Falling among older adults is a leading cause of concern due to the known impacts including physical injury, loss of independence, increased health care costs, and mortality. In efforts to decrease the numbers of falls experienced by older adults, healthcare providers assess individuals’ fall risks and provide corresponding fall prevention recommendations. The effectiveness however, of these recommendations, is only as strong as the level of adherence to those recommendations; which has proven low in recent research. Using the theoretical foundation of the Health Belief Model, this study quantified adherence to environmental fall prevention recommendations. Twenty-two community-dwelling older adults participated in this randomized control group study that took place across three home visits, scheduled approximately 30 days apart. Participants were interviewed regarding their recent falls and perceived susceptibility to future falls; then a home evaluation was conducted. Treatment group participants were provided personalized education explaining how and why environmental fall prevention recommendations were important to decrease their risk of falls while control group participants were provided general recommendations. A two-sample t-test for independent groups determined a statistically significant relationship: participants who received personalized education intervention were more likely to follow recommendations than those who received general education intervention. Multiple regressions were conducted to review relationships between an individual’s recent falls, and their perceived susceptibility to future falls, with their extent of adherence with fall prevention recommendations. No statistically significant relationship was found. This study suggests that providing personalized education for community-dwelling older adults regarding environmental fall prevention recommendations increases their extent of adherence with such recommendations.

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La croissance et le vieillissement sont inévitables pour la race humaine. Chez les personnes âgées, le vieillissement est souvent accompagné par de nombreuses formes de maladies et de dangers dont les chutes qui affectent la qualité de vie et qui posent un enjeu socio-économique. Mais les chutes sont évitables. Les acteurs de santé, les scientifiques et les chercheurs combinent actuellement des efforts pour développer des systèmes de détection et de prédiction des chutes. Dans le contexte de la prédiction des chutes, l'objectif de cette thèse est d'élaborer le profile actimétrique des patients sensibles aux chutes afin de les alerter d'une possible chute. Ceci consiste principalement à développer un système capable de surveiller les paramètres de la marche des personnes durant leurs activités quotidiennes avec un minimum d'intrusivité. Dans une première contribution, nous avons proposé une classification générique des systèmes liés à la chute en fonction du déploiement de leurs capteurs. Nous avons distingué les systèmes portables, les systèmes non-portables et les systèmes qui combinent les deux. En se basant sur cette classification, nous avons proposé notre plateforme WMFL v1.0 dans une deuxième contribution. WMFL combine une chaussure équipée par des capteurs de force avec des dalles où nous avons intégrés des capteurs optiques infrarouges. La fusion de ces deux systèmes assure une prévention à l'intérieure et à l'extérieure des locaux. WMFL peut être aussi déployées dans une clinique. Dans une troisième contribution, nous avons proposé une méthode de prédiction des chutes en se basant sur l'analyse du déplacement du centre de pression (projeté du centre de masse) sur la surface plantaire du pied durant la marche. La méthode utilise la fenêtre glissante spatio-temporelle pour alerter le patient d'une chute potentielle et pour déterminer le risque de chute à la fin de la marche. / Growth is the normal change of the human body and getting old is inevitable to human race. As a result, elderly people are subject to many forms of diseases and dangers among which falls are considered very serious in terms of quality of life and socio-economic costs. But falls can be manageable. Health practitioners, scientists and researchers currently combine efforts to develop systems capable of detecting and predicting falls. In the context of fall prediction, the goal of this thesis is to elaborate the actimetric profile of fall sensitive patients to alert them from a potential fall. It mainly consists of developing a system capable of monitoring gait and balance parameters during their daily activities with minimum intrusiveness. These are usually assessed in clinical settings using high-cost tools. In our first contribution, we proposed a generic classification of fall-related systems based on their sensors deployment. These are classified as Wearable, Non-Wearable and Fusion Systems. Based on the generic classification, we proposed the WMFL v1.0 platform in our second contribution. WMFL fuses a Foot Wear Force Sensing device with an Ambient system using IR-sensing floor tiles. The platform can be deployed at homes or in clinics. It ensures an indoor-outdoor protection. In a third contribution, we proposed an early fall detection approach to determine the risk of falling by analyzing the displacement of the Center of Pressure projecting the amount of sway of the Center of Mass on the foot plantar surface. The method uses the spatio-temporal sliding window to alert the patient of a potential fall.

