Aging Population Research Articles

Admission Prediction Using Time Series Analysis

Efficient resource allocation and strategic planning in educational institutions heavily rely on accurate predictions of student admissions. This paper presents a detailed investigation into the application of time series analysis techniques for admission prediction. We explore the utilization of historical admission data, spanning multiple academic cycles, to train and evaluate several time series models.The study encompasses a comparative analysis of traditional statistical models such as autoregressive integrated moving average (ARIMA) and seasonal autoregressive integrated moving average (SARIMA) alongside more advanced deep learning techniques like long short-term memory (LSTM) networks. By evaluating the performance metrics, including accuracy, robustness, and computational efficiency, we aim to identify the most suitable model for admission prediction tasks. Moreover, the research delves into the impact of various external factors such as changes in the academic calendar, socio-economic indicators, and demographic shifts on admission patterns. Understanding these factors is crucial for enhancing the predictive capabilities of the models and enabling institutions to adapt their strategies accordingly. The experimental results and comparative analysis provide valuable insights for educational institutions, enabling them to make data-driven decisions regarding enrollment management strategies and resource allocation. Ultimately, this research contributes to the advancement of admission prediction methodologies, facilitating more efficient and informed decision-making processes in the educational domain.

Treatment of Periprosthetic Hip Fractures Vancouver B1 and C: The Significance of Bicortical Fixation. A Bicentric Study Comparing Two Osteosynthesis Systems.

INTRODUCTION The incidence of periprosthetic fractures (PFFs) is estimated to range from 0.1% to 4.1%1, due to the increasing prevalence of joint arthroplasties, coupled with an aging population. Numerous risk factors, including advanced age (>80 years), female gender, implant type, prior diagnoses of osteonecrosis and rheumatoid arthritis, revision surgery, aseptic stem mobilization, and the use of non-cemented stems, have been identified. Survivors of periprosthetic fractures often experience functional deterioration, facing a fourfold higher risk of hospitalization for postoperative complications compared to patients undergoing primary implantation, especially in the first postoperative year. MATERIALS AND METHODS Between 2018 and 2022, at the Maggiore Hospitals in Bologna and the San Matteo Policlinic in Pavia, we performed osteosynthesis on 84 patients with periprosthetic fractures of Vancouver type B1 or C. In 38 patients, we employed angular stable plates with the Zimmer Biomet NCB-PP® system. In 46 patients, we utilized INTRAUMA plates: DF distal femur and PFF proximal. Relevant postoperative follow-up outcomes considered included reintervention, infectious complications, radiographic healing, and functional recovery, with reference to changes in the Glasgow Outcome Scale (GOS) and the Harris Hip Score (HHS). All patients underwent clinical and radiographic evaluations during the follow-up period, averaging 28 months (range: 12-48 months), with a minimum follow-up duration of 12 months. RESULTS At the 4-month postoperative assessment, 71% of patients maintained their preoperative functional level, 19% experienced a 1-point GOS scale drop, and 10% died (GOS 5). The average HHS at 4 months was 80.2 points (range: 65-90). At the 6-month follow-up, 98.2% of patients achieved complete healing on radiographic examination. Only 1 patient (1.2%) developed a pseudoarthrosis site with synthesis device rupture. Only 1 patient (1.2%) required additional surgical treatment 2 years later due to the development of un aseptic perisynthetic fluid collection, while the remaining 5 patients (6%) who developed complications benefited from conservative treatment: 4 patients (3.6%) with infectious complications were treated with intravenous antibiotics. In the 2 patients (2.3%) with mobilization or rupture of synthesis devices, clinical and radiographic monitoring was opted for. 8 patients (10.7%) died: one 48 hours after the surgery, and the other 7 more than one month after the surgery. CONCLUSION Our clinical findings align with to existing scientific literature on periprosthetic fractures (B1 and C according to Vancouver classification). Moreover, good stability has been guaranteed at the radiological follow up by Zimmer Biomet NCB-PP® and INTRAUMA DF distal femur and PFF proximal plates. The locking construct allows for improved stability especially in osteoporotic bone.

