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Balance disorders and falls are prevalent among multiple pathologies that affect the musculoskeletal or sensorineural systems. Annually, fall-related injuries put excessive economic burden on society and yet, current clinical balance assessment tools based on functional tests are inaccurate and have limited association with fall risk. Therefore, there is a growing need of an accurate balance and fall risk assessment tool for clinical use. The primary purpose of this research was to develop an accurate Center of Pressure (COP) based balance assessment tool to study postural instability and fall risk. Chapter 1 aimed at development of the COP based tool using cost effective equipment- a Wii Balance Board (WBB) and testing its accuracy and errors. The result of this study indicated that the WBB tool is reliable in assessing balance and the linearity and hysteresis errors in WBB tool are higher than force plates but it compares well in terms of cost, portability and availability. Chapter 2 aimed at assessing the relation between the radiographic parameters of balance, COP metrics, and health related quality of life in adults with spinal deformities. The results of this investigation revealed that just like radiographic parameters, COP metrics could help explain some variability in symptoms in patients with comparable extent of deformity. Chapter 3 attempted to establish a threshold value of COP metrics for binary classification of fall risk in patients with multiple sclerosis (MS). The findings of this study highlighted path length as an excellent predictor of future falls with high test accuracy, sensitivity and specificity. This dissertation concludes that the WBB tool has the potential to revolutionize balance and fall risk assessment in clinical fields such as geriatrics, rehabilitation, neurology, and orthopedics.

Quality of life (QOL) is an important aspects of overall well-being in older adults. QOL is associated with functional, physical, and psychological health; all of which can be improved with increased physical activity. A high fall risk is associated with low physical function and QOL. One in four older adults experiences a fall each year, making it necessary to focus public health interventions towards decreasing fall risk and improving QOL in older adults. Bingocize® is a health promotion program designed to promote health, health knowledge, physical activity, and social engagement among older adults. The purpose of this study was to determine the effects of the new version of Bingocize® on QOL and fall risk in community-dwelling older adults (N=36; mean age 73.63 ± 6.97). Participants were clustered and randomly assigned to (a) experimental (n=19; participating in Bingocize® program, which included the bingo game, exercise, and health education) or (b) control (n=17; only played bingo). Each group completed a 12-week intervention that consisted of two 45-60 minute sessions per week. Pre and post data assessments included the TUG, 30-second chair stand, 4-staged balance, handgrip strength, WHOQOL-BREF, PANAS, and a health knowledge quiz. A mixed design analysis of variance (ANOVA) was used to compare intervention effects. There were no significant interactions for any of the variables, with the exception of positive affect (PA) (F (1,34) = 5.66, p = 0.02, 𝜂𝑝 2 = 0.15, power = 0.64) and handgrip strength (F (1,34) = 8.31, p = 0.007, 𝜂𝑝 2 = 0.196, power = 0.80).. There was also a significant main effect for time for health knowledge. Post hoc analysis using independent samples t-tests were conducted on PA (t (33) = 2.39, p = 0.023, two-tailed) and handgrip strength (t (34) = 2.85, p = 0.007, two-tailed). Participating in the Bingocize® health promotion program can produce a meaningful and detectable change in handgrip strength and PA in community-dwelling older adults.

Objective: The objective of this study is to examine relations between patient safety culture and processes of care, specifically, how patient safety culture influences the prevention of patient falls. The purpose of this inquiry is to identify the barriers and facilitators that can advance an inpatient rehabilitation facility to become a high reliability organization and advance interdisciplinary teamwork. Method: A qualitative phenomenological approach was conducted and an interpretive phenomenological analysis explored the experiences of frontline staff with regard to patient safety culture and fall prevention. The study utilized semi-structured interviews with 24 frontline staff from three inpatient rehabilitation hospitals. Participants were selected using purposive sampling and individually interviewed. Results: Findings revealed barriers and facilitators for each dimension of patient safety culture that drive fall prevention. Teamwork within and across disciplines, such as between nursing and therapy, affect how they communicate with one another. Issues related to staffing were the most common concerns amongst nursing staff; especially the issue of staffing ratio and patient acuity. Leadership played a role in supporting the culture of safety and holding staff accountable. Conclusion: Fall prevention requires collaborative efforts between nursing and therapy in an inpatient rehabilitation setting. Dimensions of patient safety culture such as good teamwork, effective communication, adequate staffing, nonpunitive response to errors, and strong leadership support are essential in maintaining a high reliability process for adaptive learning and reliable performance.

