Polypharmacy in older adults – prevalence, risk factors, and associations with mortality – and the role of diabetes

Polypharmacy is common in ageing populations, but its impact on older adults’ health and the role of diabetes are uncertain. This PhD aimed to better understand the prevalence and risk factors of polypharmacy and its associations with mortality, and to explore the role of diabetes in those relationships. Using data from the English Longitudinal Study of Ageing (2004–05 to 2012–13), this work comprised four studies. The first investigated the prevalence and risk factors of undiagnosed diabetes. The prevalence of diagnosed (7.7% and 11.5%) and undiagnosed (2.4% and 3.4%) diabetes increased between 2004 and 2012. However, men aged 50–74 reported a stable prevalence of undiagnosed diabetes and improved awareness. The second examined the prevalence and risk factors of polypharmacy according to diabetes status (diagnosed and undiagnosed). Older adults with diabetes had a higher prevalence of polypharmacy (41.1% versus 14.8%) and heightened polypharmacy (5.8% versus 1.7%) compared with those without diabetes, even excluding antihyperglycemic drugs. People with diabetes who were men and obese were more likely to show polypharmacy and heightened polypharmacy. The third investigated associations between different levels of polypharmacy and all-cause and cause-specific mortality over six years. Polypharmacy and heightened polypharmacy showed dose-response relationships with all-cause (hazard ratio (HR) 1.51, 2.29) and cardiovascular disease (CVD) (subdistribution hazard ratio (SHR) 2.45, 3.67) mortality. Diabetes was a confounder in this relationship and independently related to all-cause mortality. The fourth explored associations between high-risk medications and all-cause and cause-specific mortality among older adults with polypharmacy. Older adults with polypharmacy who took mental health drugs, opioids and muscle relaxants were at higher risk of all-cause (HR 1.55) and CVD (SHR 2.11) mortality. These findings highlight the importance of greater awareness of polypharmacy among older adults in England, especially those on specific high-risk medications, and special care for older people with diabete

Learning Multi-Level Information for Dialogue Response Selection by Highway Recurrent Transformer

With the increasing research interest in dialogue response generation, there is an emerging branch formulating this task as selecting next sentences, where given the partial dialogue contexts, the goal is to determine the most probable next sentence. Following the recent success of the Transformer model, this paper proposes (1) a new variant of attention mechanism based on multi-head attention, called highway attention, and (2) a recurrent model based on transformer and the proposed highway attention, so-called Highway Recurrent Transformer. Experiments on the response selection task in the seventh Dialog System Technology Challenge (DSTC7) show the capability of the proposed model of modeling both utterance-level and dialogue-level information; the effectiveness of each module is further analyzed as well

La enseñanza del español en Taiwán: la importancia del bloque cultura en los planes de estudio y el desarrollo de la competencia comunicativa intercultural (2009-2014)

