Falling during walking leads to millions of emergency room visits every year for all age groups and is a significant medical concern. While gait training has shown some promise for fall prevention, we know relatively little about how humans maintain stability, how we can quantify it and how we can use this knowledge to increase the success of fall prevention training. In this dissertation, I studied how human stability responds to continuous, small magnitude perturbations and to voluntary changes in gait characteristics by examining movement variability and long-term and instantaneous dynamic stability. In the first set of experiments, participants were exposed to continuous, pseudo-random external perturbations of the visual field and support surface in a Computer Assisted Rehabilitation ENvironment (CAREN). Participants exhibited increased step widths, shorter step lengths and increased step variability, orbital and short-term local instability. Despite this, mean instantaneous lateral stability remained approximately constant. In the second set of experiments, participants voluntarily adopted changes in their step widths and step lengths. Wider steps were associated with increased step width variability, decreased nonlinear stability, decreased anterior-posterior margins of stability and increased instantaneous lateral stability. Shorter steps were associated with decreased short-term and orbital stability but did not affect mean instantaneous stability. When instantaneous stability was examined between steps, as opposed to as an average over many steps, results from both studies indicated a relationship between each step’s stability and the stability of the immediately preceding step. From these studies, we now know that unpredictable, continuous perturbations during human walking applied in a given direction can be used to elicit predictable responses in motion variability and stability in that same direction. We know that the type of stability examined can influence the conclusions drawn about an individual’s stability during perturbed walking. For example, an individual’s variability may indicate increased risk of falling while he or she simultaneously demonstrates increased orbital stability and instantaneous lateral stability. A challenge faced in this area of research will be to understand how quantitative measures of stability relate to how we perceive our stability. / text

Στην παρούσα εργασία γίνεται αρχικά μελέτη τρωτότητας και επικινδυνότητας του ηφαιστείου της Σαντορίνης με σκοπό την μελέτη και μείωση του ηφαιστειακού κινδύνου στο νησί σε περίπτωση έκρηξης. Έπειτα καταλήγει σε προτάσεις που βοηθούν στην πρόληψη και στην σωστή διαχείριση της κατάστασης σε περίπτωση έκτακτης ανάγκης. Στο πρώτο κεφάλαιο της εργασίας περιγράφεται ο ηφαιστειακός κίνδυνος και δίνονται συγκεκριμένοι ορισμοί για έννοιες που είναι απαραίτητες γύρο από αυτόν. Ακόμη γίνεται αναφορά σε παραδείγματα άλλων ηφαιστειακών εκρήξεων με μεγάλη έκλυση τέφρας που μας ενδιαφέρουν καθώς και στην πρόσφατη σεισμική δραστηριότητα της Σαντορίνης για τα έτη 2011-2012 και ακολουθεί αναφορά σχετικά με τον στόχο της εργασίας. Το δεύτερο κεφάλαιο αναφέρεται στην ηφαιστειότητα της Σαντορίνης. Δίνεται η γενική περιγραφή των ενεργών ηφαιστείων της καλδέρας (Νέα Καμένη και Κολούμπο) και αναλύεται το γεωδυναμικό πλαίσιο, η γεωλογία και η ιστορική εξέλιξη της Σαντορίνης. Ακολούθως αναφέρεται η καθημερινή παρακολούθηση του ηφαιστείου από το ΗΜΠΙΣ και από το οποίο αντλούνται συνεχώς νέες πληροφορίες σχετικά με το ηφαίστειο. Στο τρίτο κεφάλαιο γίνεται αναλυτική περιγραφή για το κλίμα της Σαντορίνης και δίνονται τα ανεμολόγια που χρησιμοποιήθηκαν στην μελέτη για τον υπολογισμό της επικινδυνότητας για κάθε μήνα ξεχωριστά. Στο τέταρτο κεφάλαιο δίνονται οι μελέτες που έχουν γίνει μέχρι σήμερα για το θέμα και αναλύονται τα 4 σενάρια μελέτης και οι λόγοι επιλογής τους. Αυτά είναι με βάση την πηγή της έκρηξης (Κολούμπο ή Νέα Καμένη) σε συνδυασμό με το είδος της έκρηξης (υπό-Πλινιακή, Πλινιακή) iii Στο πέμπτο κεφάλαιο παρουσιάζονται τα αποτελέσματα από την έκθεση πληθυσμού και τρωτότητας για την Σαντορίνη και οι υποδομές που υπάρχουν στο νησί. Στο έκτο κεφάλαιο δίνεται η ανάλυση επικινδυνότητας για διάχυση τέφρας στην ατμόσφαιρα σε περίπτωση έκρηξης του ηφαιστείου και για κάθε σενάριο ξεχωριστά. Για τη συγκεκριμένη ανάλυση χρησιμοποιήθηκε το λογισμικό πρόγραμμα Tephra2 και έπειτα σχεδιάστηκαν οι ζώνες επικινδυνότητας αναλυτικά για κάθε μήνα και συγκεντρωτικά για κάθε περίοδο (τουριστική-χειμερινή). Στο έβδομο