Data collected from 11 GPS-collars were processed, transformed numerically and finally converted into maps for analyzing. 8.092 locations were determined for four adult females (AF) and one adult male (AM) in the Wet Chaco, and one AF, one juvenile male (JM) and four AM in the Dry Chaco, during 1,867 days. GIS and kernel methodology were used to calculate daily distance of movement, home range-HR (95% isopleth), and core area (considered as 50% isopleth). In the Wet Chaco HR were 56 Km2 and 238 km2 for females and males respectively; while in the Dry Chaco HR were 685 Km2 and 844.5 km2 for females and males respectively, and 172 Km2 for a juvenile. Core areas of individual activity for each jaguar, were on average 11.5 Km2 and 33.55 km2 for AF and AM respectively in the Wet Chaco, while in the Dry Chaco were larger: 115 km2 for five AM and 225 Km2 for an AF and 32.4 Km2 for a JM. In both ecoregions, only one relevant overlap of HR of adults was reported. During the reproduction season, the HR (95% K) of one AM overlapped 49.83% with that of one AF. At the Wet Chaco, the maximum daily distance moved by an AF was 14.5 Km and 11.6 Km for the AM, while the Maximum Mean Daily Moved (MMDM) distance was 5.6 km for an AF and 3.1 km for an AM. At the Dry Chaco, the maximum daily distance for an AF was 61.7Km., 50.9Km for the AM and 6.6 Km for the JM, while the MMDM distance was 13.2 km for an AM and 8.4 km for an AF. This study confirmed that, as the invasion to jaguar habitat increased, it resulted in fragmented landscapes that influence spacing patterns of jaguars. Males used largest HR that of the smaller females and males covers largest distances that of the females. There appeared to be important spatial segregation between not only females but also males. It is likely that the larger areas used by males are partly caused by the sexual dimorphism in body size that entails differences in prey requirements. These could explain the larger distances travelled daily by males.

Keywords: Chaco ecoregions, Jaguar, home range, Panthera onca, Paraguay

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1340 Clinical Risk Score for Mortality and Predictors of Severe Disease in Adult Patients with Dengue

Authors: Siddharth Jain, Abhenil Mittal, Surendra Kumar Sharma

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Background: With its recent emergence and re-emergence, dengue has become a major international public health concern, imposing significant financial burden especially in developing countries. Despite aggressive control measures in place, India experienced one of its largest outbreaks in 2015 with Delhi being most severely affected. There is a lack of reliable predictors of disease severity and mortality in dengue. The present study was carried out to identify these predictors during the 2015 outbreak. Methods: This prospective observational study conducted at an apex tertiary care center in Delhi, India included confirmed adult dengue patients admitted between August-November 2015. Patient demographics, clinical details, and laboratory findings were recorded in a predesigned proforma. Appropriate statistical tests were used to summarize and compare the clinical and laboratory characteristics and derive predictors of mortality and severe disease, while developing a clinical risk score for mortality. Serotype analysis was also done for 75 representative samples to identify the dominant serotypes. Results: Data of 369 patients were analyzed (mean age 30.9 years; 67% males). Of these, 198 (54%) patients had dengue fever, 125 (34%) had dengue hemorrhagic fever (DHF Grade 1,2)and 46 (12%) developed dengue shock syndrome (DSS). Twenty two (6%) patients died. Late presentation to the hospital (≥5 days after onset) and dyspnoea at rest were identified as independent predictors of severe disease. Age ≥ 24 years, dyspnoea at rest and altered sensorium were identified as independent predictors of mortality. A clinical risk score was developed (12*age + 14*sensorium + 10*dyspnoea) which, if ≥ 22, predicted mortality with a high sensitivity (81.8%) and specificity (79.2%). The predominant serotypes in Delhi (2015) were DENV-2 and DENV-4. Conclusion: Age ≥ 24 years, dyspnoea at rest and altered sensorium were identified as independent predictors of mortality. Platelet counts did not determine the outcome in dengue patients. Timely referral/access to health care is important. Development and use of validated predictors of disease severity and simple clinical risk scores, which can be applied in all healthcare settings, can help minimize mortality and morbidity, especially in resource limited settings.

