Representing older people: towards meaningful images of the user in design scenarios

Designing for older people requires the consideration of a range of difficult and sometimes highly personal design problems. Issues such as fear, loneliness, dependency, and physical decline may be difficult to observe or discuss in interviews. Pastiche scenarios and pastiche personae are techniques that employ characters to create a space for the discussion of new technological developments and as a means to explore user experience. This paper argues that the use of such characters can help to overcome restrictive notions of older people by disrupting designers' prior assumptions. In this paper, we reflect on our experiences using pastiche techniques in two separate technology design projects that sought to address the needs of older people. In the first case pastiche scenarios were developed by the designers of the system and used as discussion documents with users. In the second case, pastiche personae were used by groups of users themselves to generate scenarios which were scribed for later use by the design team. We explore how the use of fictional characters and settings can generate new ideas and undermine rhetorical devices within scenarios that attempt to fit characters to the technology, rather than vice versa. To assist in future development of pastiche techniques in designing for older people, we provide an array of fictional older characters drawn from literary and popular culture.</p

Chlamydial conjunctivitis presenting as pre septal cellulitis

Chlamydia conjuctivitis results from infection by chlamydia trachomatis, the commonest treatable sexually transmitted infection in Europe. Its clinical manifestations involve the conjunctiva and the cornea. The inflammation under the upper eyelid may be sufficient to present as ptosis, however previously it has not been documented to cause a preseptal cellulitis. We present such a case. A 15-year-old girl was diagnosed with a left viral conjunctivitis. Five days later, she returned with marked oedema of the left upper and lower lids accompanied by erythema. The tarsal conjunctiva revealed follicles and large papillae and extra ocular movements revealed discomfort on elevation. A secondary diagnosis of bacterial pre septal cellulitis was made and the treatment was changed a broad spectrum oral antibiotic. On review at two days, the patient now complained of a large amount of purulent discharge in association with the marked pre septal swelling. As previous bacteriology and virology had been negative, the patient was re swabbed for chlamydia. This proved positive and her symptoms completely resolved following administration of Azithromycin. In this particular case recognition of the pathogen is important to alert the patient to the likelihood of unknown genital infestation. In all cases of positive culture, the patient should be counselled to attend a genitourinary clinic and to alert any sexual partners to the need to do likewise

The effect of socio-economic status on severity of periocular basal cell carcinoma at presentation

Purpose: To evaluate the influence of socio-economic factors on size of periocular basal cell carcinoma at presentation. Methods: All periocular basal cell carcinoma cases receiving treatment from the oculoplastics team in South Glasgow Hospitals NHS Trust, Glasgow, between 1999 and 2009, were identified retrospectively. Information collected included demographic details of patients, side and site of lesions, type of lesions, and size of lesions. The size of lesion was defined as small for any dimension not exceeding 5 mm, medium for dimensions between 6 mm and 10 mm, and large for dimensions exceeding 11 mm. Home address was used to determine the Scottish Index of Multiple Deprivation rank. The demographics, size of lesion, and Scottish Index of Multiple Deprivation rank were investigated using the general linear regression modelling. Results: Of the 67 cases, 24 were men and 43 were women. The mean age was 71.5 years. There were a total of 67 identified cases, of which 38 presented with small-size lesions, 24 with medium-size lesions, and 5 with large-size lesions. Scottish Index of Multiple Deprivation is related to the presenting incidence of basal cell carcinoma, with the lower ranks presenting more frequently. Conclusions: Socio-economic deprivation is associated with larger and more frequent presentation of periocular basal cell carcinoma. This highlights the importance of raising awareness among populations of the more deprived areas of the significance of lumps and bumps within the periocular regions

Changes in Hepatic Blood Flow and Liver Function during Closed Abdominal Hyperthermic Intraperitoneal Chemotherapy following Cytoreduction Surgery

Background. The increase in intra-abdominal pressure (IAP) during closed abdominal hyperthermic intraperitoneal chemotherapy (HIPEC) leads to major haemodynamic changes and potential organ dysfunction. We investigated these effects on hepatic blood flow (HBF) and liver function in patients undergoing HIPEC following cytoreductive surgery and fluid management guided by dynamic preload indices. Methods. In this prospective observational clinical study including 15 consecutive patients, we evaluated HBF by transesophageal echocardiography and liver function by determination of the indocyanine green plasma disappearance rate (ICG-PDR). Friedman’s two-way analysis of variance by ranks and Wilcoxon signed-rank test were performed for statistical analysis. Results. During HIPEC, HBF was markedly reduced, resulting in the loss of any pulsatile Doppler flow signal in all but one patient. The ICG-PDR, expressed as median (interquartile 25–75), decreased from 23 (20–30) %/min to 18 (12.5–19) %/min (p<0.001). Despite a generous crystalloid infusion rate (27 (22–35) ml/kg/h), cardiac index decreased during the increased IAP period, inferior vena cava diameter decreased, stroke volume variation and pulse pressure variation increased, lung compliance dropped, and there was an augmentation in plateau pressure. All changes were significant (p<0.001) and reversed to baseline values post HIPEC. Conclusion. Despite optimizing intravenous fluids during closed abdominal HIPEC, we observed a marked decrease in HBF and liver function. Both effects were transient and limited to the period of HIPEC but could influence the choice between closed or open abdominal cavity procedure for HIPEC and should be considered in similar clinical situations of increased IAP