κεφάλαιο έγινε η τελική εκτίμηση του ηφαιστειακού κινδύνου. Αυτή προέκυψε από τις προηγούμενες μελέτες (πληθυσμού, τρωτότητας και επικινδυνότητας) και δημιουργήθηκαν ζώνες για διαφορετικά επίπεδα κινδύνου. Το όγδοο κεφάλαιο αναφέρεται στη διαχείριση του κινδύνου. Αρχικά δίνονται γενικές πληροφορίες για τα μέτρα που πρέπει να ληφθούν σε περίπτωση ηφαιστειακής έκρηξης και καταλήγει με συγκεκριμένες προτάσεις για κάθε ένα από τα σενάρια που μελετήθηκαν στη παρούσα εργασία. Από τη μελέτη προκύπτει ότι θα επηρεαστεί μεγάλο μέρος του νησιού ιδιαίτερα στα νότια λόγω έκρηξης του ηφαιστείου ακόμη και αν είναι μικρού μεγέθους. Έτσι φαίνεται η σημαντικότητα δημιουργίας ενός συγκεκριμένου σχεδίου έκτακτης ανάγκης εστιασμένο στη περίπτωση της Σαντορίνης πέρα από το γενικό σχέδιο ‘’Ξενοκράτης’’, το οποίο υπάρχει στην Ελλάδα για περιπτώσεις φυσικών καταστροφών. Τέλος ως συνέχεια της εργασίας μπορεί να γίνει μελέτη του ηφαιστειακού κινδύνου με τη χρήση του προγράμματος ΒΕΤ_VH (όμως δε λαμβάνει υπόψη μετεωρολογικά δεδομένα) και να γίνει σύγκριση των τελικών αποτελεσμάτων. / Hazard analysis due to Tephra fall, risk assessment and mitigation management for Santorini volcano In this project, firstly, it is given a study for the vulnerability and hazard assessment of Santorini’s volcano, Greece, with primary aim the further study and elimination of the volcanic risk on the island, in case of an eruption. Finally, it concludes with suggestions about the appropriate mitigation and management strategies in case of an emergency situation. On the first chapter of the project it is stated the description of the volcanic risk and all the significant definitions and meanings concerning volcanic risk. In addition, there is a description of other volcanic eruptions, which ended in a huge amount of Tephra fall and of the recent seismicity during 2011-2012 in Santorini. Then, the main reason and target of the presented project are presented. The second chapter presents the volcanism of Santorini. There is a deepest description of the 2 main volcano sources of the caldera (Nea Kameni and Kolumbo), and an analysis of the geodynamics, geology and history of Santorini. Also, the Institute for the Study and Monitoring of the Santorini Volcano (I.S.M.O.SA.V.) provides Santorini with an integral monitoring system, which guarantees the timely prediction of a possible volcanic eruption and undertakes the responsibility of disproving any false statements or rumors regarding a negative state of the volcano. The climate of the island and the meteorological data, which were used for the study of the hazard assessment are analyzed on the third chapter for every month separately. There are already some studies about the hazard assessment in Santorini. These studies and the 4 new scenarios of study for this project are given on the fourth v chapter. The 4 new scenarios combine the possible eruption source (Kolumbo, Nea Kameni) with the type of the volcanic eruption (sub-Plinian, Plinian). On the fifth chapter are presented the results of the population (value) and vulnerability assessment, as well as all the infrastructures stated on the island. On the sixth chapter is given the analysis of hazard assessment for the case of Tephra diffusion in the atmosphere and for each scenario of study. For the above analysis, the software Tephra2 was used and thereafter more specific hazard zones where formed for every month of the year and for every season (touristic-winter). On the seventh chapter is given the final estimation of the volcanic hazard. This estimation is a result of the previous studies (value, vulnerability and hazard) and every zone presents a different risk level. Finally, the eighth chapter is the part of the risk management. In the beginning of the chapter are given general mitigation strategies in case of a volcanic eruption and ends in more specified suggestions for every scenario of study separately. This project shows that a big part of the caldera, mainly in the south will be affected in case of a volcano eruption even if the eruption is of a small scale. That necessitates the creation of an emergency plan specialized for the Santorini case, different from the general national emergency plan ‘’Xenokratis’’, which already exists in Greece for possible natural disasters. For future study, it can be carried out a study of the volcanic risk with the use of the BETH_VH software (does not includes meteorological data) and to compare the final results of the two studies.

