In consideration of the demographic trends of our population, it is necessary to deal with the old age problems and problems of geriatric patients. The controversial topic of restraints, especially sensitive in association with old frail people, is closely related. The issue of restraints is defined by law. However, the ethical aspects of their application should also be considered. The theoretical part of this thesis deals with the topic of old age and serious problems of this period of life, including mental disorders. It introduces the field of geriatrics and geriatric patients. In further chapters, this thesis discusses the restraints and ethical issues related to their use. By using qualitative research methods, the empirical part of this thesis surveys the attitudes of healthcare professionals towards this issue. It discusses specific restraints and the reasons for which they are used. The results show that the most important value of healthcare professionals is health and the most respected ethical principle is the principle of beneficence. Key Words: old age, geriatric patient, health risk, restraints, ethical principle

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After sixteen intensive months, I quit my employed position as a security guard at a local hospital. By drawing on my autoethnographic experiences in the form of “ethnographic fiction writing”, as well as eight interviews with my former male colleagues, I explore how the guards’ constructions of masculinity intersect with their security assessment and subsequent application of force, chemical incarceration, and other coercive security tactics on involuntarily-committed mental health patients. The narratives are framed by the available literature on gender and masculinity within the security, police, prison and military institutions, as well as the theoretical notions of gendered institutions (Acker), hegemonic masculinity (Connell & Messerschmidt), doing gender (West & Zimmerman), and Dave Holmes’s application of Foucauldian biopolitical power to forensic healthcare settings. These concepts are used in tandem with a creative methodological tool to reveal the “messy”, “bloody” and “gendered” ways in which hospital life unfolds between the guard, the nurse, and the patient prisoner. By escaping more traditional forms of academic writing, I am able to weave raw, sensitive and reflexive thoughts and emotions into the research design and analysis. The analysis is divided into two narratives: “Us” and “Them”. “Us” emphasizes the gendered ways in which the hospital guard learns, reproduces, resists, lives up, or fails to live up to the masculine codes of the profession. Here, the guard must confront cultural demands to demonstrate physical prowess, authority and heroism during a patient battle. “Them” explores how hegemonic masculinity shapes the hierarchical and coercive relations between the guard, the nurse, and the patient, and reinforces psychiatrized discourses that promote punishment, pain, bureaucracy and control. Overall, these findings call for the abolition of physical restraint, chemical incarceration and other coercive security measures within our healthcare institutions, and encourage future research to give voice to the lived experiences of women guards and security management teams.

Physical restraint use and falls are common in institutional care of old people and various attempts have been made to reduce their occurrence. Falls and concomitant injuries are a major problem due to their negative effect on morbidity and mortality. Prevention of falls and injuries is the most common reason for physically restraining old people in institutional care. Its use has, however, been questioned both from an ethical perspective, since restraints can be perceived as coercive and also because of the lack of sound evidence of their effectiveness in preventing falls, as well as the adverse effects associated with their use. The main purposes of this thesis were to investigate differences in the us of physical restraints over time, to identifify risk factors for falls among people with dementia, to evaluate the effects of a restraint minimization program on staff knowledge, attitudes, and work environment and use of physical restraints and the quality of care. The present thesis is based on three main data collections, two census surveys conducted within institutional care for old people in the county of Västerbotten in 2000 (n=3,804) and 2007 (n=2,970) and one cluster-Randomized Controlled Trial (RCT) including 40 group dwellings for people suffering from dementia where the intervention consisted of staff education. The use of physical restraints increased slightly between 2000 and 2007 (16.2% to 18.4%, p=0.016). Analyses suggest that the increase might be independent of any change in resident characteristics. Restrained residents were also subjected to restraints for longer times in 2007. During a six-month follow-up 64/160 (40.0%) residents in group dwellings for those with dementia sustained at least one fall. Independent risk factors for falls were ‘requiring help with hygiene’, ‘displaying verbally disruptive/attention-seeking behavior’, ‘able to rise from a chair’, ‘walking with assistive devices’, and ‘participating in outdoor walks’, which explained 36.1% of the falls. The majority of the 191 falls were un-witnessed, 35% occurred during the night and anxiety and confusion were the most common symptoms preceding the falls. A six-month restraint minimization program showed a positive impact on staff knowledge, attitudes and work environment as well as on the use of physical restraints and subjectively estimated quality of care. Residents in the intervention group present throughout the entire study period had lower odds, relative to the residents in the control group of being physically restrained at follow-up (OR= 0.21, CI 95%=0.08-0.57) after controlling for potential confounders and the cluster effect. Adjusted analyses including all residents present at either baseline or follow-up also showed that the use of physical restraints was less in the intervention group relative to the control group at follow-up. There was no change in the occurrence of falls or use of psychoactive drugs. The intervention also reduced stress of conscience, job demands and strain in the staff, and improved their job control and the caring climate. Subgroup analysis indicated a greater effect in units where the use of physical restraints had been reduced or remained constant. In conclusion, physical restraint use and falls remains common in institutional care of old people. The practice of physical restraint seems to have changed. In the RCT it was found that it is possible to change restraint practice and also to improve staff work environment. Falls among residents with dementia require a certain mobility function and anxiety and confusion are common symptoms preceding falls.