Keywords: dengue, mortality, predictors, severity

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1339 Decision-Tree-Based Foot Disorders Classification Using Demographic Variable

Authors: Adel Khorramrouz, Monireh Ahmadi Bani, Ehsan Norouzi

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Background:-Due to the essential role of the foot in movement, foot disorders (FDs) have significant impacts on activity and quality of life. Many studies confirmed the association between FDs and demographic characteristics. On the other hand, recent advances in data collection and statistical analysis led to an increase in the volume of databases. Analysis of patient’s data through the decision tree can be used to explore the relationship between demographic characteristics and FDs. Significance of the study: This study aimed to investigate the relationship between demographic characteristics with common FDs. The second purpose is to better inform foot intervention, we classify FDs based on demographic variables. Methodologies: We analyzed 2323 subjects with pes-planus (PP), pes-cavus (PC), hallux-valgus (HV) and plantar-fasciitis (PF) who were referred to a foot therapy clinic between 2015 and 2021. Subjects had to fulfill the following inclusion criteria: (1) weight between 14 to 150 kilogram, (2) height between 30 to 220, (3) age between 3 to 100 years old, and (4) BMI between 12 to 35. Medical archives of 2323 subjects were recorded retrospectively and all the subjects examined by an experienced physician. Age and BMI were classified into five and four groups, respectively. 80% of the data were randomly selected as training data and 20% tested. We build a decision tree model to classify FDs using demographic characteristics. Findings: Results demonstrated 981 subjects from 2323 (41.9%) of people who were referred to the clinic with FDs were diagnosed as PP, 657 (28.2%) PC, 628 (27%) HV and 213 (9%) identified with PF. The results revealed that the prevalence of PP decreased in people over 18 years of age and in children over 7 years. In adults, the prevalence depends first on BMI and then on gender. About 10% of adults and 81% of children with low BMI have PP. There is no relationship between gender and PP. PC is more dependent on age and gender. In children under 7 years, the prevalence was twice in girls (10%) than boys (5%) and in adults over 18 years slightly higher in men (62% vs 57%). HV increased with age in women and decreased in men. Aging and obesity have increased the prevalence of PF. We conclude that the accuracy of our approach is sufficient for most research applications in FDs. Conclusion:-The increased prevalence of PP in children is probably due to the formation of the arch of the foot at this age. Increasing BMI by applying high pressure on the foot can increase the prevalence of this disorder in the foot. In PC, the Increasing prevalence of PC from women to men with age may be due to genetics and innate susceptibility of men to this disorder. HV is more common in adult women, which may be due to environmental reasons such as shoes, and the prevalence of PF in obese adult women may also be due to higher foot pressure and housekeeping activities.

Keywords: decision tree, demographic characteristics, foot disorders, machine learning

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1338 Risk of Fatal and Non-Fatal Coronary Heart Disease and Stroke Events among Adult Patients with Hypertension: Basic Markov Model Inputs for Evaluating Cost-Effectiveness of Hypertension Treatment: Systematic Review of Cohort Studies

Authors: Mende Mensa Sorato, Majid Davari, Abbas Kebriaeezadeh, Nizal Sarrafzadegan, Tamiru Shibru, Behzad Fatemi

Abstract:

Markov model, like cardiovascular disease (CVD) policy model based simulation, is being used for evaluating the cost-effectiveness of hypertension treatment. Stroke, angina, myocardial infarction (MI), cardiac arrest, and all-cause mortality were included in this model. Hypertension is a risk factor for a number of vascular and cardiac complications and CVD outcomes. Objective: This systematic review was conducted to evaluate the comprehensiveness of this model across different regions globally. Methods: We searched articles written in the English language from PubMed/Medline, Ovid/Medline, Embase, Scopus, Web of Science, and Google scholar with a systematic search query. Results: Thirteen cohort studies involving a total of 2,165,770 (1,666,554 hypertensive adult population and 499,226 adults with treatment-resistant hypertension) were included in this scoping review. Hypertension is clearly associated with coronary heart disease (CHD) and stroke mortality, unstable angina, stable angina, MI, heart failure (HF), sudden cardiac death, transient ischemic attack, ischemic stroke, subarachnoid hemorrhage, intracranial hemorrhage, peripheral arterial disease (PAD), and abdominal aortic aneurism (AAA). Association between HF and hypertension is variable across regions. Treatment resistant hypertension is associated with a higher relative risk of developing major cardiovascular events and all-cause mortality when compared with non-resistant hypertension. However, it is not included in the previous CVD policy model. Conclusion: The CVD policy model used can be used in most regions for the evaluation of the cost-effectiveness of hypertension treatment. However, hypertension is highly associated with HF in Latin America, the Caribbean, Eastern Europe, and Sub-Saharan Africa. Therefore, it is important to consider HF in the CVD policy model for evaluating the cost-effectiveness of hypertension treatment in these regions. We do not suggest the inclusion of PAD and AAA in the CVD policy model for evaluating the cost-effectiveness of hypertension treatment due to a lack of sufficient evidence. Researchers should consider the effect of treatment-resistant hypertension either by including it in the basic model or during setting the model assumptions.

Keywords: cardiovascular disease policy model, cost-effectiveness analysis, hypertension, systematic review, twelve major cardiovascular events

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1337 The Healthcare Costs of BMI-Defined Obesity among Adults Who Have Undergone a Medical Procedure in Alberta, Canada

Authors: Sonia Butalia, Huong Luu, Alexis Guigue, Karen J. B. Martins, Khanh Vu, Scott W. Klarenbach

Abstract:

Obesity is associated with significant personal impacts on health and has a substantial economic burden on payers due to increased healthcare use. A contemporary estimate of the healthcare costs associated with obesity at the population level are lacking. This evidence may provide further rationale for weight management strategies. Methods: Adults who underwent a medical procedure between 2012 and 2019 in Alberta, Canada were categorized into the investigational cohort (had body mass index [BMI]-defined class 2 or 3 obesity based on a procedure-associated code) and the control cohort (did not have the BMI procedure-associated code); those who had bariatric surgery were excluded. Characteristics were presented and healthcare costs ($CDN) determined over a 1-year observation period (2019/2020). Logistic regression and a generalized linear model with log link and gamma distribution were used to assess total healthcare costs (comprised of hospitalizations, emergency department visits, ambulatory care visits, physician visits, and outpatient prescription drugs); potential confounders included age, sex, region of residence, and whether the medical procedure was performed within 6-months before the observation period in the partial adjustment, and also the type of procedure performed, socioeconomic status, Charlson Comorbidity Index (CCI), and seven obesity-related health conditions in the full adjustment. Cost ratios and estimated cost differences with 95% confidence intervals (CI) were reported; incremental cost differences within the adjusted models represent referent cases. Results: The investigational cohort (n=220,190) was older (mean age: 53 standard deviation [SD]±17 vs 50 SD±17 years), had more females (71% vs 57%), lived in rural areas to a greater extent (20% vs 14%), experienced a higher overall burden of disease (CCI: 0.6 SD±1.3 vs 0.3 SD±0.9), and were less socioeconomically well-off (material/social deprivation was lower [14%/14%] in the most well-off quintile vs 20%/19%) compared with controls (n=1,955,548). Unadjusted total healthcare costs were estimated to be 1.77-times (95% CI: 1.76, 1.78) higher in the investigational versus control cohort; each healthcare resource contributed to the higher cost ratio. After adjusting for potential confounders, the total healthcare cost ratio decreased, but remained higher in the investigational versus control cohort (partial adjustment: 1.57 [95% CI: 1.57, 1.58]; full adjustment: 1.21 [95% CI: 1.20, 1.21]); each healthcare resource contributed to the higher cost ratio. Among urban-dwelling 50-year old females who previously had non-operative procedures, no procedures performed within 6-months before the observation period, a social deprivation index score of 3, a CCI score of 0.32, and no history of select obesity-related health conditions, the predicted cost difference between those living with and without obesity was $386 (95% CI: $376, $397). Conclusions: If these findings hold for the Canadian population, one would expect an estimated additional $3.0 billion per year in healthcare costs nationally related to BMI-defined obesity (based on an adult obesity rate of 26% and an estimated annual incremental cost of $386 [21%]); incremental costs are higher when obesity-related health conditions are not adjusted for. Results of this study provide additional rationale for investment in interventions that are effective in preventing and treating obesity and its complications.