This thesis examines the methods through which Gail Anderson-Dargatz and Ann-Marie MacDonald construct region in their novels The Cure for Death by Lightning and Fall on Your Knees. These texts, like all successful regional novels, describe more than geography. Their regions are also functions of time. I introduce the term "temporal region" to describe the spaces created by this interdependence of time and place. I then focus upon the specifics of descriptive and narrative approach that lead to the convincing portrayal of the Shuswap and Cape Breton Island in the texts. Anderson-Dargatz and MacDonald direct attention to the foddways of their regions, expressing the connection between consumption choices and a society's historical and physical location. The authors also articulate their regions by highlighting cultural diversity in the areas they describe. In this way they deny the social homogeneity more sentimental regional texts often rely upon. Finally, the novelists use an appropriately Canadian method of regional opposition to define their temporal regions according to that which they are not ~ they are not American, glamorous, or urban. They therefore must be Canadian, quotidian, and rural.

The main objective of this work is to address the growing concern of balance loss and falls in the aging population. The initial aspect looks at balance control in a dynamic environment. Observation of age and gender influence on motor control will be made related to a new dynamic balance testing platform (DBTP). The topic of focus in the second portion relates to reaction time in an unstable environment. Research has found that balance improves when physical activity is a part of daily life for seniors. Physical activity influence on reaction time will be investigated with a new approach to exercise classes for seniors. Finally, an understanding of motor control and balance may be acquired and physical activity incorporated into the life of an elderly individual, however this will never fully prevent falls from taking place. A novel approach to injury prevention due to falls is explored in the final portion of this thesis. Study One - Using a newly constructed dynamic balance testing platform (DBTP), balance ability of three age groups was observed in two visual conditions and in relation to gender. Center of Gravity excursion (COGex) was observed to determine the differences between age groups and gender. Platform response patterns were also observed to asses the functionality of the DBTP as a new tool for balance testing. Three things were found: 1) Age differencesrelated to platform movement suggested that balance decreased with age in both visual conditions. 2) Gender differences between COGex found that males covered the most distance in both visual conditions when compared to females. 3) Gender differences between platform characteristics showed that females balanced longer and had lower platform movement rate than males, in both visual conditions. In order to consider the DBTP as a new tool for determination of balance ability, more refined tests are necessary. Study Two - Using pre- and post-training tests, the effects of a Fitball® exercise program on performance in eight subjects was documented. The exercise program focused on improving dynamic balance and postural stability of seniors. To evaluate progress-related changes, pre and post-tests in a dynamic environment were applied. Center of gravity (COG) excursion, catch success rate, and balance success rate were quantified, and synchronized data collection of 3D motion capture (VICON v8i) and ground reaction force (2 KISTLER platforms) was analyzed. During pre- and post-tests, participants stood in a walk-like stance and were asked to catch a weighted ball, which dropped unexpectedly. Results showed no significant changes in balance success rate. Significant improvements were found, however, in both COG control and catch success rate following training (p 0.05). Study Three - Falls in the elderly are inevitable so it is necessary to take precautions. This study looks at falls in relation to velocity characteristics of various locations on the trunk, and contrasts them to activities of daily living (ADL) in 13 individuals. A threshold level was established to be 2.0m/s, a value that exceeded all maximum resultant velocities for ADL, but was superseded by all fall activity resultant velocities. This suggests that a life vest, which responds similar to a vehicle airbag, may be created and worn that will deploy past a threshold of 2.0m/s with the incidence of a fall. / xiii, 91 leaves : ill. ; 29 cm. --