I den här uppsatsen analyserar jag protagonisten Jean-Baptiste Clamences moraliska utveckling i Albert Camus’ roman Fallet. Jag använder A.J. Greimas aktantmodell och dennes utveckling av Vladimir Propps funktionsanalys för att nå mitt syfte. Jag föreslår även en kombination av de båda teorierna till ett schema, aktantfunktionsschemat, som jag använder för att tolka Clamences moraliska utveckling. Genom aktant-funktionsanalysen visar det sig hur Clamence gradvis djupnar och växer fast i sitt fall och sin skuld. Han söker den moraliska oskuld som flytt men inser till slut att den har gått oåterkalleligt förlorad. Istället underkastar han sig sin skuld och blir domare-botgörare – en falsk profet som förhärligas i självförgudningen.Men utvecklingen av samtalet går fel. Istället för att bryta ner den andre och tvinga fram dennes bekännelse möter Clamence sin överman i samtalspartnern, och jag argumenterar för att Clamence misslyckas med sitt syfte, underkastar sig samtalspartnern och gränsar till vansinnet. Det mest förvånande resultatet av analysen är hur samtalspartnern måste framstå som den verklige hjälten i historien vilket kräver en ny definition av aktanterna och klargörandet av en bakomliggande historia. Jag föreslår att samtalspartnern kan ses som en ny Kristus men tillstår behovet av vidare forskning. / In this essay I analyse the moral progression of Jean-Baptiste Clamence, the protagonist in Albert Camus’ novel The Fall. I employ A.J. Greimas’ actantial model and his development of Vladimir Propp’s function analysis for my purposes. I also propose a combination of the theories into a new actantial-functional scheme through which I analyses Clamence’s moral progression. Through the actantial-functional analysis it becomes clear how Clamence gradually deepens and grows rooted in his fall and guilt. Though seeking the moral innocence which he has lost he finally realises that it is gone forever and instead he submits to his fate and becomes judge-penitent – a false prophet indulging in self-deification. But the development of the conversation goes wrong. Instead of breaking the interlocutor down and forcing his confession Clamence meets his superior in the interlocutor, and I argue that Clamence fails in his aim, surrenders to the other and borders on madness. The most intriguing result of the analysis is how the interlocutor must stand out as the true hero of the novel which calls for a new definition of the actants in the novel and for the need of a primary story. I suggest that the interlocutor may be seen as an incarnation of Christ but acknowledges the need of further research.

