Patients returning to sport after anterior cruciate ligament (ACL) reconstruction surgery currently have a high risk for sustaining a second ACL injury and having early signs of knee osteoarthritis. Assessing lower extremity kinetics and kinematics during landing can provide information about a patient's risk for sustaining a second ACL injury and having further joint trauma. However, currently accepted methods to assess kinetics and kinematics are not feasible to use in most non-research settings as they are expensive, time consuming, and take up a lot of space. The goal of this project was to identify methods to assess landing mechanics which are reliable and feasible to use in non-research settings. First, we found that the loadsol®, a wireless force sensing shoe insole, is valid relative to embedded force plates and repeatable between days for assessing kinetics and kinetic symmetry during bilateral and unilateral landing tasks. Second, we developed a new method to collect continuous kinematic data using a low-cost videocamera, disposable markers, and an automated point tracking program. This method was validated against a 3D motion capture system for measuring a fixed angle and for measuring sagittal plane running kinematics. Third, we found that the new video analysis method is valid relative to 3D motion capture and is repeatable between days for assessing frontal and sagittal plane knee kinematics during landing. Finally, we used the loadsol® and automated 2D video analysis to assess landing mechanics in both patients following ACL reconstruction and healthy uninjured control participants in a non-research setting. We found that, relative to controls, patients following ACL reconstruction had reduced kinetic symmetry during bilateral landing, where they offloaded their surgical limb and relied more heavily on their non-surgical limb. Additionally, patients following ACL reconstruction had reduced knee flexion range of motion symmetry during unilateral landing, where they had reduced knee flexion when landing on their surgical limb. Collectively, these projects developed methods to quantitatively assess landing mechanics that are feasible to use in non-research settings, documented the validity and between-day repeatability of these methods, and demonstrated that they could be used to identify kinetic and kinematic deficits in patients following ACL reconstruction. This project is an important step toward being able to assess landing mechanics in patients recovering from an ACL reconstruction. / Doctor of Philosophy / The anterior cruciate ligament (ACL) is a bundle of connective tissue that helps stabilize the knee joint. ACL injuries are common in sport, and ACL reconstruction surgery is the most widely used treatment strategy for patients who wish to return to playing sports. Unfortunately, even after ACL surgery and rehabilitation, many patients who return to sport wind up getting hurt again and developing severe joint pain down the road. Previous research has identified movement and loading patterns which are associated with this increased risk for further injury in patients following ACL reconstruction. For example, patients who have increased asymmetry when landing from a jump, where they shift weight away from their surgical limb and towards their non-surgical limb, have an increased likelihood of sustaining a second ACL injury to either their surgical or non-surgical leg. Assessing movement during rehabilitation could help identify patients who exhibit poor movement mechanics and improve movement to reduce their risk for second injuries. However, there are not currently methods available to reliably assess movement that are feasible for widespread use in non-research settings (i.e. physical therapy clinics). The purpose of this project was to identify and develop methods to assess movement which are accurate and feasible to use in a clinical setting. In this dissertation, we first determined the accuracy of using wireless force sensing shoe insoles to measure how hard and how symmetrically people contact the ground when they land from a jump. Second, we developed a new method to measure knee motion using videos collected with low-cost cameras (e.g. iPad), and determined the accuracy of this method compared to a three-dimensional motion capture system. For the last part of this dissertation we demonstrated that the aforementioned methods could be used to identify deficits in landing mechanics in patients following ACL reconstruction in a non-research setting. When comparing ACL reconstruction patients with uninjured controls, we found movement and loading asymmetries which were expected and which are associated with the risk for second ACL injuries and early onset knee osteoarthritis. This project is an important step towards being able to assess landing mechanics in patients recovering from an ACL reconstruction, which could improve our ability to prevent subsequent injuries in this clinical population.