This research project on volcanic debris avalanches aims to provide a better understanding of the influence of the volume, fall height and topography on the deposit location and morphology. This will enable improvements in delineation of the areas at risk from volcanic debris avalanches, and improvements in management of a disaster should it occur. Undertaken to fulfil the requirements for a double degree (Geological Engineering and MSc in Hazard and Disaster Management) this work is the result of a collaboration between Polytechnic Institute LaSalle-Beauvais in France and the University of Canterbury in New Zealand. Following a brief introduction to the topic, statistical analyses of volcanic debris avalanche deposits are undertaken. Multiple variables analyses (Principal Components Analyses and Regressions) were carried out using a database of 298 volcanic debris avalanches derived from modification of Dufresne’s recent database. It was found that the volume has the main influence on the deposits rather than the fall height; the latter seems to have greater effect on avalanches of small volume. The topography into which the deposit is emplaced mainly determines its geometrical characteristics. These statistical results were compared with the results of laboratory-scale analogue modelling. A model similar to that used by Shea in 2005 provided data indicating similar trends of the influence of volume, fall height and topography on mass movement deposits at all scales. The final aspect of this project was a numerical simulation of a large debris avalanche from the north flank of the Taranaki volcano in the direction of the city of New Plymouth. The numerical code VolcFlow developed by Kelfoun in 2005 was used, after being tested against the laboratory experiments to verity its accuracy. The simulations showed that the Pouaki range protects the city of New Plymouth form major impacts from Taranaki collapses, but also indicated some potential problems with the hazard zoning and evacuation zones presently in place.

A physically inactive lifestyle is a predisposing risk factor for fall-related hip fracture. The circumstances, or precipitating factors, surrounding hip fractures are, however, not well understood, a factor of relevance for Swedish adults who have one of the highest hip fracture risks in the world. The aims of this thesis, therefore, were: to explore perceptions of physical activity (PA) among older adults, to describe the circumstances surrounding hip fracture events and the health characteristics of those who experience them. Four observational studies were conducted involving qualitative, epidemiological and mixed method designs. Participants in study I were recruited from community settings in Stockholm and Dublin (n=30). Studies II-IV (sample sizes, n=484, n=125, n=477) were based on a population-based sample of people admitted to Uppsala University hospital due to hip fracture. Study IV also incorporated the background population of Uppsala county in 2010 (n=117 494). Analysis of PA perceptions in study I revealed that PA which is functional nature is perceived as most meaningful among certain participants. The uptake of PA in later years was a means of creating a new self-identify and being active in outdoor environments was an important culture-specific motivator to PA among Swedish participants. Analysis of hip fractures patterns in studies II-III showed that: hip fractures among psychotropic drug users were twice as likely to occur during night-time hours compared to those occurring among people not receiving these drugs. Additionally, the fall-related hip fractures of community dwellers with poorest health and function tended to occur indoors during positional changes. In study IV, all categories of disease (according to the International Classification of Diseases, 10th Revision) were seen to be positively associated with hip fracture.  Cardiovascular disease and previous injury (including previous fracture) posed the highest relative and absolute fracture risks. Detailed investigation of hip fracture circumstances reveal patterns in health and functional characteristics, which provide information regarding predisposing and precipitating factors for these events. This knowledge, in combination with findings regarding PA perceptions, can be used when identifying individuals at high risk for hip fracture and when tailoring fracture prevention at an individual level to those at risk.