Keywords: administrative data, body mass index-defined obesity, healthcare cost, real world evidence

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1336 A Conceptual Framework of Digital Twin for Homecare

Authors: Raja Omman Zafar, Yves Rybarczyk, Johan Borg

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This article proposes a conceptual framework for the application of digital twin technology in home care. The main goal is to bridge the gap between advanced digital twin concepts and their practical implementation in home care. This study uses a literature review and thematic analysis approach to synthesize existing knowledge and proposes a structured framework suitable for homecare applications. The proposed framework integrates key components such as IoT sensors, data-driven models, cloud computing, and user interface design, highlighting the importance of personalized and predictive homecare solutions. This framework can significantly improve the efficiency, accuracy, and reliability of homecare services. It paves the way for the implementation of digital twins in home care, promoting real-time monitoring, early intervention, and better outcomes.

Keywords: digital twin, homecare, older adults, healthcare, IoT, artificial intelligence

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1335 Age-Based Interface Design for Children’s CAPT Systems

Authors: Saratu Yusuf Ilu, Mumtaz B. Mustafa, Siti Salwah Salim, Mehdi Malekzadeh

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Children today use computer based application in various activities especially for learning and education. Many of these tools and application such as the Computer Aided Pronunciation Training (CAPT) system enable children to explore and experience them with little supervision from the adults. In order for these tools and application to have maximum effect on the children’s learning and education, it must be attractive to the children to use them. This could be achieved with the proper user interface (UI) design. As children grow, so do their ability, taste and preferences. They interact differently with these applications as they grow older. This study reviews several articles on how age factor influences the UI design. The review focuses on age related abilities such as cognitive, literacy, concentration and feedback requirement. We have also evaluated few of existing CAPT systems and determine the influence of age-based factors on the interface design.

Keywords: children, age-based interaction, learning application, age-based capability

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1334 Effects of Eggs Storage Period and Layer Hen Age on Eggs Hatchability and Weight of Broilers of Breed Ross

Authors: Alipanah Masoud, Sheihkei Iman

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One day old chicken quality has great deal of contributions in increasing daily weight gain as well as economical productivity of broilers production. On the other hand, eggs are kept in different times in layer hens flocks and subsequently are transported to incubation units. In order to evaluate effects of two factors layer hen age and storage period of eggs on one day old broilers weight gain during feeding, eggs for layer hen gathered on 32 weeks old (young hen) and 74 weeks old (older ones) were used. Storage period for samples was set as 1 and 9 days. Data were analysed in completely randomized design in four replicates by software SAS. Results indicated that one day old broiler chickens from young had less weight gain, although they exhibited higher weight gain during next weeks. At the same time, there was no difference between chickens from eggs stored for nine days and those from stored for one day.