Excimer laser coronary angioplasty combined with drug-coated balloon in the treatment of in-stent restenosis.

The aim of this study is to investigate the safety and efficacy of excimer laser coronary angioplasty (ELCA) combined with drug-coated balloons(DCBs) in the treatment of in-stent restenosis (ISR), and to explore whether the contrast injection technique would improve the neointimal tissue ablation of ELCA. We studied patients diagnosed with ISR between January 2019 and October 2022 at two medical centers. These patients underwent DCB angioplasty guided by optical coherence tomography (OCT). Based on whether ELCA was performed before DCB treatment, patients were categorized into two groups: the ELCA + DCB group and the DCB group. All patients underwent clinical follow-up 1 year after the procedure. The primary endpoint was the 1-year rate of target lesion revascularization (TLR), which was defined as any repeat percutaneous intervention or bypass surgery on the target vessel conducted to address restenosis or other complications related to the target lesion. The secondary endpoints including immediate luminal gain (ΔMLA, defined as the difference in minimum lumen area before and after the intervention). A total of 85 lesions in 75 patients were included. The mean age of the study population was 64.2 ± 12.0 years, with 81.3% male. Baseline clinical characteristics were well-balanced, and procedural success was 100% in both groups. The ELCA + DCB group (n = 24) exhibited a greater ΔMLA compared to the DCB group (n = 61) (3.57 ± 0.79 mm² vs. 2.50 ± 1.06 mm², [95% confidence interval,CI: 0.57-1.69], p < 0.001), The reduction in 1-year TLR was more frequently observed in patients from the ELCA + DCB group compared to the DCB group (hazard ratio 0.33 [95% CI: 0.11-0.99]; log-rank p = 0.048). The exploratory analysis showed that ELCA with contrast infusion is associated with greater acute lumen gain compared to ELCA with saline infusion (p < 0.001). The combination of ELCA and DCB is a safe and effective treatment strategy for in-stent stenosis. Additionally, compared with saline injection, ELCA with contrast injection is associated with greater acute lumen gain. However, the optimal contrast agent concentration and long-term outcome of the contrast injection technique need confirmation through larger sample sizes and prospective studies.

Cancer experience in metaphors: patients, carers, professionals, students – a scoping review

The use of metaphors to talk about cancer experiences has attracted much research and debate, especially in the case of military metaphors. However, questions remain about what metaphors are used...

Strategic technological processes in hospitals: Conflicts and personal experiences of healthcare teams.

Global health systems operate amid dynamic factors, including demographic shifts, economic variations, political changes, technological progress, and societal trends that lead to VUCA reality (Volatility, Uncertainty, Complexity, and Ambiguity). To address these challenges, healthcare organizations are increasingly turning to Strategic Technological Processes and digital transformation. Against this background, the current study examined the personal experiences, conflicts, difficulties, and moral dilemmas attendant upon accommodating this digital transformation of healthcare professionals. The study involved 27 healthcare professionals working in Israeli hospitals, whose experiences and perspectives were central to understanding the impact of digital transformation in healthcare settings. The study methodology rested on in-depth interviews, which were analyzed through the prism of the Listening Guide analytical technique. The research obtained pre-approval from the Ethics Committee at the researcher's institution. The study revealed that the healthcare professionals are indeed facing ethical conflicts and personal challenges related to digitalization (such as providing the best quality of care, being the best caregiver, and acting for the betterment of the hospital). It also identified dilemmas resulting from conflicts between the needs and demands of the health system and the healthcare professionals' values and resources. The study findings highlight the impact of ethical and moral challenges accompanying strategic organizational and digital transformation changes implemented by healthcare organizations worldwide. These challenges arise as healthcare institutions adapt to the demands of the 21st century, potentially leading to burnout and moral distress among healthcare professionals, further exacerbating the already stressful reality they face. In conclusion, the study emphasizes the critical necessity for comprehensive support strategies to alleviate stress and burnout among healthcare professionals. As healthcare organizations and personnel navigate significant organizational changes to address contemporary challenges, prioritizing the well-being of healthcare workers through effective support mechanisms becomes imperative.