Paramedic utility in screening patients who present to Emergency Medical Services and who may benefit from an Advance Care Plan: A mixed methods study with explanatory sequential design

We used a two phased mixed methods study with an explanatory sequential design to understand how frequently paramedics attend patients who, on paramedic assessment with the Gold Standards Framework Proactive Identification Guidance, are end-of-life and have advance care planning. We subsequently explored paramedic views on paramedic screening of patients to assess if they are end-of-life and onward referral to their General Practitioner for advance care planning.Paramedics screened and recorded 14.9% of patients as end-of-life and 44.3% of these patients were assessed to have no advance care plan in place. Where paramedics screened patients and they did have an advance care plan in place, 36.8% had only a Do Not Attempt Cardiopulmonary Resuscitation. Paramedics found using the Gold Standards Framework Proactive Identification Guidance to screen patients for end-of-life status useful and straightforward and considered themselves well placed to complete this task. Future research is required to address the practicalities of implementing a paramedic screening and referral tool for end of life care that results in the intended outcome of supporting effective advance care planning

Exploring the physiological, neurophysiological and cognitive performance effects of elevated carbon dioxide concentrations indoors

Rationale: An accumulation of CO2 in occupied indoor spaces is correlated to negative impacts on concentration, sleepiness and aspects of cognitive performance. However factors such as: (a) the relative effect of CO2 itself compared to other pollutants; (b) the minimum necessary exposure time for cognitive performance to be affected; and (c) the physiological drivers of cognitive performance reductions due to increased indoor CO2 concentrations are not yet clear. Method: A within-subjects counterbalanced study design was used to test cognitive performance, subjective and physiological parameters of 31 volunteers during short (< 40 minutes) exposures to normal CO2 (830 ppm) and high CO2 (2,700 ppm, raised by introducing pure CO2 alongside the occupant generated CO2). The study was conducted in a small naturally ventilated office and EEG was used as an objective indicator of sleepiness. Results: The addition of pure CO2 to the room resulted in the absence of an expected learning effect in two cognitive performance test battery components without measurably affecting any of the physiological, psychological, or reported comfort, sick building syndrome and health variables measured. However participants who had slept less the previous night appeared more susceptible to becoming sleepier as a result of the increased CO2. Contributions: The results suggest (1) the addition of pure CO2 may influence aspects of cognitive performance after only short exposures (2) these changes occur in the absence of clear physiological drivers, (3) lack of sleep may mediate people’s response to higher CO2 concentration

Greywater recycling: Treatment options and applications

Wastewater is an immense resource that could find significant applications in regions of water scarcity. Greywater has particular advantages in that it is a large source with a low organic content. Through critical analysis of data from existing greywater recycling applications, this paper presents a review of existing technologies and applications by collating a disparate information base and comparing/contrasting the strengths and weaknesses of different approaches. Simple technologies and sand filters have been shown to have a limited effect on greywater; membranes are reported to provide good solids removal but cannot efficiently tackle the organic fraction. Alternatively, biological and extensive schemes achieve a good general treatment of greywater with particularly effective removal of organics. The best overall performances were observed within schemes that combine different types of methods to ensure effective treatment of all the fractions

Scenario-based requirements elicitation for user-centric explainable AI

Explainable Artificial Intelligence (XAI) develops technical explanation methods and enable interpretability for human stakeholders on why Artificial Intelligence (AI) and machine learning (ML) models provide certain predictions. However, the trust of those stakeholders into AI models and explanations is still an issue, especially domain experts, who are knowledgeable about their domain but not AI inner workings. Social and user-centric XAI research states it is essential to understand the stakeholder’s requirements to provide explanations tailored to their needs, and enhance their trust in working with AI models. Scenario-based design and requirements elicitation can help bridge the gap between social and operational aspects of a stakeholder early before the adoption of information systems and identify its real problem and practices generating user requirements. Nevertheless, it is still rarely explored the adoption of scenarios in XAI, especially in the domain of fraud detection to supporting experts who are about to work with AI models. We demonstrate the usage of scenario-based requirements elicitation for XAI in a fraud detection context, and develop scenarios derived with experts in banking fraud. We discuss how those scenarios can be adopted to identify user or expert requirements for appropriate explanations in his daily operations and to make decisions on reviewing fraudulent cases in banking. The generalizability of the scenarios for further adoption is validated through a systematic literature review in domains of XAI and visual analytics for fraud detection