Yes / NIHR - Health and Social Care Delivery Research (HSDR) programme (project number NIHR129488)

No / This report describes the work of Robertson Cooper Ltd and UMIST to identify good practice in stress prevention and then identify organisations within the UK that could be called beacons of excellence in comparison to this model. Part one of this report summarises and draws conclusions from all of the substantive academic studies on stress prevention over the last decade and uses this information, as well as advice gained from a panel of international experts, to develop a comprehensive stress prevention model. Part two of the report uses this model to describe examples of stress prevention practices that Robertson Cooper Ltd has identified within a wide range of UK organisations. Case studies are presented for each aspect of the good practice model. Examples of real documentation and organisational practice are presented. / Health and Safety Executive (HSE)

CHDS State/Local / Approved for public release, distribution is unlimited / In "The Principles of Prevention and the Development of the Prevention Triangle Model for the Evaluation of Terrorism Prevention," we propose the theoretical and practical development of the Prevention Triangle, a graphical model designed to define a system for evaluating national, state, and local terrorism prevention mandates and programs. Based upon objectives detailed in the National Strategy for Homeland Security, and derived through an analysis of selected prevention theories and programs - primarily those aimed at crime prevention - this study first seeks a theoretical basis for the prevention of terrorism in the form of four principles before deriving and defining representative evaluative criteria for designing and measuring the efficacy of prevention programs. / Civilian, Homeland Security Liaison, The City of New York

This study employs interviews to measure the perceptions of sixteen teachers, nine school principals, and seven School Resource Officers on the Drug Abuse Resistance Education (DARE) program, offered to grade six students in one small (population approximately 70,000) city in western Canada. Perceptions in three areas are examined: curricular content, program delivery, and efficacy. Subjects overwhelming viewed the curricular content favourably. Similarly, there was strong agreement that the program was well delivered. The efficacy of the program was judged less positively; however, this did not mitigate the subjects' strong desire to continue implementation of the program. These results are consistent with the research literature on DARE which documents the popularity of the program, but acknowledges that it appears to have limited effects upon reducing student drug use. The results of this study are used to examine five options for delivering an in-school program for preventing or reducing drug abuse and violence among students. The options explored range from retaining the DARE program in its current form, to eliminating it, reforming it, implementing an alternative program, or designing an entirely new drug and violence prevention program. The conclusion drawn is that the DARE program should be withdrawn and replaced with an entirely new drug and violence prevention program and curriculum specific to community realities and needs. / vii, 109 leaves ; 28 cm.

Undernäring är ett stort problem bland äldre både internationellt och inom svensk hälso- och sjukvård. Inom den svenska äldrevården används verktyget Mini Nutritional Assessment (MNA), (bilaga 3) för screening av nutritionsstatus. Trots detta är var tredje patient underviktig inom den svenska äldrevården. Undernäring leder till en minskad livskvalitet, ökad risk för infektioner, ökad sjuklighet och en ökad dödlighet. Vid ett minskat intag av energi och näringsämnen, som understiger kroppens behov, förbrukar kroppen sina depåer av näringsämnen och muskulaturen bryts ner. Förutsättningen för en god hälsa och sjukdomsläkning är ett gott näringstillstånd. Enligt Virginia Henderson har alla människor vissa gemensamma egenskaper och behov, där omvårdnaden skall planeras utifrån patientens upplevda behov och bristande förmåga att tillfredsställa dessa. Sjuksköterskan har enligt International Council of Nurses [ICN], (2000) ett grundläggande ansvarsområden att främja hälsa, förebygga sjukdom, lindra lidande samt återställa hälsa. Syftet var att undersöka effekter av omvårdnadsåtgärder som syftar till att förebygga undernäring hos äldre i äldrevård. En forskningsöversikt genomfördes utifrån 14 inkluderade artiklar. Sökningen av artiklarna gjordes i databaserna PubMed, CINAHL och Psycinfo. Resultatet presenterades utifrån tre huvudteman, nutrition, kunskap och utbildning samt vikten av delaktighet och engagemang. Resultatet visade att nutritionsåtgärder som att förbättra måltidsmiljön, ge kosttillskott, arbeta utifrån en individanpassad vård där patienten engageras i sin egen näringsvård, var åtgärder som kan förebygga undernäring inom äldrevården. Åtgärderna kan tillämpas inom både äldreboende och sjukhus. Slutsatsen var att faktorer som upplevdes betydelsefulla ur patientens perspektiv var att själv få medverka i sin näringsvård. Nutritionsåtgärder som visat sig effektiva för äldre är kosttillskott och en familjelik måltidssituation.