EADV Task Force Pruritus White Paper on chronic pruritus and chronic prurigo: Current challenges and future solutions.

Chronic pruritus (CP) is frequent in general medicine and the most common complaint in general dermatology. The prevalence of CP is expected to rise in the future due to the ageing population. The clinical presentation, underlying aetiology and treatment strategy of CP are heterogeneous. Also, individual treatment aims and physical, psychic and economic burdens of patients might vary. Chronic prurigo (CPG) is the most severe disease in the chronic pruritus spectrum, being associated with long-standing scratch-induced skin lesions and a therapy refractory itch-scratch-cycle. It is thus important to raise disease awareness for CP and CPG in the general public and among decision-makers in the health system. Further, there is a need to support a rational clinical framework to optimize both diagnostics and therapeutics. Currently, there is still a shortcoming regarding approved therapies and understanding CP/CPG as severe medical conditions. Therefore, the EADV Task Force Pruritus decided to publish this white paper based on several consensus meetings. The group consented on the following goals: (a) ensure that CP is recognized as a serious condition, (b) increase public awareness and understanding of CP and CPG as chronic and burdensome diseases that can greatly affect a person's quality of life, (c) clarify that in most cases CP and CPG are non-communicable and not caused by a psychiatric disease, (d) improve the support and treatment given to patients with CP to help them manage their disease and (e) publicize existing therapies including current guidelines. We aim to point to necessary improvements in access and quality of care directed to decision-makers in health policy, among payers and administrations as well as in practical care.

Aging in climate change: Unpacking residential mobility and changes of social determinants of health in southern United States

The southern coastal states of the United States are susceptible to extreme weather and climate events. With growing move-in and -out older populations in the region, health implications of their residential mobility lack sufficient knowledge. Using 126,352 person-level records from 2012 to 2021, we examined geospatial and temporal patterns of older populations’ residential mobility, considering the changing social determinants of health and disparities. We found the moves of older populations with socioeconomic or health disadvantages were related to increased exposure to environmental hazards and reduced access to health resources. The findings inform targeted strategies for climate adaptation that address the needs of vulnerable aging populations.

Study of the Relation between Aging and Pesticides: A Review

Aims: The main aim of this study was to use specific data from the literature on ageing, correlating this with the pesticide contamination, in order to understand the relationship with an increasingly ageing population. Study Design: A systematic review was performed. Place and Duration of Study: Laboratory of Biomathematics of the Federal University of Alfenas, Minas Gerais State, Brazil, between April 2023 and August 2023. Methodology: A systematic search of articles was performed using the CAPES Periodic platform, a searcher from the Education Ministry of Brazil that contains Web of Science, Scopus, MedLine, from August 2020 to May 2023. For this review, the subject’s “aging theory”; “neuroscience and pathologies to aging”; “aging and aging-associated changes”; “pesticides and pesticide toxicity”; “pesticide toxicity and neurotoxicity”; “longevity and healthy aging”; “aging human and pesticides” were searched together using the type of material “articles” in English language. Some articles about “population growth”; “world population”; “population-aging” were used for epistemological composition of this work content subjects. Results: From the 19.720 articles after the exclusion and the inclusion criteria made with the subjects most pertinent to the objectives of this work; 19.570 articles were excluded, remaining 150 ones, of which 116 were qualitative in scope and 34 quantitative. Conclusion: The complex relationship between the pesticide contamination and the condition of the exposed individual may be associated with premature ageing and a greater susceptibility to debilitating age-related diseases. Although technology is increasingly improved in its innovations, health and environmental regulations have not been able to rid the production processes of their potential to pollute the environment and cause health problems for those exposed to them.