Safety of workers in the construction environment remains one of the greatest challenges faced by the construction industry today. Activity-based hazard identification and prevention is limited because construction safety information and knowledge tends to be scattered and fragmented throughout safety regulations, accident records, and experience. With the advancement of information technology in the building and construction industry, a missing link between effective activity-level construction planning and Building Information Modeling (BIM) becomes more evident. The objectives of this study are 1) to formalize the safety management knowledge and to integrate safety aspects into BIM, and 2) to facilitate activity-based hazard identification and prevention in construction planning. To start with, a Construction Safety Ontology is created to organize, store, and re-use construction safety knowledge. Secondly, activity-based workspace visualization and congestion identification methods are investigated to study the hazards caused by the interaction between activities. Computational algorithms are created to process and retrieve activity-based workspace parameters through location tracking data of workers collected by remote sensing technology. Lastly, by introducing workspace parameters into ontology and connecting the ontology with BIM, automated workspace analysis along with job hazard analysis are explored. Results indicate that potential safety hazards can be identified, recorded, analyzed, and prevented in BIM. This study integrates aspects of construction safety into current BIM workflow, which enables performing hazard identification and prevention early in the project planning phase.

Fall er et stort og økende problem for eldre kvinner og menn i den vestlige verden. En rekke forskningsrapporter dokumenterer at det er mulig å forebygge fall, og tverrfaglige tiltak har vist størst effekt. Fallforebygging har derfor vært et satsingsområde i Stavanger kommune i en årrekke. Implementering av nye tiltak er krevende, og er det derfor viktig å undersøke i hvilken grad ny kunnskap har betydning for praksis. Studien bygger på teori om tverrfaglighet, salutogenese og coping fordi forståelse av disse begrepene er viktig for gjennomføring av tiltak. Hensikt med studien var å få mer kunnskap om forekomst og konsekvenser av fall blant pasienter i sykehjem og pasienter som får hjemmesykepleie. Dessuten var hensikten å få kunnskap om hvordan ansatte i sykehjem og hjemmesykepleie oppfatter fall, hvordan ansatte vurderer pasienters og pårørendes opplevelser etter fall og hva som i dag gjøres for å forebygge fall. Studien ble gjennomført som en todelt evaluering som bestod av en kvantitativ og en kvalitativ studie. Den kvantitative delen beskrev det enkelte fall, og personene som falt. Data fra fallregistreringsskjema fra 12 sykehjem og 5 hjemmebaserte tjenester, i en periode på fire måneder, ble analysert. I den kvalitative delen ble oppfølging av fall beskrevet og sammenlignet med fastsatte prosedyrer, retningslinjer og faglige normer, ved bruk av fokusgruppeintervju med ansatte i sykehjem og hjemmesykepleien. Det ble registrert 798 fall i perioden og av disse resulterte 170 i skade. Totalt falt 363 pasienter, 45 % av pasientene i sykehjem, og 6 % av pasientene som bodde hjemme. Alle ansatte gav utrykk for at det var viktig å redusere risiko for fall, og at tverrfaglig samarbeid var viktig. Ansatte gav også utrykkfor at det er lett å registrere fall og vanskelig ”å gjøre noe med det”. Dette bekreftes i resultat fra den kvantitative undersøkelsen der det ikke var dokumentert oppfølging for å hindre nye fall i 50 % av tilfellene. Miljøtilrettelegging var det tiltaket som oftest blir omtalt for å redusere fallrisiko for pasienter i hjemmet, for pasienter i sykehjem tilsyn. Pasientene ble i liten grad fulgt opp med individuell kartlegging og tverrfaglig innsats. For bedre implementering av forskningsbasert kunnskap innen fallforebygging er det nødvendig å identifisere målgruppen. Andre forbedringsområder er å ta hensyn til pasientenes erfaringer, fokusere på pasientenes egne ressurser og individuelle mestringstrategier. Ledere må i større grad legge til rette for tverrfaglighet, samt etterspør evaluering av tiltak rettet mot målgruppen. / Falls and fear of falling is a major and increasing problem for older males and females in the Western world. The effectiveness of falls prevention programmes is well documented and the multidisciplinary approach has been proven to be the most effective. For this reason the municipality of Stavanger has given priority to falls prevention programmes in the care for the elderly. The implementation of new models of care is challenging, it is therefore important to determine whether new techniques achieve good outcomes which in turn can influence how we deliver our service. The theory of this study is based upon understanding the concepts of a