published_or_final_version / Medicine / Doctoral / Doctor of Philosophy

In exploring current responses to crime, particularly youth involvement in gangs, this thesis examines two approaches: Crime Prevention through Social Development (CPSD) and risk-based prevention. The former is associated with the provision of socially-designed measures to address and eliminate the risk factor associated with persistent offending. The latter, however, refers to the implementation of risk management and statistical assessment to manage the risk factor associated with persistent offending. In light of these two approaches, this thesis examines a debate which purported that crime prevention practices has wholly shifted away from an emphasis on CPSD towards risk-based prevention. This thesis also examines the opposing debate which explains that CPSD and risk-based prevention have emerged into a balanced approach. Taking into account 19 youth gang prevention projects in Canada, the above debates are investigated. Drawing from the analysed project, this thesis concludes that, the crime prevention practices of the analyzed projects significantly rely on risk-based prevention. As a result, the approaches of CPSD still exist in rhetoric and in practice however, its influence on crime prevention initiatives is very limited. Hence, current approaches neither reflect a total shift away from CPSD nor a balanced approach.

Approved for public release; distribution is unlimited. / The purpose of this thesis is to evaluate critically the ongoing reform of the High Intensity Drug Trafficking Area (HIDTA) Investigative Support Center (ISC). Prior to 9/11, the national intelligence apparatus was littered with flaws, including lack of information sharing, interagency conflict, and autonomous operations. The HIDTA Intelligence Support Center in New Mexico was no exception. Post 9/11, many national agencies realized that in order to address successfully the increasing threat of terror, several changes needed to be made in the intelligence system at all levels. Similarly, the HIDTA Investigative Support Center has reacted to the post 9/11 environment by more strictly enforcing its framework for information-sharing and instituting a series of changes in its institutional processes. This process of reform has yielded positive results for the New Mexico HIDTA ISC. The ISC has now transformed into the centerpiece of information exchange and interagency cooperation among HIDTA members. The ISC is also acting as a conduit or "Fusion Center" for information sharing between agencies investigating crimes relating to drug trafficking, terrorism, and money laundering. / Captain, United States Army, New Mexico Army National Guard

Syfte sjuksköterskans erfarenheter av det preventiva arbetet rörande övervikt och fetma hos barn och ungdomar. Bakgrund Fetma är ett världsomspännande problem som drabbar över 10% av världens befolkning. WHO uppskattar att 42 miljoner barn under 5 år har övervikt eller fetma. Fler människor avlider i dagsläget av sjukdomar relaterat till övervikt och fetma än av undervikt och malnutrition. Fördelningen av de som har övervikt och fetma är skev och de ur samhällets lägre sociala skikt, invandrare eller bor på glesbygden har högre risk att drabbas. De fysiska och psykiska negativa konsekvenserna av fetma och övervikt är många. Metod En kvalitativ litteraturstudie där 11 artiklar har ingått. Genom kritisk granskning och analys har artiklarna sammanställts till ett resultat. Resultat Resultatet innefattar två huvudkategorier: “Sjuksköterskans erfarenhet av det preventiva arbetet” som tar upp möjligheter och hinder vid rådgivning, bemötande och interaktion, hjälpmedel och tid. Den andra huvudkategorin - “Vårdens organisation” beskriver bristfälligt samarbete och stöd samt riktlinjer och preventionsåtgärder.   Konklusion Det finns ett stort behov av att ge sjuksköterskor mer tid att arbeta preventivt, mer kunskap om hjälpmedel och fler möjligheter att samarbeta med kollegor och andra professioner. / Aim Nurses’ experiences of the preventive work regarding overweight and obesity in children and adolescents.   Background Obesity is a worldwide problem that affects over 10% of the world population. WHO estimates that 42 million children under 5 years are overweight or obese. More people die of diseases related to overweight and obesity than of underweight and malnutrition. The distribution of those with overweight and obesity is skewed and from society’s lower social strata, immigrants or people living in a rural areas have a higher risk to be obese. The physical and psychological consequences of obesity are many.   Method A qualitative literature review that included 11 articles. The result was created by a critical review, analyze and summarization.   Result The result included two main themes: “ Nurses’ experience in the preventive work” which addressed the opportunities and barriers with counseling, refutation and interaction, aids and time. The last major category - “Healthcare organization” describes insufficient cooperation and support as well as guidelines and prevention measures. Conclusion There is a great need to give nurses more time to work preventive, give more knowledge of utilities and more opportunities to collaborate with colleagues and other professionals.