Residents who fall in SNF either sustain significant decline to quality of life or die from their injuries. The average fall costs about $34,000 per incident. On average, 19.8% of residents fall at least once per month. The purpose of this project was to assess, identify, and advance nursing practice to decrease falls by evaluating current facility standard of practice, fall policy, procedures, and protocol. The objective was to create actions that would close the communication gap between clinicians and residents. This project encourages clinicians to intertwine resident feedback and strategies into the plan of care to help reduce fall risk. A focus group was conducted with 11 residents with previous fall experience. Through structured discussion, several important gaps in communication related to residents' plan of care were identified. Examples identified include, 10 of 11 residents indicated they were never asked to participate in their plan of care, 10 of 11 residents indicated staff did not listen to them, and 11 of 11 stated they did not know they could change the plan of care that staff had put in place. Further feedback from the focus group demonstrated residents desire to be involved in their care however, they were largely excluded from this process in the past. This project contributes to positive social change by identifying ways to close the communication gaps and reduce risk for falls by intertwining clinician and resident fall practices. A highly recommended fall committee was established at the project facility to encourage staff buy in, advancement of nursing practice and resident involvement in reducing falls.

Introduction The consequences of falling can be fatal to elderly. The mortality, morbidity and the risk ofanxiety and depression increases following a fall. Drug prescription is a preventable fall risk,making the association between antihypertensive medications and risk of falling an importantarea of investigation. Aim Compile the results from studies which have examined the effect of initiating or changing theantihypertensive medication on fall risk in people aged 60 years or older. Methods Data sources: MEDLINE and Cochrane databases. Study selection: Original articles ofcohort-, case control-, case crossover-, cross-sectional- and randomized controlled trial type,published between January 2000 and May 2019 and written in English were included. Dataassessment: 6 studies met the criteria and were included. Study quality was assessed for eachstudy. Results Three studies found significant short-term increase in fall risk, regardless of drug type. Onestudy discovered an 18% increase in fall risk for every 5-day gap in treatment. Two studiesevaluated antihypertensive drug types separately and found contradictive results of thiazidediuretics on short-term fall risk. Calcium channel blockers showed a protective effect andbeta blockers an increased risk during the first 3 weeks after initiating treatment. Conclusions No consistent consensus was seen regarding the short-term fall risk in separateantihypertensive drug types, though most studies agree in a short-term risk increase aftergeneral antihypertensive treatment initiation or change.