After sixteen intensive months, I quit my employed position as a security guard at a local hospital. By drawing on my autoethnographic experiences in the form of “ethnographic fiction writing”, as well as eight interviews with my former male colleagues, I explore how the guards’ constructions of masculinity intersect with their security assessment and subsequent application of force, chemical incarceration, and other coercive security tactics on involuntarily-committed mental health patients. The narratives are framed by the available literature on gender and masculinity within the security, police, prison and military institutions, as well as the theoretical notions of gendered institutions (Acker), hegemonic masculinity (Connell & Messerschmidt), doing gender (West & Zimmerman), and Dave Holmes’s application of Foucauldian biopolitical power to forensic healthcare settings. These concepts are used in tandem with a creative methodological tool to reveal the “messy”, “bloody” and “gendered” ways in which hospital life unfolds between the guard, the nurse, and the patient prisoner. By escaping more traditional forms of academic writing, I am able to weave raw, sensitive and reflexive thoughts and emotions into the research design and analysis. The analysis is divided into two narratives: “Us” and “Them”. “Us” emphasizes the gendered ways in which the hospital guard learns, reproduces, resists, lives up, or fails to live up to the masculine codes of the profession. Here, the guard must confront cultural demands to demonstrate physical prowess, authority and heroism during a patient battle. “Them” explores how hegemonic masculinity shapes the hierarchical and coercive relations between the guard, the nurse, and the patient, and reinforces psychiatrized discourses that promote punishment, pain, bureaucracy and control. Overall, these findings call for the abolition of physical restraint, chemical incarceration and other coercive security measures within our healthcare institutions, and encourage future research to give voice to the lived experiences of women guards and security management teams.

In Europe, the deployment characteristics of frontal crash restraints are generally optimised to best protect an average young male, since a 50th percentile male dummy is used in a stylised frontal impact scenario. These single point restraint systems may not provide similar levels of effectiveness when the crash scenarios vary with respect to the regulatory and consumer crash test procedures. Previous research has demonstrated that varying restraint deployment characteristics according to occupant and crash variation can provide further injury reduction in frontal impacts. This thesis reports the investigation conducted to assess the potential real world injury reduction benefit of smart restraint systems in frontal impacts. The intelligent capability of the restraint was achieved by varying the seat belt load limiter (SBL) threshold, according to the frontal crash scenario. Real world accident data (CCIS) were analysed to identify the target population of vehicle occupants and frontal impact scenarios where employing smart load limiters could be most beneficial, particularly in reducing chest injury risk. From the accident sample, the chest was the most frequently injured body region at an AIS 2+ level in frontal impacts (7% of front seat occupants). The proportion of older vehicle front seat occupants (>64 years old) with AIS 2+ injury was also greater than the proportion of younger occupants. Additionally, older occupants were more likely to sustain seat belt induced serious chest injury in low and moderate speed frontal crashes. Numerical simulations using MADYMO software were conducted to examine the effect of varying the load limiter thresholds on occupant kinematics and injury outcome in frontal impacts. Generic baseline driver and front passenger numerical models were developed using a 50th percentile dummy and were adapted to accommodate a 5th and 95th percentile dummy. Simulations were performed where the load limiter threshold was varied in five frontal impact scenarios which were selected to cover as wide a range of real frontal crash conditions as possible. From the simulation results, it was found that for both the 50th and 95th percentile dummy in front seating positions (driver and passenger), the low SBL provided the best chest injury protection, without increasing the risk to other body regions. In severe impacts, the low SBL allowed the dummy to move further towards the front facia, thus increasing the chance of occupant hard contact with the vehicle interiors. The Smart load limiters predicted no injury risk reduction for the 5th percentile drivers, who are shorter and tend to sit closer to the steering wheel. The potential injury reduction of the smart load limiters was quantified by applying the estimated injury risk reduction from the simulation to the real world accident data sample. Thoracic injury predictions from the simulations were converted into injury probability values using AIS 2+ age dependent thoracic risk curves which were developed and validated based on a methodology proposed by Laituri et al. (2005). Real world benefit was quantified using the predicted relative AIS 2+ risk reduction and assuming an appropriate adaptive system was fitted to all the cars in the real world sample. When applying the AIS 2+ risk reduction findings to the weighted accident data sample, the risk of sustaining an AIS 2+ seat belt injury reduced from 1.3% to 0.9% for younger front seat occupants, 7.6% to 5.0% for middle aged front seat occupants and 13.1% to 8.6% for the older front seat occupants. The research findings clearly demonstrate a chest injury reduction benefit across all age groups when the load limiter characteristics are varied. It suggests that employing a smart load limiter in a vehicle would not only benefit older occupants but also middle aged and young occupants. The benefit does appear to be most pronounced for older occupants, since the older population is more vulnerable to chest injury. As the older population of car users is rapidly rising, the benefits of smarter systems can only increase in the future.