Assessment of Nutritional Status And Functional Capacity of Rural Elderly Population In Chattogram, Bangladesh

Background: Bangladesh, like many developing countries, is experiencing population ageing. There is inadequate information regarding the prevalence of malnutrition and functional dependency in community-living rural senior residents in this country. The study aims to determine the nutritional status and functional capacity of the rural elderly population of Chattogram District of Bangladesh and to search for its associated factors. Methods: This community-based cross-sectional study included 213 subjects aged 60 years and over from two Upazilla of Chattogram district by a multistage random sampling technique. Sociodemographic and clinical data were collected using a structured questionnaire, nutritional status was assessed with the Mini Nutritional Assessment-Short Form (MNASF) tool and functional assessment was done using the Modified Barthel self-care index (BSI).Results: The participants’ mean age was 66.1 ± 6.5 years and 51.6 % was female. More than half of the participants (45.4%) were illiterate. The majority of them were living in a joint family with their spouse. About 70% of the participants were from lower socioeconomic classes, 82.2% were not engaged in any vocational activity, 74.6% were entirely dependent economically on others, and 110 (51.6%) had multi- morbidity. The prevalence of malnutrition and risk of malnutrition were 29.9% and 56.8% of the study sample, respectively. About 44% of the participants need help to perform their daily activities. Poor nutritional status was significantly more frequent in elderly subjects aged more than 70 years, in respondents living without a partner, and in older people with multi-morbidity. Conclusion: Poor nutritional status was commonly observed among older adults living in rural areas in Chattogram. The associated factors should be further considered for targeting particularly vulnerable individuals. Bangladesh J Medicine 2024; 35: 76-81

The Concerns of Community-Dwelling Older Women Living with Urinary Incontinence: Qualitative Research.

The world including Iran is facing population aging. Urinary incontinence (UI) is one of the most common health concerns of older women that can be accompanied by an increased sense of loneliness, social restrictions, and disruption in activities of daily living in addition to the regular challenges of old age. This study was aimed at explaining the concerns of community-dwelling older women living with UI. This study used the conventional, qualitative, content analysis approach with purposive sampling. Twenty interviews were conducted with 18 participants, including 15 community-dwelling older women with UI and three family members (a husband and two daughters), over the span of 14months (from August 2021 to October 2022). The data were collected via semi-structured, face-to-face interviews until data saturation was achieved, and were analyzed using Graneheim and Lundman's method. The findings revealed that the concerns of older women with UI include the impasse of UI, being powerless in life, distorted social identity, and marital frustration, which fell under the main theme of sense of inadequacy. Recognizing the concerns of older women with UI can make health care teams more sensitive to the importance of resolving these concerns and can offer some insight into how best to provide targeted training, support, and counseling services at individual, family, and society levels, to eventually resolve the older adult's sense of inadequacy.

Projected estimates of cancer in Canada in 2024.

Cancer surveillance data are essential to help understand where gaps exist and progress is being made in cancer control. We sought to summarize the expected impact of cancer in Canada in 2024, with projections of new cancer cases and deaths from cancer by sex and province or territory for all ages combined. We obtained data on new cancer cases (i.e., incidence, 1984-2019) and deaths from cancer (i.e., mortality, 1984-2020) from the Canadian Cancer Registry and Canadian Vital Statistics Death Database, respectively. We projected cancer incidence and mortality counts and rates to 2024 for 23 types of cancer, overall, by sex, and by province or territory. We calculated age-standardized rates using data from the 2011 Canadian standard population. In 2024, the number of new cancer cases and deaths from cancer are expected to reach 247 100 and 88 100, respectively. The age-standardized incidence rate (ASIR) and mortality rate (ASMR) are projected to decrease slightly from previous years for both males and females, with higher rates among males (ASIR 562.2 per 100 000 and ASMR 209.6 per 100 000 among males; ASIR 495.9 per 100 000 and ASMR 152.8 per 100 000 among females). The ASIRs and ASMRs of several common cancers are projected to continue to decrease (i.e., lung, colorectal, and prostate cancer), while those of several others are projected to increase (i.e., liver and intrahepatic bile duct cancer, kidney cancer, melanoma, and non-Hodgkin lymphoma). Although the overall incidence of cancer and associated mortality are declining, new cases and deaths in Canada are expected to increase in 2024, largely because of the growing and aging population. Efforts in prevention, screening, and treatment have reduced the impact of some cancers, but these short-term projections highlight the potential effect of cancer on people and health care systems in Canada.