Falls and fall related injuries are a major health issue to the elderly population of Sweden. The number of accidents in the community caused by falls is increasing. It is mainly the elderly who need to be hospitalized after a fall. Patients with stroke, cognitive disorders, or hip fracture, have a particularly high risk of falling. A common consequence of falls is femur fractures. To prevent and reduce the occurrences of falls in hospitals, an individual care plan aimed at the patient, is required, as well as an individual and feasible nursing intervention. It also require that health professionals use their knowledge and the patient’s and the hospital's resources, to implement the care plan. Since 2008 SKL runs a national effort to reduce preventable harm and improve patient safety, where fall related injuries are an area of focus. Aim: The aim with this study is to examine and describe health professionals' attitudes towards falls and fall prevention, and whether the nursing staff considers themselves to be proficient in falls and fall prevention. Method: This was a quantitative study and Mann Whitney U test were conducted in order to analyse and summarize the answers from the questionnaires. Results: The respondents have a positive attitude towards fall prevention. The perception among the nursing staff is that they feel well trained in fall prevention, and have sufficient knowledge in fall prevention. Conclusion: The conclusion of this study is that nurses and nursing staff take falls among patients very seriously and have a positive attitude towards fall prevention. They also consider themselves to have a good knowledge about falls and fall prevention. / Fall och fallskador är ett stort folkhälsoproblem för den äldre befolkningen i Sverige. Antalet olyckor i samhället orsakade av fall ökar. Det är de äldre som oftast behöver sjukhusvård efter fallolyckor. Patienter med stroke, kognitiva störningar eller höftfrakturer har en särskilt hög risk att råka ut för fall och fallskador. En vanligt förekommande konsekvens av fall är höftfrakturer. För att förebygga och minska att fall sker krävs en individuell vårdplan för patienten och individuella och genomförbara omvårdnadsåtgärder. Det krävs att vårdpersonal använder sina kunskaper och patientens och sjukhusets resurser för att genomföra vårdplanen. Sedan 2008 driver SKL en nationell satsning för att minska antalet vårdskador och öka patientsäkerheten. Ett område som omfattas av denna nationella satsning är fall och skador till följd av fall. Syfte: Syftet med den här studien är att undersöka och beskriva vårdpersonalens attityder till fall och fallprevention och om vårdpersonal anser sig ha goda kunskaper om fall och fallprevention. Metod: Studien har använt sig av en kvantitativ metod i form av en enkätundersökning. Beskrivande statistik och Mann Whitney U test användes för att bearbeta enkätsvaren. Resultat: Resultatet visar att vårdpersonal till övervägande del har en positiv uppfattning till fallprevention och ser allvarligt på fallskador. Enkäten visar att vårdpersonalen upplever och känner att de är välutbildade i fallprevention och har kunskaper för att ge och skapa en god fallprevention i sitt arbete. Slutsats: Slutsatsen i denna studie är att vårdpersonal tar fall och fallskador på allvar och har en positiv uppfattning till fallprevention. De anser sig också ha goda kunskaper inom fall och fallprevention.

Introduction: Falls are the leading cause of death due to injury among the elderly. Every 24 minutes an older adult dies from a fall related injury. Studies using 3 different methods were performed at a large urban, academic medical center in the US. Aim #1: Understand the advantages and disadvantages of QI methodologies (Lean and Six Sigma) and HFE when applied to fall prevention in the acute care setting: o Evaluate the contribution of QI and HFE to fall prevention with a focus on reducing falls with serious injury. o Use studies with different methodologies (Lean, Six Sigma) to develop and implement an intervention with the goal of decreasing total falls and falls with injury. o Compare methodologies (Lean, Six Sigma and HFE) to understand their benefits and limitations. Aim #2: Develop recommendations for fall prevention: o Investigate interventions and assess success of fall prevention. o Develop an understanding of interventions that prevent falls resulting in injury. Methodology and Results: Study #1 (Method = Lean, Intervention = Standard Work): Study #1 used Lean techniques such as standard work to improve fall risk assessment and intervention selection. Total falls decreased by 22%. At first glance this appears successful but a deeper evaluation of the serious injuries revealed more improvement is needed. There were still 15 falls with serious injuries that occurred among the three oncology divisions. These rare but serious injuries result in a longer hospital stay and increased cost of treatment that is not reimbursed. Due to a climate of increasing financial pressure further reduction of serious injury was desired. Study #2 (Method = Six Sigma, Intervention = Patient Partnering: Study #2 used Six Sigma tools to investigate root causes of falls. An intervention called Patient Partnering was developed to encourage patients to call for help and participate in preventing their own falls. There were no falls with serious injury for over 14 consecutive months. However, the intervention was difficult to sustain due to resistance from nurses and patients. Falls with injuries resumed as the intervention ceased. Study #3 (Method = Qualitative HFE, Intervention = Patient Interview): Study #3 was a qualitative study based on Human Factors principles to understand patient s perception of fall risk. It was found that patients did not think they would fall and felt particularly safe and protected while in hospital. They found it difficult to get around with IV tubes and crowed spaces. They wanted information and assistance when they need it, in the format they prefer (customized for each individual patient). Impact on society: Falls prevention interventions need to be designed for all the stakeholders (patients and staff). Patients think nurses will keep them safe and are willing to participate with fall prevention if they feel it is tailored to their needs. Until all perspectives are taken into account it is unlikely that there will be sustained and embedded improvements. Key message: Falls with injury are rare events with complex root causes that require agile solutions with constant revision to align with rapidly changing conditions and interactions. Reducing injury will take a balance between safe environment, organization, processes, tasks and behaviors from staff and patients.