After sixteen intensive months, I quit my employed position as a security guard at a local hospital. By drawing on my autoethnographic experiences in the form of “ethnographic fiction writing”, as well as eight interviews with my former male colleagues, I explore how the guards’ constructions of masculinity intersect with their security assessment and subsequent application of force, chemical incarceration, and other coercive security tactics on involuntarily-committed mental health patients. The narratives are framed by the available literature on gender and masculinity within the security, police, prison and military institutions, as well as the theoretical notions of gendered institutions (Acker), hegemonic masculinity (Connell & Messerschmidt), doing gender (West & Zimmerman), and Dave Holmes’s application of Foucauldian biopolitical power to forensic healthcare settings. These concepts are used in tandem with a creative methodological tool to reveal the “messy”, “bloody” and “gendered” ways in which hospital life unfolds between the guard, the nurse, and the patient prisoner. By escaping more traditional forms of academic writing, I am able to weave raw, sensitive and reflexive thoughts and emotions into the research design and analysis. The analysis is divided into two narratives: “Us” and “Them”. “Us” emphasizes the gendered ways in which the hospital guard learns, reproduces, resists, lives up, or fails to live up to the masculine codes of the profession. Here, the guard must confront cultural demands to demonstrate physical prowess, authority and heroism during a patient battle. “Them” explores how hegemonic masculinity shapes the hierarchical and coercive relations between the guard, the nurse, and the patient, and reinforces psychiatrized discourses that promote punishment, pain, bureaucracy and control. Overall, these findings call for the abolition of physical restraint, chemical incarceration and other coercive security measures within our healthcare institutions, and encourage future research to give voice to the lived experiences of women guards and security management teams.

Les accords verticaux correspondent pour l'essentiel au monomarquisme, à la distribution exclusive, à l'achat exclusif, à la distribution sélective, à la franchise et à la concession. Bien que leur diversité soit grande, ils constituent la plupart du temps des accords "de" concurrence car ils développent la concurrence intermarques. L'objectif principal de cette étude est de rechercher et d'analyser les critères d'appréciation des accords verticaux de distribution en droit de la concurrence français, communautaire et argentin. En droit de la concurrence communautaire, les accords de distribution font l'objet d'une importante réglementation et d'une riche jurisprudence. Les règles relatives aux accords verticaux ont subi une réforme qui a abouti à l'adoption d'un nouveau règlement d'exemption par catégorie (Règlement n° 330/2010) accompagné de nouvelles Lignes directrices sur les restrictions verticales. De nombreux accords verticaux bénéficient ainsi d'une exemption catégorielle leur conférant une présomption de légalité et en l'absence que ces accords bénéficient d'un règlement d'exemption par catégorie, ils demeurent tout de même exemptables, à condition que soit établi un bilan économique positif, notamment en raison de gains d'efficience. À la différence du droit communautaire de la concurrence, le droit argentin de la concurrence relatif aux accords verticaux n'a pas adopté de règlements d'exemption par catégorie et les autorités de concurrence argentines procèdent à une analyse au cas par cas des accords au travers de la règle de raison ainsi qu'à une analyse de leur incidence sur l'intérêt économique général. / Vertical agreements mostly correspond to single branding, exclusive distribution, exclusive purchase, selective distribution, franchising and concession. Although their variety is large, most of the time they constitute competition agreements because they increase inter-brand competition. The main aim of this study is to look for and to analyse the assessment criteria of distribution vertical agreements in French, European and Argentine Competition Laws. In European Competition Law, an important set of regulations and a rich case-law exist concerning distribution agreements. The rules concerning vertical agreements have been reformed ; as a consequence of this reform, a new Block Exemption Regulation (Regulation No 330/2010) has been adopted and accompanied by new Guidelines on Vertical Restraints. Lots of vertical agreements also benefit from Block Exemption which confers them a presumption of legality and in case these agreements do not benefit from the Block Exemption Regulation, they still can be exempted on the condition that a positive economic balance should be established, notably in view of efficiency gains. Unlike European Competition Law, the Argentine Competition Law concerning vertical agreements has not adopted Block Exemption Regulation and the Argentine competition authorities analyse each agreement in the light of the Rule of Reason and analyse their impact on the general economic interest.

This work explores the use of carbon-infiltrated carbon nanotube (CI-CNT) forests as a material for fabricating compliant MEMS devices. The impacts of iron catalyst layer thickness and carbon infiltration time are examined. An iron layer of 7nm or 10nm with an infiltration time of 30 minutes produces CI-CNT best suited for compliant applications. Average maximum strains of 2% and 2.48% were observed for these parameters. The corresponding elastic moduli were 5.4 GPa and 4.1 GPa, respectively. A direct comparison of similar geometry suggested CI-CNT is 80% more flexible than single-crystal silicon. A torsional testing procedure provided an initial shear modulus of about 5 GPa for the 7-nm, 30-min CI-CNT. The strain and elastic modulus values were used to design numerous functional devices which were then fabricated in CI-CNT. A series of compliant cell restraint mechanisms were developed, assessed, and revised. A passive restraint with no moving parts was found to be both the most effective design and the easiest design to produce economically. A refined version of the passive restraint has been released commercially. Another series of designed devices successfully demonstrates the implementation of CI-CNT LEM designs.