Keywords: egg, chicken, hatchability, layer

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1333 Investigation and Monitoring Method of Vector Density in Kaohsiung City

Authors: Chiu-Wen Chang, I-Yun Chang, Wei-Ting Chen, Hui-Ping Ho, Chao-Ying Pan, Joh-Jong Huang

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Dengue is a ‘community disease’ or ‘environmental disease’, as long as the environment exist suitable container (including natural and artificial) for mosquito breeding, once the virus invade will lead to the dengue epidemic. Surveillance of vector density is critical to effective infectious disease control and play an important role in monitoring the dynamics of mosquitoes in community, such as mosquito species, density, distribution area. The objective of this study was to examine the relationship in vector density survey (Breteau index, Adult index, House index, Container index, and Larvae index) form 2014 to 2016 in Kaohsiung City and evaluate the effects of introducing the Breeding Elimination and Appraisal Team (hereinafter referred to as BEAT) as an intervention measure on eliminating dengue vector breeding site started from May 2016. BEAT were performed on people who were suspected of contracting dengue fever, a surrounding area measuring 50 meters by 50 meters was demarcated as the emergency prevention and treatment zone. BEAT would perform weekly vector mosquito inspections and vector mosquito inspections in regions with a high Gravitrap index and assign a risk assessment index to each region. These indices as well as the prevention and treatment results were immediately reported to epidemic prevention-related units every week. The results indicated that, vector indices from 2014 to 2016 showed no statistically significant differences in the Breteau index, adult index, and house index (p > 0.05) but statistically significant differences in the container index and larvae index (p <0.05). After executing the integrated elimination work, container index and larvae index are statistically significant different from 2014 to 2016 in the (p < 0.05). A post hoc test indicated that the container index of 2014 (M = 12.793) was significantly higher than that of 2016 (M = 7.631), and that the larvae index of 2015 (M = 34.065) was significantly lower than that of 2014 (M = 66.867). The results revealed that effective vector density surveillance could highlight the focus breeding site and then implement the immediate control action (BEAT), which successfully decreased the vector density and the risk of dengue epidemic.

Keywords: Breteau index, dengue control, monitoring method, vector density

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1332 Inhibitory Action of Fatty Acid Salts against Cladosporium cladosporioides and Dermatophagoides farinae

Authors: Yui Okuno, Mariko Era, Takayoshi Kawahara, Takahide Kanyama, Hiroshi Morita

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Introduction: Fungus and mite are known as allergens that cause an allergic disease for example asthma bronchiale and allergic rhinitis. Cladosporium cladosporioides is one of the most often detected fungi in the indoor environment and causes pollution and deterioration. Dermatophagoides farinae is major mite allergens indoors. Therefore, the creation of antifungal agents with high safety and the antifungal effect is required. Fatty acid salts are known that have antibacterial activities. This report describes the effects of fatty acid salts against Cladosporium cladosporioides NBRC 30314 and Dermatophagoides farinae. Methods: Potassium salts of 9 fatty acids (C4:0, C6:0, C8:0, C10:0, C12:0, C14:0, C18:1, C18:2, C18:3) were prepared by mixing the fatty acid with the appropriate amount of KOH solution to a concentration of 175 mM and pH 10.5. The antifungal method, the spore suspension (3.0×104 spores/mL) was mixed with a sample of fatty acid potassium (final concentration of 175 mM). Samples were counted at 0, 10, 60, 180 min by plating (100 µL) on PDA. Fungal colonies were counted after incubation for 3 days at 30 °C. The MIC (minimum inhibitory concentration) against the fungi was determined by the two-fold dilution method. Each fatty acid salts were inoculated separately with 400 µL of C. cladosporioides at 3.0 × 104 spores/mL. The mixtures were incubated at the respective temperature for each organism for 10 min. The tubes were then contacted with the fungi incubated at 30 °C for 7 days and examined for growth of spores on PDA. The acaricidal method, twenty D. farinae adult females were used and each adult was covered completely with 2 µL fatty acid potassium for 1 min. The adults were then dried with filter paper. The filter paper was folded and fixed by two clips and kept at 25 °C and 64 % RH. Mortalities were determained 48 h after treatment under the microscope. D. farina was considered to be dead if appendages did not move when prodded with a pin. Results and Conclusions: The results show that C8K, C10K, C12K, C14K was effective to decrease survival rate (4 log unit) of the fatty acids potassium incubated time for 10 min against C. cladosporioides. C18:3K was effective to decrease 4 log unit of the fatty acids potassium incubated time for 60 min. Especially, C12K was the highest antifungal activity and the MIC of C12K was 0.7 mM. On the other hand, the fatty acids potassium showed no acaricidal effects against D. farinae. The activity of D. farinae was not adversely affected after 48 hours. These results indicate that C12K has high antifungal activity against C. cladosporioides and suggest the fatty acid potassium will be used as an antifungal agent.