Population aging, human capital accumulation, and coordination of policies

Population aging, human capital accumulation, and coordination of policies

Resveralogues protect HepG2 cells against cellular senescence induced by hepatotoxic metabolites

Progressive liver disease and dysfunction cause toxic metabolites including ammonia and unconjugated bilirubin to accumulate in plasma. As the population ages alternatives to liver transplantation become increasingly important. One approach for use as a bridge to transplant or recovery is the use of bioartificial liver systems (BALS) containing primary or immortalised hepatocytes as ex-vivo replacements or supports for endogenous liver function. However, exposure to the hepatotoxic metabolites present in plasma causes the rapid failure of these cells to carry out their primary metabolic functions despite remaining viable. Hypothesizing that this loss of core hepatocyte phenotypes was caused by cell senescence we exposed HepG2 cell populations, grown in both standard two-dimensional tissue culture systems and in three dimensional cultures on novel alginate modified HEMA-MBA cryogels, to physiologically reflective concentrations of hepatotoxic metabolites and cytokines. HepG2 cells are forced into senescence by the toxic metabolites in under six hours (as measured by loss of thymidine analog incorporation or detectable Ki67 staining) which is associated with a ten to twenty-fold reduction in the capacity of the cultures to synthesise albumin or urea. This state of senescence induced by liver toxins (SILT) can be prevented by preincubation with either 2–5 µM resveratrol, its major in vivo metabolite dihydroresveratrol or a series of novel resveralogues with differential capacities to scavenge radicals and activate SIRT1 (including V29 which does not interact with the protein). SILT appears to be a previously unrecognised barrier to the development of BALS which can now be overcome using small molecules that are safe for human use at concentrations readily achievable in vivo.

Health Problems Faced by Elderly and Services Offered by Old Age Home/Aafiat, Lahore, Social Welfare Department, Punjab

The demand for increased physical as well as psychological healthcare facilities is driving up concerns about an ageing population, especially in resource-constrained countries. Older adults in Pakistan experience insecurity due to a number of social and economic causes. In such situations, when conventional family care is unavailable or the elderly lack resources like housing, old age homes offer services to the elderly. The present quantitative study aimed to ascertain the demographic profile of the elderly population residing in an old age home or Aafiat, investigate the factors that contribute to their residence in an old age home, examine the physical and mental health challenges experienced by those receiving residential care, and find out the elderly population's satisfaction level with the services provided by the old age home. However, this article merely addressed the issues with older people's physical and mental health and how satisfied they were with the services and facilities the old age home offered. It was a cross-sectional study, and in order to gather data, interviews were conducted with each of the 25 inmates who were present at the Lahore old age home/Aafiat. According to the findings, the majority of respondents expressed high satisfaction with the level of services received; however, the data revealed that the elderly in the old age home experienced several challenges linked to their physical and mental health.

Multinational Medical Care Evaluation Concerning Aging Populations

Multinational Medical Care Evaluation Concerning Aging Populations

Association of low muscle mass with cognitive function and mortality in USA seniors: results from NHANES 1999–2002