This study arranges symptoms of polarity into a causal sequence# beginning with the origin of contrarieties and ending with the ultimate effect. The origin is considered as the fall of man, denoting both a mythic concept and a specific act of betrayal. This study argues that a sense of separateness precedes the fall or act of separation; the act of separation produces various kinds of fragmentation; and the fragments are reunited through paradox. Therefore, a causal relationship exists between the "fall" motif and the concept of paradox.

There is no greater work of literature, perhaps, than the Bible. The Bible has shaped and influenced more literature, art, and culture than any other work in our time. The effects of the Bible’s words are still woven into modern literature today, illustrating that the Bible’s themes, allegories, parables, fables, metaphors, and characters are things that we humans are unable to depart far from even many decades later. One of the very first stories in the Bible, found at the beginning in Genesis, tells of Adam and Eve. Adam and Eve’s depiction as the first kind of our species and the story of their creation to their Fall is one transformative story that humans seem destined to repeat. This cycle of falling is rampant in American literature, from the nineteenth century to the twenty-first century, appearing in works by prominent authors such as R. W. B. Lewis, Leo Marx, and John Steinbeck. Steinbeck’s novel East of Eden wrestles heavily with both biblical themes and metaphors and acts as a biblical framework for the Fall narrative and the book of Genesis. This thesis seeks to examine the Fall as a conceptual metaphor for American literature and thinking through John Steinbeck’s East of Eden and attempts to explain why literature, and humans, keep endlessly returning to the Fall.

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Background: Parkinson’s disease (PD) is a common, progressive neurodegenerative disorder, recognized by the motor symptoms of bradykinesia, tremor, rigidity, and postural impairment. At clinical onset, extensive amounts of dopaminergic neurons have already been lost. The duration of this prodromal phase is uncertain, and it is thought to include predominantly non-motor symptoms. The progressive nature and the symptoms of PD are disabling and reduces the quality of life. Among patients affected in working age, early cessation of employment is common, and such socioeconomic consequences of PD may contribute to an impaired quality of life. The aims of this thesis were to investigate the life situation for people affected by PD in working age, with attention to factors of importance for quality of life and working situation, and to evaluate long-term associations between potential prodromal signs and the later development of PD.Methods: We used a postal survey to investigate the self-perceived life situation among working-aged individuals with PD compared to matched controls, with a specific attention to socioeconomic consequences of disease (paper I). To investigate risk markers preceding the diagnosis of PD (paper II-IV), we used data from nationwide registers. Study II was performed as a cohort study, based on the Swedish Military Service Conscription Register, and study III-IV were performed as nested case-control studies based on a cohort comprising all Swedish citizens aged ≥50 years in 2005.Results: In the survey study (paper I), 38% of the PD participants and 9% of the controls were dissatisfied with life as a whole, and the working situation was an independent risk factor for dissatisfaction with life. In total, 59% of the PD participants had reduced working hours or stopped working due to PD, and many PD participants struggled to cope with their work demands. Support from employer was associated with a higher likelihood to remain employed.We found that low muscle strength in young adulthood, (paper II) and depression (paper III) were associated with an increased risk of PD over follow-up times of more than 2 decades, and that patients with PD were at increased risk of fall-related injuries, hip fractures in particular, a decade or more before the PD diagnosis (paper IV). For depression and fall-related injuries, the association with PD was clearly time-dependent, strongest in the last years before the diagnosis of PD.Conclusions: The results suggest that the prodromal phase of PD may last for more than 2 decades and include also motor symptoms. The consequences of PD include a reduced quality of life associated with the working situation. Employer’s support appear to be particularly important for a successful vocational rehabilitation.