Tripping causes a significant number of falls in the elderly. These falls often result in medical costs, hospitalization, disability, decrease in quality of life, and sometimes death. Knowledge of why trips occur and the mechanics of successful recovery from a trip is critical to increasing knowledge of how to prevent falls due to trips. Two separate studies are reported in this thesis. The first study assessed if men recover from a trip equally well when stepping with their dominant or non-dominant lower limbs. An experimental model of tripping was used to determine each subject's trip recovery capability when stepping with the dominant or non-dominant lower limb. Although most subjects were able to recover better when stepping with one lower limb compared to the other, there was no recognizable trend across the subjects. Based on these results, there is insufficient data to recommend the preferential investigation of the dominant or non-dominant lower limb in future trip research. The second study investigated peak joint torques after stepping to recover from a simulated trip. The same protocol as the first study was used for simulating trips. Increasing trip severity resulted in increased ankle plantarflexor torque in young subjects and increased hip extensor torque in both young and older subjects. Older men used higher hip extensor torques and lower knee extensor torques compared to young men. Implications to falls from trips are discussed. / Master of Science

This thesis is concerned with architecture and its changes through four seasons. It is about drawing new images of a building in different seasons. Like trees change their leaves in seasons and like people change their clothes in seasons, this project is about architecture changing its architectural elements in four seasons. It all began with an imagination of how a building would respond differently in each of the four seasons. The project, located at the waterfront of Old Town, Alexandria, Virginia, is an Aquatic Center with swimming pools, changing areas, saunas, fitness area, and massage areas. The Aquatic Center creates different images to its visitors through surrounding natures and their changes, architectural elements and their movements, visitors and their activities. The goal was to provide people unique and different experiences every time they visit. / Master of Architecture

BACKGROUND: Stroke survivors fall 7 times more annually than same-aged healthy adults; and most fall within the first 2 to 6 months post stroke after transition of care home from the acute setting. These falls cause hip fractures and other bodily injury, further compounding post-stroke mobility, fear of falling, social isolation, and social dependence while collectively yielding poorer outcomes at greater financial burden. PROBLEM: To date, no fall prevention program has targeted stroke survivors as they prepare for transition of care home from the acute setting. PURPOSE: The purpose of this practice inquiry is to develop an evidence-based fall prevention program aimed at empowering acute stroke survivors preparing for transition of care home from the acute setting. METHODS: An extensive literature review was synthesized to assess post-stroke falls epidemiology, contributing factors, potential consequences, and the current status of ameliorative interventions. A modified conceptual framework based upon the Science of Unitary Human Beings, theories of health empowerment, cognitive plasticity, and cognitive reserve was created to synergistically inform fall prevention program development. Literature review synthesis and modified conceptual framework collectively informed subsequent construction of a mixed theory-outcome-activities approach logic model to systematically guide proposed program implementation and evaluation plans. RESULTS: A novel evidence-based empowerment-focused fall prevention program was developed for acute stroke survivors preparing for transition of care home from the acute setting. CONCLUSION: The multi-interventional Patient Empowerment at Transitions of Care Fall Prevention Program for Stroke Survivors inspires a paradigm shift in the way stroke professionals and survivors view recovery and inherent survivor potential. The proposed fall prevention program is informed by a solid theoretical foundation and rigorous literature review of high-level evidentiary support. Moreover, existing dynamic funding opportunities promote subsequent program implementation and evaluation facilitated by Patient-Centered Outcome Research Institute grant pursuit.

Thesis (Ph. D.)--Columbia University, 1943. / Reproduced from type-written copy. Published also without thesis note. Vita. Bibliography: p. [167]-175.

Thesis (Ph. D.)--Columbia University, 1943. / Reproduced from type-written copy. Published also without thesis note. Vita. Bibliography: p. [167]-175.

