Effectiveness of non-pharmacological interventions to prevent falls in older people: a systematic overview. The SENATOR Project ONTOP Series

Background: Falls are common events in older people, which cause considerable morbidity and mortality. Non-pharmacological interventions are an important approach to prevent falls. There are a large number of systematic reviews of non-pharmacological interventions, whose evidence needs to be synthesized in order to facilitate evidence-based clinical decision making. Objectives: To systematically examine reviews and meta-analyses that evaluated non-pharmacological interventions to prevent falls in older adults in the community, care facilities and hospitals. Methods: We searched the electronic databases Pubmed, the Cochrane Database of Systematic Reviews, EMBASE, CINAHL, PsycINFO, PEDRO and TRIP from January 2009 to March 2015, for systematic reviews that included at least one comparative study, evaluating any non-pharmacological intervention, to prevent falls amongst older adults. The quality of the reviews was assessed using AMSTAR and ProFaNE taxonomy was used to organize the interventions. Results: Fifty-nine systematic reviews were identified which consisted of single, multiple and multi-factorial non-pharmacological interventions to prevent falls in older people. The most frequent ProFaNE defined interventions were exercises either alone or combined with other interventions, followed by environment/assistive technology interventions comprising environmental modifications, assistive and protective aids, staff education and vision assessment/correction. Knowledge was the third principle class of interventions as patient education. Exercise and multifactorial interventions were the most effective treatments to reduce falls in older adults, although not all types of exercise were equally effective in all subjects and in all settings. Effective exercise programs combined balance and strength training. Reviews with a higher AMSTAR score were more likely to contain more primary studies, to be updated and to perform meta-analysis. Conclusions: The aim of this overview of reviews of non-pharmacological interventions to prevent falls in older people in different settings, is to support clinicians and other healthcare workers with clinical decision-making by providing a comprehensive perspective of findings.

Novel efficient technologies in Europe for axle bearing condition monitoring – the MAXBE project

Axle bearing damage with possible catastrophic failures can cause severe disruptions or even dangerous derailments, potentially causing loss of human life and leading to significant costs for railway infrastructure managers and rolling stock operators. Consequently the axle bearing damage process has safety and economic implications on the exploitation of railways systems. Therefore it has been the object of intense attention by railway authorities as proved by the selection of this topic by the European Commission in calls for research proposals. The MAXBE Project (http://www.maxbeproject.eu/), an EU-funded project, appears in this context and its main goal is to develop and to demonstrate innovative and efficient technologies which can be used for the onboard and wayside condition monitoring of axle bearings. The MAXBE (interoperable monitoring, diagnosis and maintenance strategies for axle bearings) project focuses on detecting axle bearing failure modes at an early stage by combining new and existing monitoring techniques and on characterizing the axle bearing degradation process. The consortium for the MAXBE project comprises 18 partners from 8 member states, representing operators, railway administrations, axle bearing manufactures, key players in the railway community and experts in the field of monitoring, maintenance and rolling stock. The University of Porto is coordinating this research project that kicked-off in November 2012 and it is completed on October 2015. Both on-board and wayside systems are explored in the project since there is a need for defining the requirement for the onboard equipment and the range of working temperatures of the axle bearing for the wayside systems. The developed monitoring systems consider strain gauges, high frequency accelerometers, temperature sensors and acoustic emission. To get a robust technology to support the decision making of the responsible stakeholders synchronized measurements from onboard and wayside monitoring systems are integrated into a platform. Also extensive laboratory tests were performed to correlate the in situ measurements to the status of the axle bearing life. With the MAXBE project concept it will be possible: to contribute to detect at an early stage axle bearing failures; to create conditions for the operational and technical integration of axle bearing monitoring and maintenance in different European railway networks; to contribute to the standardization of the requirements for the axle bearing monitoring, diagnosis and maintenance. Demonstration of the developed condition monitoring systems was performed in Portugal in the Northern Railway Line with freight and passenger traffic with a maximum speed of 220 km/h, in Belgium in a tram line and in the UK. Still within the project, a tool for optimal maintenance scheduling and a smart diagnostic tool were developed. This paper presents a synthesis of the most relevant results attained in the project. The successful of the project and the developed solutions have positive impact on the reliability, availability, maintainability and safety of rolling stock and infrastructure with main focus on the axle bearing health.

The international diffusion of project management

This paper examines the international diffusion of one business practice, project management, through the prism of prior literature and data on the diffusion of ISO 9000. The study took an inductive approach, building theory through the iterative collection and analysis of quantitative and qualitative data. The findings problematise the central position accorded to the S-curve model and neo-institutional theory in explaining technology diffusion. The research posits three distinct processes driving the diffusion process: utility, institutional isomorphism, and competitive isomorphism, with the latter consisting of three primary mechanisms: competitive imitation, trendslators and fashion retailers. Contrary to prior literature, national, quasi-professional associations are found to be central to the diffusion process and play a key role in advocating and containing management technologies.