multidisciplinary approach, salutogenesis and coping, and how they impact on the implementation of falls prevention interventions. The objectives of this study were to obtain data about falls amongst patients in nursing homes and those patients receiving home care. To explore how the health professional documents and evaluates the patients’ and relatives’ experience after a fall, and to find out which falls prevention interventions are currently being utilised. A two part evaluation was chosen for this study. Part one outlines the fall description and the types of patients who fell. Part two reviews the interventions utilised after a fall and benchmarks them against recognised standards and procedures. Data gathered from 12 nursing homes and 5 home care units, using the fall registration form, over a period of four months, was analysed. Further information was obtained by conducting focus group interviews with the staff of nursing homes and home care units. During the period 798 falls were registered of which 170 falls resulted in injuries. A total of 365 patients fell, 45% of all patients in nursing homes and 6% of all patients receiving home care. All staff expressed the importance of reducing risk of falling, and providing multidisciplinary interventions. They gave the impression that it was easy to register falls, but difficult to follow up with interventions. This was supported with the results from the quantitative study, 50% of falls had no documentation of follow up. For patients living at home environmental changes were the most used intervention, for patients in nursing homes being looked after were most important. Individual assessment and multidisciplinary interventions were rarely carried out. For successful implementation of evidence based practice in falls prevention it is important to identify the target group. Other areas to be improved include the utilisation of patient assessments and ongoing evaluations with the focus on patients’ resources and individual coping strategies. Managers should ensure the adoption of the multidisciplinary team approach to interventions and implement regular assessments and evaluation of the target group / <p>ISBN 978-91-85721-33-7</p>

The overall goal of my research was to advance our understanding of the potential for novel compliant flooring systems to reduce the risk for fall-related injuries in older adults, including fall-related traumatic brain injury (TBI). This entailed an assessment of how these floors affect the competing demands of fall-related TBI – impact severity attenuation in concert with minimal concomitant impairments to balance control and postural stability. Two studies are included as part of this thesis. The first study used a mechanical drop tower to assess the effects of four traditional flooring systems and six novel compliant flooring conditions on the impact dynamics of a surrogate headform during the impact phase of simulated ‘worst- case’ head impacts. The second study entailed an assessment of the effect of two traditional and three novel compliant floors on the initial phase of the compensatory balance reactions of older adult men and women living in a residential-care facility environment following an externally induced perturbation using a tether-release paradigm. Overall, this thesis demonstrates that novel compliant floors substantially attenuate the forces and accelerations applied to the head during simulated worst- case impacts when compared to traditional flooring surfaces such as vinyl and carpet with underpadding. These benefits are achieved without compromising indices of balance control, supported by the finding that parameters characterizing early compensatory balance reactions were unaffected by the novel compliant floors tested. This work supports the introduction of pilot installations of novel compliant flooring systems into environments with high incidences of falls to test their effectiveness at reducing fall-related injuries in clinical settings.

This study examines the image of house and home as the reification of our domains as living, dwelling, housed beings in three novels: Isabel Allende's The House of the Spirits; Anne-Marie MacDonald's Fall On Your Knees; and Toni Morrison's Beloved. Being human, we form through perception, build through forming, dwell in building, and perceive through dwelling. Through close reading and analysis, this thesis examines questions of: If we are how we dwell, then what happens when the structures and the spaces of our dwellings become haunted? What happens when "home" becomes a facade that suspends necessary elements of dwelling? This study projects that if we are how we dwell, the very nature of our being entails a constant questioning of what it is we allow a presence to in our how we form, build, dwell, and perceive within both tangible and intangible realms and the influential perspicacity literature bears within this process.