La tesis titulada La enseñanza del español en Taiwán, la importancia del bloque cultura en los planes de estudio y el desarrollo de la competencia comunicativa intercultural (2009-2014), es consecuencia del aumento del alumnado que quiere estudiar español en Taiwán y de la importancia que el país está dando a estos estudios. El marco teórico de la tesis gira en torno al concepto de cultura, la relación entre la cultura española y la cultura taiwanesa, sus diferencias y semejanzas, la importancia de la competencia comunicativa intercultural, la relevancia de las instituciones internacionales como el Consejo de Europa, con su Marco Común Europeo de Referencia (MCER), y el Instituto Cervantes, con su Plan Curricular del Instituto Cervantes (PCIC), etc. Se ha trabajado con una población de profesorado extraída de las Universidades de: Fujen, Providence, Tamkang y con una muestra de alumnado de dichas universidades, con el fin de conocer sus opiniones sobre el proceso de enseñanza/aprendizaje del español, como lengua extranjera. También se ha elaborado una plantilla de análisis para estudiar los contenidos de 8 manuales utilizados por el alumnado y el profesorado. Tras la investigación realizada podemos concluir que si queremos desarrollar la competencia comunicativa intercultural del alumnado, deberíamos tener en cuenta el componente social, la dimensión psíquica, las costumbres y los hábitos estandarizados de la cultura meta. También, en el aprendizaje del español como lengua extranjera en Taiwán, es necesario conocer y reflexionar sobre las dos culturas: española y taiwanesa. Los Modelos de las seis dimensiones culturales de Hofstede (2010), nos han servido para reflexionar sobre la gran diferencia existente entre la cultura taiwanesa y la cultura española, en concreto en el Individualismo, en la Evasión de la incertidumbre y en el Pragmatismo. Otro aspecto muy importante, es el relacionado con la comunicación no verbal, que en la cultura taiwanesa no se manifiesta de manera tan expresiva como en la española. En definitiva, lo que se pretende es que el alumnado sea capaz de comprender las dos culturas implicadas en el proceso de enseñanza/aprendizaje de E/LE, y que llegue a detectar sus diferencias y semejanzas. Por otra parte, ha quedado demostrado que la ¿Cultura con minúscula¿, aquella que es más próxima a la vida cotidiana, es la que más ayuda a un estudiante para la comprensión del idioma y su buen uso. Cabe destacar que a la mayoría del alumnado le interesa la cultura y está de acuerdo en que la asignatura bloque cultura (conjunto de asignaturas que recoge sobre todo los aspectos socioculturales), despierta su motivación e interés por el español, lo que supone que se deben aumentar los contenidos de la cultura no formal (comportamiento, vida diaria, lenguaje corporal, etc.). Esto nos lleva a reflexionar sobre la importancia de los aspectos socioculturales, olvidados en ocasiones en favor de la ¿Cultura con mayúscula¿, que viene en los libros y cuyo nivel de comprensión está en muchas ocasiones por encima del que posee el alumnado. Si nos centramos en los docentes, éstos consideran que la mayoría de los estudiantes no adquieren los conocimientos socioculturales. Por lo tanto, necesitan utilizar otros recursos didácticos y reflexionar sobre la utilidad de la enseñanza a la hora de hablar un idioma. También, deberían convertirse en orientadores del aprendizaje y diseñadores de actividades para mejorar la calidad de la enseñanza/aprendizaje. Y a todos estos aspectos, habría que añadir que para obtener un buen aprendizaje de un idioma, es necesario trabajar con grupos pequeños en clase y así favorecer la práctica del idioma, potenciar recursos audiovisuales, metodologías interactivas-motivadoras, estancias en el extranjero, y profesorado muy formado desde el punto de vista didáctico.Departamento de Pedagogí

Las dimensiones culturales aplicadas a la enseñanza / aprendizaje de ELE: Un análisis de caso entre la cultura española y la cultura china

En este estudio se tratan los aspectos culturales, en concreto, los que están relacionados con la cultura española y la cultura china. En primer lugar, tratamos aspectos culturales comunes o diferenciadores entre España y Taiwán según el Modelo de las seis dimensiones elaborado por Hofstede. En segundo lugar, analizamos las aportaciones realizadas por Hall respecto del Modelo contextual. Los resultados de este estudio tienen importantes implicaciones didácticas que podrían servir de guía para la enseñanza de ELE, y también, esperamos que la aplicación de las citadas teorías a diversos campos sirva de ayuda a los interesados

Influence of the Mega-Urban Heat Island on Spatial Transfer of Summer Thermal Comfort: Evidence from Tianjin, China