Bakgrund: I det naturliga åldrandet sker det förändringar med kroppen som påverkar den äldres dagliga liv. I åldrandet tillkommer ofta sjukdomar som kräver behandling i form av läkemedel. Termen polyfarmaci används vid användning av flera läkemedel inom vetenskapen. Läkemedel är idag den vanligaste behandlingsformen som kan bidra till både positiva och negativa konsekvenser hos den äldres hälsa. Syfte: Syftet var att belysa omvårdnadsproblem vid polyfarmaci hos äldre. Metod: En litteraturöversikt utfördes över 11 kvantitativa artiklar som söktes fram i databaserna Cinahl, PubMed och MedLine. Sökorden som bland annat användes var polyfarmaci, äldre, riskfaktorer och omvårdnad. Den teoretiska utgångspunkten i arbetet är sjuksköterskan Carnevalis (1996) modell som handlar om omvårdnadsdiagnostik. Resultat: Ur de valda artiklarnas resultat framkom det fyra huvudkategorier: 1) fall och fallrisk som berör hur den äldres risk för fall ökar vid intag av många läkemedel och vad konsekvensen av detta leder till. 2) Bristande följsamhet belyser orsaker till varför läkemedelsordinationer inte följs av varken patienter eller vårdpersonal. 3) Nutritionsstatus och malnutrition berör hur polyfarmaci kan påverka den äldres nutritionsstatus och att en följd av detta kan leda till malnutrition och andra konsekvenser. Den sista huvudkategorin som är 4) funktionsnedsättning berör hur polyfarmaci kan påverka den äldres funktionsförmåga i dagligt liv. Diskussion: En svårighet som framkommer är att definitionen för polyfarmaci inte är helt fastställd. Trots detta framkommer det omvårdnadsproblem som har samband med läkemedel men som även kan korrelera med multisjuklighet som är vanligt förkommande i och med det naturliga åldrandet. / Background: In the natural aging process, changes occur in the body that affect the elderly person's daily life. Aging often leads to diseases that require treatment in form of drugs. The term polypharmacy describes the use of multiple drugs. Medications are the most common form of treatment and may contribute to both positive and negative effects on elderly’s health. Aim: The aim was to illuminate nursing problems in elderly regarding polypharmacy. Method: A literature review was performed based on 11 quantitative scientific articles. Databases used were Cinahl, PubMed and MedLine. Among the keywords used were polypharmacy, aged, risk factors and nursing. The theoretical framework was nurse Carnevali’s model (1996) dealing with nursing diagnosis. Results: From the selected articles’ results revealed four main categories were: 1) fall and risk of falling, which relate to how the elderly’s risk of falling increases with intake of many medications and its consequences, 2) non- adherence highlights the reasons why prescriptions are not followed neither by patients nor healthcare professionals. 3) Nutritional status and malnutrition concerns how polypharmacy can affect the elderly’s nutritional status and as a consequence lead to for example malnutrition, and 4) functional decline and the elderly’s (dis)ability to function in daily life is the last major category that could be affected by polypharmacy. Discussion: A difficulty that emerges from the literature is that the definition of polypharmacy is not identified. Despite this, it appears the nursing problems related to drugs can also correlate with multimorbidity which is common in the natural aging process.

Fallolyckor är ett allvarligt problem bland äldre människor i dagens samhälle. Ett fall kan leda till svårigheter att utföra aktiviteter i vardagen. Arbetsterapeuten har därför en viktigt roll i arbetet för att förhindra fall men trots det finns det få studier om arbetsterapeuters erfarenheter om arbete med fallprevention. Syftet var att beskriva arbetsterapeuters erfarenheter av att arbeta med fallprevention hos äldre i ordinärt boende. Metoden var en kvalitativ design med semistrukturerade intervjuer. Deltagare rekryterades genom bekvämlighetsurval och totalt deltog nio arbetsterapeuter från två olika kommuner i södra Sverige i examensarbetet. Kvalitativ innehållsanalys användes för att analysera materialet. Resultatet kunde sammanfattas i fyra kategorier; arbetsterapeuters uppfattningar om fallprevention, vikten av samverkan, redskap för att identifiera fallrisker och fallpreventiva åtgärder i ordinärt boende. De i sin tur delades in i elva underkategorier. Slutsatsen var att fallprevention är ett område som är svårt att arbeta förebyggande med. Oftast kopplas arbetsterapeuten in när fall redan har inträffat, men flera arbetsterapeuter betonade att de önskade att arbeta mer förebyggande för att förhindra fall. / Fall accidents are a serious problem among older people in today's society. A fall can lead to difficulties in performing everyday activities. Therefore, the occupational therapist  plays an important role in preventing falls, but despite that there is only a few studies about their experience of work with fall prevention. The purpose was to describe occupational therapist’s experiences of working with fall prevention among elderly in an ordinary residence. The method was qualitative design with a semi-structured interview. Participants were recruited through a convenient selection and a total of nine occupational therapists from two different municipalities in southern Sweden participated in the study. Qualitative content analysis was used to analyze the material. The results could be summarized in four categories: occupational therapists perceptions of fall prevention, the importance of interaction, tools for identifying fall risks and fall preventive interventions in an ordinary residence. Which turned in to eleven subcategories. The conclusion was that fall prevention is a difficult area to work preventive with. Most often, the occupational therapists are called in when the fall already has occurred, but several occupational therapists underlined that they wanted to work more towards the prevention of falls.