BackgroundSarcopenia and cognitive impairment have been linked in prior research, and both are linked to an increased risk of mortality in the general population. Muscle mass is a key factor in the diagnosis of sarcopenia. The relationship between low muscle mass and cognitive function in the aged population, and their combined impact on the risk of death in older adults, is currently unknown. This study aimed to explore the correlation between low muscle mass and cognitive function in the older population, and the relationship between the two and mortality in older people.MethodsData were from the National Health and Nutrition Examination Survey 1999–2002. A total of 2540 older adults aged 60 and older with body composition measures were included. Specifically, 17–21 years of follow-up were conducted on every participant. Low muscle mass was defined using the Foundation for the National Institute of Health and the Asian Working Group for Sarcopenia definitions: appendicular lean mass (ALM) (< 19.75 kg for males; <15.02 kg for females); or ALM divided by body mass index (BMI) (ALM: BMI, < 0.789 for males; <0.512 for females); or appendicular skeletal muscle mass index (ASMI) (< 7.0 kg/m2 for males; <5.4 kg/m2 for females). Cognitive functioning was assessed by the Digit Symbol Substitution Test (DSST). The follow-up period was calculated from the NHANES interview date to the date of death or censoring (December 31, 2019).ResultsWe identified 2540 subjects. The mean age was 70.43 years (43.3% male). Age-related declines in DSST scores were observed. People with low muscle mass showed lower DSST scores than people with normal muscle mass across all age groups, especially in the group with low muscle mass characterized by ALM: BMI (60–69 years: p < 0.001; 70–79 years: p < 0.001; 80 + years: p = 0.009). Low muscle mass was significantly associated with lower DSST scores after adjusting for covariates (ALM: 43.56 ± 18.36 vs. 47.56 ± 17.44, p < 0.001; ALM: BMI: 39.88 ± 17.51 vs. 47.70 ± 17.51, p < 0.001; ASMI: 41.07 ± 17.89 vs. 47.42 ± 17.55, p < 0.001). At a mean long-term follow-up of 157.8 months, those with low muscle mass were associated with higher all-cause mortality (ALM: OR 1.460, 95% CI 1.456–1.463; ALM: BMI: OR 1.452, 95% CI 1.448–1.457); ASMI: OR 3.075, 95% CI 3.063–3.088). In the ALM: BMI and ASMI-defined low muscle mass groups, participants with low muscle mass and lower DSST scores were more likely to incur all-cause mortality ( ALM: BMI: OR 0.972, 95% CI 0.972–0.972; ASMI: OR 0.957, 95% CI 0.956–0.957).ConclusionsLow muscle mass and cognitive function impairment are significantly correlated in the older population. Additionally, low muscle mass and low DSST score, alone or in combination, could be risk factors for mortality in older adults.

Millet based Nutritious Powder for the Geriatric Population

Objective: This study aimed to utilize finger millet as a primary ingredient for creating nutritious millet powder suitable for hot beverages. Desiccated coconut was incorporated for color enhancement. The optimization process involved sensory evaluation and trials on a laboratory scale. Three variations of millet products and two recipes were developed: one for a beverage made by mixing millet (Ragi/ Finger millet) nutritious powder with hot water, and another for millet nutritious halua powder fortified with nutrients. Additionally, a millet nutritious powder based on Pearl millet was formulated for easy consumption by the ageing population.  Methods: The study involved the preparation and experimentation of three types of millet nutritious powder, derived from finger and pearl millet, targeting the nutritional needs of ageing individuals. Age-related challenges such as esophagus stenosis were taken into account during formulation. The viscosity graphs were utilized to refine the texture of the food, ensuring ease of swallowing. Laboratory-scale trials and benchtop sensory evaluations were conducted to optimize the formulations. The acceptability of the beverages was assessed using a 9-point hedonic scale.  Results: The formulated millet nutritious powders demonstrated excellent nutrient composition, with calcium content exceeding three times that of a cup of milk. The halua powder exhibited low viscosity, high solubility, and excellent swallowing properties. The optimized beverages achieved a total acceptability score exceeding 7 on the hedonic scale, indicating favourable consumer reception. The study successfully developed three variants of millet nutritious powder tailored for aging individuals, addressing concerns related to swallowing difficulties and offering a comfortable dietary option.  Conclusion: In conclusion, this study demonstrates the feasibility of utilizing finger and pearl millet to create nutritious powders suitable for hot beverages, particularly catering to the dietary needs of the aging population. The formulations offer a convenient and easily consumable option for individuals facing challenges with chewing solid food. Moreover, the affordability and widespread accessibility of the developed food products make them suitable for diverse populations, highlighting their potential for addressing nutritional needs on a broader scale.