Keywords: fatty acid salts, antifungal effects, acaricidal effects, Cladosporium cladosporioides, Dermatophagoides farinae

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1331 Central Line Stock and Use Audit in Adult Patients: A Quality Improvement Project on Central Venous Catheter Standardisation Across Hospital Departments

Authors: Gregor Moncrieff, Ursula Bahlmann

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A number of incident reports were filed from the intensive care unit with regards to adult patients admitted following operations who had a central venous catheter inserted of the incorrect length for the relevant anatomical site and catheters not compatible with pressurised injection inserted whilst in theatre. Incorrect catheter length can lead to a variety of complications and pressurised injection is a requirement for contrast enhanced computerised tomography scans. This led to several patients having a repeat procedure to insert a catheter of the correct length and also compatible with pressurised injection. This project aimed to identify the types of central venous catheters used in theatres and ensure the correct equipment would be stocked and used in future cases in accordance the existing Association of Anaesthetics of Great Britain and Northern Ireland guidelines. A questionnaire was sent out to all of the anaesthetic department in our hospital aiming to determine what types of central venous catheters were preferably used by anaesthetists and why these had been chosen. We also explored any concerns regarding introduction of standardised, pressure injectable central venous catheters to the theatre department which were already in use in other parts of the hospital and in keeping with national guidance. A total of 56 responses were collected. 64% of respondents routinely used a central venous catheter which was significantly shorter than the national recommended guidance with a further 4 different types of central venous catheters used which were different to other areas of the hospital and not pressure injectable. 75% of respondents were in agreement to standardised introduction of the pressure injectable catheters of the recommended length in accordance with national guidance. Reasons why 25% respondents were opposed to introduction of these catheters were explored and discussed. We were successfully able to introduce the standardised central catheters to the theatre department following presentation at the local anaesthetic quality and safety meeting. Reasons against introduction of the catheters were discussed and a compromise was reached that the existing catheters would continue to be stocked but would only be available on request, with a focus on encouraging use of the standardised catheters. Additional changes achieved included removing redundant catheters from the theatre stock. Ongoing data is being collected to analyse positive and negative feedback from use of the introduced catheters.

Keywords: central venous catheter, medical equipment, medical safety, quality improvement

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1330 Exploring the Factors Affecting the Dependability of Mobile Devices in the Current World

Authors: Mayowa A. Sofowora, Seraphim D. Eyono Obono

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In recent times the level of advancement in electronics and manufacturing technologies for portable electronic devices, especially for mobile devices such as cell phones, smartphones, personal digital assistants and tablet computers is unprecedented. Mobile devices have become indispensable to individuals, and businesses all over the world. The high level of manufacturing and production of mobile devices has led to the rapid release of newer and sleeker models with new features and capabilities. However, these newer models therefore render older models obsolete, and this pushes people to frequently replace their devices. The drawback of such frequent replacements is that a large number of devices are disposed and they end up as e-waste. The fact that e-waste constitutes a major hazard to human health and to the environment is the motivation behind this study whose aim is to develop a model of possible factors that affects the dependability of mobile devices which in turn leads to the obsolescence of these devices.