The demand for information in a systematic way about ecology of target insect species of transgenic plants has increased in recent decades due to the growing interest in this new technology in pest management. Larval mobility in agricultural ecosystems when on occurrence of contamination of Bt crops, intentionally or unintentionally - has been subject of study by several researchers, however information about larval mobility in tropical conditions are still scarce. This scenario created opportunity for hypothesis testing on behavioural aspects of Spodoptera frugiperda (JE Smith) (Lepidoptera: Noctuidae) in landscapes with spatial-temporal co-occurence of Bt and non-Bt cotton plants. The main objective of the current research was to study the larval dispersal of the pest in field and laboratory conditions in order to insert computational modelling components to describe the evolution of resistance to Bt cotton. In the first chapter of this thesis, it is presented a general introduction. In the second one, we studied the feeding behaviour associated with larval dispersal of S. frugiperda genotypes and possible effects on spatial distribution of the resistant individuals in Bt and non-Bt cotton fields. We analyzed in the third chapter the consequences to resistance progress of the dispersal pattern of susceptible, Cry1F-resistant and heterozygous genotypes of S. frugiperda in pure and contaminated artificial landscapes. In the fourth chapter we assessed the impact of the dispersal by ballooning combined with walking dispersal on resistance evolution in conditions of plant mixture with non-Bt and Bt cotton plants in events with high and non-high dose. In the last chapter, we compared the movement dynamics of S. frugiperda genotypes between 28oC and 32oC, and with an individual-based model we analyzed the possibility if one of the genotypes could persist and would lead the other to the exclusion on refuge areas with non-Bt cotton plants. In a general way, faced on the larval dispersal of S. frugiperda genotypes, the results found here highlight the importance of implementation of strategies to avoid contamination through inadequate agronomic practices such as destruction of cotton plants after harvest, volunteer plant control, and seed saving after harvest. All information generated in this thesis could contribute in the optimization of regional resistance management within a concept of insect population control in wide areas. / A demanda por informações de forma sistematizada sobre ecologia de insetos-praga alvos de plantas transgênicas tem crescido nas últimas décadas devido ao proeminente interesse nesta tecnologia no manejo de pragas. A mobilidade larval em ecossistemas agrícolas quando na ocorrência de contaminação de plantas Bt, de forma intencional ou não intencional, tem sido assunto de estudo por diversos Pesquisadores, entretanto informações sobre a mobilidade larval em condições tropicais são ainda escassas. Este cenário criou oportunidades para testes de hipóteses em aspectos comportamentais de Spodoptera frugiperda (JE Smith) (Lepidoptera: Noctuidae) em paisagens com co-ocorrência espaço-temporal de plantas de algodão Bt e não Bt. O principal objetivo desta pesquisa foi estudar a dispersão larval da praga em condições de campo e de laboratório em ordem para inserir componentes de modelagem computacional para descrever a evolução da resistência ao algodão Bt. No primeiro capítulo desta tese, é apresentada uma introdução geral. No segundo capítulo, foi estudado o comportamento alimentar associado com a dispersão larval de genótipos de S. frugiperda e possíveis efeitos na distribuição espacial de indivíduos resistentes em campos de algodão Bt e não Bt. Foram analisadas no terceiro capítulo as consequências para o progresso da resistência do padrão de dispersão de genótipos suscetíveis, resistentes a Cry1F e heterozigotos de S. frugiperda em paisagens artificiais com pureza e com contaminação. No quarto capítulo, avaliou-se o impacto da dispersão por balonismo combinado dispersão por caminhamento na evolução da resistência em condições de mistura de plantas de algodão não Bt e algodão Bt em eventos com alta e baixa dose. No último capítulo, foi comparada a dinâmica de movimentação de genótipos de S. frugiperda entre as temperaturas de 28°C e 32°C, e com um modelo baseado no indivíduo analisou-se a possibilidade se um dos genótipos poderia persistir e levar o outro a exclusão em áreas de refúgio com plantas de algodão não Bt. Baseado na dispersão larval de genótipos de S. frugiperda, os resultados encontrados ressaltam a necessidade de implementação de estratégias para evitar contaminação por meio de práticas agronômicas inadequadas tais como destruição de plantas após a colheita, controle de plantas voluntárias, e o ato de se salvar as sementes após a colheita. Todas informações geradas nesta tese poderão contribuir para otimização de manejo da resistência regional dentro de um conceito de controle de insetos em grandes áreas.

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<p>In William Golding’s Free Fall, the novel ends without its protagonist, Sammy Mountjoy, receiving the atonement he seeks. As a consequence, the novel ends in an unresolved manner, leaving Sammy in a state of suspension. Despite having a metaphysical awakening in a Nazi POW camp, the consequences of his enlightenment do not reflect the way the Sammy retrospectively narrates the tale of his life. The existentialist theories of Danish thinker and writer Søren Kierkegaard offer a solution to the dilemma. Kierkegaard’s theories concerning the aesthetic, ethical and religious spheres of life, as well as his concept of ‘existential dread’, may be used to show that Sammy is able to make a ‘leap of faith’ from the aesthetic to the ethical sphere. However, because of his inability to make the last leap into the metaphysical sphere of life, he does not attain the insight he needs, namely that he is ‘a child of the finite and infinite’. The essay relates the ways Sammy Mountjoy fits into the Sartrean and Kierkegaardian expressions of existentialism, soon moving on to describe the details of Kierkegaard’s thought concerning the three spheres of life and the concept of ‘dread’. Sammy’s preoccupation with the present, his focus on the exterior rather than the interior and his inability to commit himself to people or situations fit neatly into the criterion for the aesthetic sphere of life. This, in turn, leads him to a state of dread, which reaches its climax in the dark cupboard. When released from his imprisonment Sammy has reached a state of awareness concerning the “vital morality” between people, previously a foreign concept. However, Kierkegaard points out that also the ethical sphere is flawed, leaving the religious/metaphysical sphere as Sammy’s ultimate destination. By failing to make the final ‘leap of faith’, due to a misguided conception of the boundaries between the ethical and the Absolute, Sammy falls short of the resolution he desires and the forgiveness he seeks from the three people that have influenced him the most. Thus an explanation is proposed to the unresolved manner in which Free Fall ends.</p>