Introduction: The Centers for Disease Control and Prevention found that each year over three million people are treated for fall injuries, and of those three million, one in five falls causes serious injury. One clinical report stated only 37% of elderly patients are asked about falls in the primary care setting. The report found barriers to further fall-related care were due to the many factors that go into assessing if a patient is a fall-risk. Thus, assessing the fall risk for a large elderly population can be both challenging and time-consuming. The purpose of this study is to evaluate the effectiveness of assessing fall risk with the Theoretical Timed Up and Go (T-TUG), using Wave 1 of the Irish Longitudinal Database (TILDA). The validation was done by comparing the T-TUG results to that of the Impairments survey and activities of daily living (ADLs) found in the TILDA. Methods: The data used in this study were obtained from Wave 1 of the TILDA. The TILDA is a survey-designed longitudinal study on aging done on a national scale in Ireland. Study participants who passed inclusion criteria were divided into those who had reported falling in the previous year (N=1221) and those who had not (N=4857). The T-TUG is a fall-risk calculator developed from the NSHAP database, with a multiple regression function using the Timed Up and Go as the dependent variable, and age, gender, body mass index, and over the counter and prescription drugs as the predictor variables. The NSHAP regression coefficients were combined with the TILDA participant parameters defined above to calculate new T-TUG scores for the TILDA cohort. Differentiation between the fall and no fall groups for the T-TUG, ADLs and Impairments survey were done using the Mann-Whitney U Test (p < 0.05). Receiver Operator Characteristics (ROC) curve analyses were done to identify cut-off points, sensitivities, and specificities differentiating the fall and no fall groups for these assessments. Results: Mann-Whitney analysis demonstrated that the fall group scores were statistically different from the no fall group for all three assessments (p-value < 0.001). As determined by AUC, the ROC analysis indicated that the T-TUG (AUC=0.570, p Conclusion: All assessments evaluated were effective at differentiating participants within this database reporting a fall within the last year from those who had not. Whereas the T-TUG and Impairments survey were equally effective at detecting true fallers and non-fallers, the ADLs were much more effective at detecting non-fallers. The T-TUG has the potential to be an EMR based fall risk calculator and could be invaluable as an institutional triage tool.

Bakgrund: Fall och fallskador hör till ett av de stora folkhälsoproblemen i Sverige men även internationellt. Fall är den vanligaste orsaken till skador hos äldre personer över 65 år och resulterar ofta i allvarliga konsekvenser för samhället, vården och individen.  Syfte: Att kartlägga fallpreventiva insatser beskrivna i internationell vetenskaplig litteratur avseende äldre (65+) patienter inom slutenvård samt att studera effekten av dessa insatser. Metod: Litteraturöversikt där 17 vetenskapliga kvantitativa artiklar granskades. Resultat: Resultat från denna litteraturöversikt visade att fallriskbedömning var en vanligt förekommande del i det fallpreventiva arbetet internationellt och en förutsättning för individuella fallpreventiva insatser inom slutenvård. I fallriskbedömningen betonades vikten av att inkludera riskfaktorer förknippade med fall som främst var hög ålder och lång vårdtid. De fallpreventiva insatser som identifierades kategoriserades in i fyra huvudsakliga områden; utbildning, övervakning/tillsyn, fysisk träning och vårdmiljö. Slutligen framkom i resultaten att multifaktoriell fallprevention och sjuksköterskeledda timsrundor (IR) hade effekt på minskning av fall. Slutsats: Få studier undersökte effekten av fallpreventiva insatser, därför behövs ytterligare studier göras på området för att resultaten ska vara generaliserbara. Utbildning och ökad tillsyn eller personaltäthet visade sig sannolikt vara faktorer med betydelse för minskning av fall, detta kan vara av intresse för framtida forskning. / Background: Falls and fall related injuries are one of the major public health issues in Sweden as well as internationally. Falls are the most common cause of injury in older people over the age of 65 and often result in serious consequences for society, healthcare and the individual. Aim: To identify preventive measures for falls described in international scientific literature regarding elderly (65+) inpatients and to study the effects of these measures.  Method: Literature review of 17 quantitative assessed scientific articles.       Results: Results from this literature review showed that fall risk assessment was a common part of the fall prevention strategy internationally and a prerequisite for individual fall preventative measures in care settings. The fall risk assessment emphasized the importance of including risk factors associated with falls which were old age and long hospital stay. The fall preventions interventions identified were categorized into four main areas; education, monitoring/supervision, physical training and hospital environment. Finally the results showed that multifactorial fall prevention and intentional rounding (IR) had an effect on reducing falls.  Conclusion: Few studies examined the effect of fall prevention measures, further studies are therefore needed for the results to be generalizable. Education and increased monitoring/supervision were probably found to be factors with significance for reducing in falls, this may be of interest in upcoming research.

In 1943 occupied Yugoslavia became the scene of ferocious fighting on a large scale as axis forces launched two major anti-guerrilla operations, codenamed “Weiss” and “Schwartz”, in an all-out effort to put an end to the Yugoslav communist resistance. Despite the axis being massively superior in material terms, sometimes even outnumbering their opponents by six to one, both operations ended in failure as the partisans managed to fight their way out of the German trap. Scholarly research concerning these operations almost exclusively aims to explain their outcome by examining German mistakes, while far lessresearch has been conducted with the intent of examining the outcome of the operations from a partisan perspective. The purpose of this study is to investigate whether the partisan success during these operations can be explained by them using the set of methods of force employment which Stephen Biddle calls “the modern system”, and thereby make a first attempt at explaining the outcome of the operations on the tactical and operational level from a partisan point of view. The result of this study shows that the partisan success indeed can be explained by Biddles theory, at least to some extent, but that a more comprehensive study would need to be conducted to fully verify these claims. The study has thus fulfilled its purpose and provides a small but important contribution to the scholarly debate upon which further research can be conducted concerning the partisan successes during 1943.