Keywords: dependability, mobile devices, obsolescence, e-waste

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1329 Getting Back Out There Looking like That: A Visual Critique of Rebecca Welton’s Costuming in Reference to Female Representation in Television

Authors: Abigail R. Gardner

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With the rise of big budget television comes a demand for more nuanced characters. However, female characters are often underdeveloped, especially those who do not fit neatly into societal norms. This study examines how Ted Lasso’s Rebecca Welton challenges this idea by using her on-screen fashion to mirror her motivations and character development. Through detailed analysis, this research explores how Rebecca’s wardrobe adds depth to her character, contrasting traditional strategies of costuming female characters in mainstream movies and television. While women, especially older women, are getting more screen time, very few have been given a wardrobe to reflect their dynamic characters. Rebecca’s costumes represent a form of visual storytelling typically reserved for film, but with the rise of single-camera television, there is an opportunity to redefine the relationship between women and fashion on screen.

Keywords: costume design, gender and media, visual storytelling, women in television

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1328 The Role of Labour Substitution by Age in the Effect of Fertility on Living Standards: Simulations for Scandinavia

Authors: Ross Guest, Bjarne Jensen

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This paper analyses a potentially new consumption dividend from lower fertility arising from imperfect labour substitution by age. A smaller proportion of young workers relative to older workers raises relative youth wages given imperfect labour substitution by age. Discounted lifetime labour income rises which provides a consumption dividend. Simulation results are reported for the four Scandinavian countries, adopting a simple overlapping generations model. Imperfect labour substitution is modelled using a CRESH functional form of an aggregate labour index. The magnitudes of this new consumption dividend from a Low fertility projection compared with a high fertility projection are found to be approximately 4 percent annually, on average over the Scandinavian countries in the very long run, but somewhat lower in the short term. There is some sensitivity to the interest rate and the degree of consumption smoothing.

Keywords: fertility, consumption, productivity, labour substitution

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1327 The Reflexive Interaction in Group Formal Practices: The Question of Criteria and Instruments for the Character-Skills Evaluation

Authors: Sara Nosari

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In the research field on adult education, the learning development project followed different itineraries: recently it has promoted adult transformation by practices focused on the reflexive oriented interaction. This perspective, that connects life stories and life-based methods, characterizes a transformative space between formal and informal education. Within this framework, in the Nursing Degree Courses of Turin University, it has been discussed and realized a formal reflexive path on the care work professional identity through group practices. This path compared the future care professionals with possible experiences staged by texts used with the function of a pre-tests: these texts, setting up real or believable professional situations, had the task to start a reflection on the different 'elements' of care work professional life (relationship, educational character of relationship, relationship between different care roles; or even human identity, aims and ultimate aim of care, …). The learning transformative aspect of this kind of experience-test is that it is impossible to anticipate the process or the conclusion of reflexion because they depend on two main conditions: the personal sensitivity and the specific situation. The narrated experience is not a device, it does not include any tricks to understand the answering advance; the text is not aimed at deepening the knowledge, but at being an active and creative force which takes the group to compare with problematic figures. In fact, the experience-text does not have the purpose to explain but to problematize: it creates a space of suspension to live for questioning, for discussing, for researching, for deciding. It creates a space 'open' and 'in connection' where each one, in comparing with others, has the possibility to build his/her position. In this space, everyone has to possibility to expose his/her own argumentations and to be aware of the others emerged points of view, aiming to research and find the own personal position. However, to define his/her position, it is necessary to learn to exercise character skills (conscientiousness, motivation, creativity, critical thinking, …): if these not-cognitive skills have an undisputed evidence, less evident is how to value them. The paper will reflect on the epistemological limits and possibility to 'measure' character skills, suggesting some evaluation criteria.

Keywords: transformative learning, educational role, formal/informal education, character-skills

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