Human thermal comfort in urban spaces deteriorates as rapid urbanization proceeds. However, effective tests and discoveries of spatial statistic patterns are currently absent. This study collected remote sensing images and measured meteorological data of the summers of 1992–2017, Tianjin of China and aims to clarify patterns of spatial transfer and thermal comfort changes caused by a mega-UHI (Urban Heat Island). An analytic transfer matrix and the spatial autocorrelation were developed to study spatial pattern changes and features of the spatial transfer of thermal comfort caused by UHI. Results show these patterns in the affected areas can be divided into different levels: patterns of low-level affected areas transferred by circular expansion into block-mass jumping, while the position of high-level affected areas remains stable. The spatial transfer of thermal comfort in the affected areas shows two apparent stages: the transfer from areas of high-density and low-storied buildings and into areas of multiple storied buildings, and transfer from areas of low and multiple storied buildings into those of high storied buildings. This implies changes in urban planning can guide spatial, structural, and functional evolution. The study identifies features of spatial change and spatial patterns related to the influence of Mega-UHI on thermal comfort

An Investigation on the Influence of Brand-related Apps on Brand Engagement of Green Brand and Following Behaviours

There is a significant growth of the number of smartphone applications’ users around the world. Moreover, the usage of apps dominates the time spent with mobile (Chaffey, 2016). A clear business opportunity via mobile applications is appeared. Therefore, this research aims to discuss the influence of the features of brand-related applications (apps) on brand engagement and the consequences of brand engagement. The brand used as an example in this study is set as the Taiwanese green brand, Gogoro. The designed questionnaire was distributed through online platform. The further analysis for the data was conducted through IBM SPSS 23 software. The results support the hypotheses that the three features of brand-related apps positively influence on brand engagement, perceived value and satisfaction. Moreover, brand engagement significantly influences brand attitude and (e)-word-of-mouth. However, some of the features do not have the significant influence. The limitations and recommendations for further research are also included in the end

The impact of high-risk medications on mortality risk among older adults with polypharmacy: evidence from the English Longitudinal Study of Ageing

BACKGROUND: Polypharmacy is common among older people and is associated with an increased mortality risk. However, little is known about whether the mortality risk is related to specific medications among older adults with polypharmacy. This study therefore aimed to investigate associations between high-risk medications and all-cause and cause-specific mortality among older adults with polypharmacy. METHODS: This study included 1356 older adults with polypharmacy (5+ long-term medications a day for conditions or symptoms) from Wave 6 (2012/2013) of the English Longitudinal Study of Ageing. First, using the agglomerative hierarchical clustering method, participants were grouped according to the use of 14 high-risk medication categories. Next, the relationship between the high-risk medication patterns and all-cause and cause-specific mortality (followed up to April 2018) was examined. All-cause mortality was assessed by Cox proportional hazards model and competing-risk regression was employed for cause-specific mortality. RESULTS: Five high-risk medication patterns-a renin-angiotensin-aldosterone system (RAAS) inhibitors cluster, a mental health drugs cluster, a central nervous system (CNS) drugs cluster, a RAAS inhibitors and antithrombotics cluster, and an antithrombotics cluster-were identified. The mental health drugs cluster showed increased risks of all-cause (HR = 1.55, 95%CI = 1.05, 2.28) and cardiovascular disease (CVD) (SHR = 2.11, 95%CI = 1.10, 4.05) mortality compared with the CNS drug cluster over 6 years, while others showed no differences in mortality. Among these patterns, the mental health drugs cluster showed the highest prevalence of antidepressants (64.1%), benzodiazepines (10.4%), antipsychotics (2.4%), antimanic agents (0.7%), opioids (33.2%), and muscle relaxants (21.5%). The findings suggested that older adults with polypharmacy who took mental health drugs (primarily antidepressants), opioids, and muscle relaxants were at higher risk of all-cause and CVD mortality, compared with those who did not take these types of medications. CONCLUSIONS: This study supports the inclusion of opioids in the current guidance on structured medication reviews, but it also suggests that older adults with polypharmacy who take psychotropic medications and muscle relaxants are prone to adverse outcomes and therefore may need more attention. The reinforcement of structured medication reviews would contribute to early intervention in medication use which may consequently reduce medication-related problems and bring clinical benefits to older adults with polypharmacy