A knowledge management system to optimise comfort throughout the building life-cycle

Comfort is, in essence, satisfaction with the environment, and with respect to the indoor environment it is primarily satisfaction with the thermal conditions and air quality. Improving comfort has social, health and economic benefits, and is more financially significant than any other building cost. Despite this, comfort is not strictly managed throughout the building lifecycle. This is mainly due to the lack of an appropriate system to adequately manage comfort knowledge through the construction process into operation. Previous proposals to improve knowledge management have not been successfully adopted by the construction industry. To address this, the BabySteps approach was devised. BabySteps is an approach, proposed by this research, which states that for an innovation to be adopted into the industry it must be implementable through a number of small changes. This research proposes that improving the management of comfort knowledge will improve comfort. ComMet is a new methodology proposed by this research that manages comfort knowledge. It enables comfort knowledge to be captured, stored and accessed throughout the building life-cycle and so allowing it to be re-used in future stages of the building project and in future projects. It does this using the following: Comfort Performances – These are simplified numerical representations of the comfort of the indoor environment. Comfort Performances quantify the comfort at each stage of the building life-cycle using standard comfort metrics. Comfort Ratings - These are a means of classifying the comfort conditions of the indoor environment according to an appropriate standard. Comfort Ratings are generated by comparing different Comfort Performances. Comfort Ratings provide additional information relating to the comfort conditions of the indoor environment, which is not readily determined from the individual Comfort Performances. Comfort History – This is a continuous descriptive record of the comfort throughout the project, with a focus on documenting the items and activities, proposed and implemented, which could potentially affect comfort. Each aspect of the Comfort History is linked to the relevant comfort entity it references. These three components create a comprehensive record of the comfort throughout the building lifecycle. They are then stored and made available in a common format in a central location which allows them to be re-used ad infinitum. The LCMS System was developed to implement the ComMet methodology. It uses current and emerging technologies to capture, store and allow easy access to comfort knowledge as specified by ComMet. LCMS is an IT system that is a combination of the following six components: Building Standards; Modelling & Simulation; Physical Measurement through the specially developed Egg-Whisk (Wireless Sensor) Network; Data Manipulation; Information Recording; Knowledge Storage and Access.Results from a test case application of the LCMS system - an existing office room at a research facility - highlighted that while some aspects of comfort were being maintained, the building’s environment was not in compliance with the acceptable levels as stipulated by the relevant building standards. The implementation of ComMet, through LCMS, demonstrates how comfort, typically only considered during early design, can be measured and managed appropriately through systematic application of the methodology as means of ensuring a healthy internal environment in the building.

The multiple reality: A critical study on Alfred Schutz’s sociology of the finite provinces of meaning

This work is a critical introduction to Alfred Schutz’s sociology of the multiple reality and an enterprise that seeks to reassess and reconstruct the Schutzian project. In the first part of the study, I inquire into Schutz’s biographical context that surrounds the germination of this conception and I analyse the main texts of Schutz where he has dealt directly with ‘finite provinces of meaning.’ On the basis of this analysis, I suggest and discuss, in Part II, several solutions to the shortcomings of the theoretical system that Schutz drew upon the sociological problem of multiple reality. Specifically, I discuss problems related to the structure, the dynamics, and the interrelationing of finite provinces of meaning as well as the way they relate to the questions of narrativity, experience, space, time, and identity.

Afterwords: reparative queer death and the contemporary Irish novel, 1960-2000

Given that an extant comprehensive study of homosexuality and the twentieth century Irish novel has yet to produced, this thesis is an attempt at rectifying such a gap in research by way of close textual analysis of writing from the latter half of the century—that is, from 1960-2000. Analysis of seven novels by four male authors – John Broderick, Desmond Hogan, Colm Tóibín and Keith Ridgway – lead to one overarching feature common to all four writers becoming clear: the homosexual or queer is always dying or already ‘dead’. ‘Dead’ is placed in inverted commas here as it is not only biological death that characterises the fate of gay men in the aforementioned literature. In the first instance, such men are also always already ‘dead’—that is, by light of their disenfranchisement as homosexual or queer, they are, in socialized terms, examples of the ‘living’ dead. Secondly, biological death neither fully obliterates the queer body nor its disruptive influence. Consequently, one of the overarching ways in which I read queer death in the late twentieth century Irish novel is through the prism of its reparative ‘afterw(a)ord’. On the one hand, such readings are temporally based (that is, reading from a point beyond the death of the protagonist - or their ‘afterward’); while, on the other hand, such readings are stylistically premised (that is, reading or interpreting the narrative itself as an ‘afterword’). The current project thus constitutes an original contribution to knowledge by establishing variant ways of reading the contemporary Irish novel from the point of view of the queer ‘unliving’. In assessing such heterogeneous aspects of contemporary queer death, the project a) contributes to recent, largely Anglo-American-based literary theoretical research on the queer and the eschatological, and b) provides a more contemporized literary base upon which future research can uncover a continuum of Irish queer writing in the twentieth century, one concerned with writing prior to 1960 and not limited to writing my men, in which death and same-sex desire are at parallel angles to one another.

Problems with drawing lines: Theo-geographies of the Catholic parish in Ireland

While people in Catholic parishes in Ireland appear keenly aware of parish boundaries, these understandings are more often oral than cartographic. There is no digital map of all of the Catholic parishes in Ireland. However, the institutional Catholic Church insists that no square kilometre can exist outside of a parish boundary. In this paper, I explain a process whereby the Catholic parishes of Ireland were produced digitally. I will outline some of the technical challenges of digitizing such boundaries. In making these maps, it is not only a question of drawing lines but mapping people’s understanding of their locality. Through an example of one part of the digitisation project, I want to talk about how verifying maps with local people often complicates something which may have at first sight seemed simple. The paper ends on a comparison with how other communities of interest are territorialised in Ireland and elsewhere to draw out some broader theoretical and theological issues of concern.