Geometric morphometric anatomy of the lacrimal punctum in normal population: Punctum update (PUP) study – Paper 5

BackgroundTo investigate the geometric morphological differences of the lacrimal punctum by analyzing its shape in relation to age and sex in a normal population. Methods960 high-magnification slit-lamp images were obtained from 320 puncta of normal asymptomatic Indian individuals across eight decades of life. Using advanced geometric morphometric techniques, including Elliptic Fourier Analysis and Principal Component Analysis, the intricate details of the lacrimal punctum's shape in a diverse population sample were categorized by age and sex. High-resolution images of the lacrimal punctum underwent standardization for scale and orientation, followed by precise landmark identification and coordinate data extraction. ResultsThe geometric morphometry of the lacrimal punctum shows significant changes as one ages. However, the gender differences, in isolation, without consideration of age, remain subtle and are not pronounced. Interestingly, detailed Principal Component scores analysis revealed potential sex- and age-related variations specifically for the left and right lower puncta, which warrant further investigation. These changes could reflect unique aging changes in the proximal lacrimal drainage system. ConclusionThe study is a starting point for geometric morphometric analysis of the lacrimal punctum and provides valuable insights into the punctal changes in size, orientation, and overall morphology across different age groups and between sexes. These findings highlight the significance of considering individual age-wise anatomical variations to better understand the lacrimal punctum.

The Basic Process of Lighting as Key Factor in the Transition towards More Sustainable Urban Environments

The design of lighting installations on roads and urban infrastructure has strictly followed the regulatory requirements of each country for a long time. Based on the traffic intensity, the presence of pedestrians and the nature of activities within the area, these regulations have been used to establish the luminance or illuminance levels from or on the pavement, the minimum average uniformity, the maximum glare and the minimum energy efficiency. Accurate values of these static parameters are supposed to ensure safety, security, and efficacy, and have traditionally been considered as the main targets of lighting installations. Therefore, compliance with these regulations indicates whether an installation is legal or not. Although this philosophy is operative, the reality is different due to two main issues. First, the progressive ageing of populations, mainly in North America and Europe, the changing circumstances of traffic flow and modalities and the presence of groves or socioeconomic factors, might have a strong impact on the safety, security and sustainability of cities. Secondly, the current regulations leave out perceived safety and security issues, as well as the well-being of people; that is, how people feel about the city independently of real danger. In this research, the Basic Process of Lighting (BPL) is formulated including, for the first time, the human factors involved when people develop their activities under public lighting. Using this framework, the potential factors influencing human wellbeing and feelings are summarized after being rated by people in a survey distributed among 133 participants. The results highlight a higher perceived impact of social factors compared to physical and visual ones.

Micro-Costing Analysis for the Treatment of Atrial Fibrillation: An Economic Evaluation of the First Italian Experience of Same-Day Discharge Protocol for Cryoballoon Atrial Fibrillation Ablation

Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia, and its prevalence is expected to increase further due to the aging population, increasing prevalence of risk factors, improving detection methods, and broadening of catheter ablation indications. Along with limited healthcare resources and bed availability, these reasons led to the development of a same-day discharge (SDD) protocol. The aim of this study was to evaluate the health and economic impact of a routine adoption of same-day discharge after cryoballoon AF ablation. Methods: Consecutive patients with symptomatic and drug-refractory AF scheduled for first-time AF ablation were screened, and if deemed suitable, the SDD protocol was proposed and, if accepted, enrolled in the protocol. Results: A total of 324 patients were screened, and 118 were considered eligible for the SDD pathway. Fifty-two patients accepted the SDD pathway and were included in this study. The analysis showed that the variation in resource consumption associated with cryoablation in SDD is equal to EUR 739.85/patient. The analysis showed that the main cost driver for ordinary hospitalization was represented by the hospital stay, which was calculated to be 36% of the total cost. In total, there was a cost reduction of EUR 38.472 thanks to optimized AF patient management from the standard recovery setting to SDD. Conclusions: SDD after cryoballoon ablation of AF is feasible in selected patients with a standardized protocol.